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Jansen MP, Hodgins D, Mastbergen SC, Kloppenburg M, Blanco FJ, Haugen IK, Berenbaum F, Eckstein F, Roemer FW, Wirth W. Can gait patterns be explained by joint structure in people with and without radiographic knee osteoarthritis? Data from the IMI-APPROACH cohort. Skeletal Radiol 2024; 53:2409-2416. [PMID: 38536417 PMCID: PMC11410921 DOI: 10.1007/s00256-024-04666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE To determine the association between joint structure and gait in patients with knee osteoarthritis (OA). METHODS IMI-APPROACH recruited 297 clinical knee OA patients. Gait data was collected (GaitSmart®) and OA-related joint measures determined from knee radiographs (KIDA) and MRIs (qMRI/MOAKS). Patients were divided into those with/without radiographic OA (ROA). Principal component analyses (PCA) were performed on gait parameters; linear regression models were used to evaluate whether image-based structural and demographic parameters were associated with gait principal components. RESULTS Two hundred seventy-one patients (age median 68.0, BMI 27.0, 77% female) could be analyzed; 149 (55%) had ROA. PCA identified two components: upper leg (primarily walking speed, stride duration, hip range of motion [ROM], thigh ROM) and lower leg (calf ROM, knee ROM in swing and stance phases). Increased age, BMI, and radiographic subchondral bone density (sclerosis), decreased radiographic varus angle deviation, and female sex were statistically significantly associated with worse lower leg gait (i.e. reduced ROM) in patients without ROA (R2 = 0.24); in ROA patients, increased BMI, radiographic osteophytes, MRI meniscal extrusion and female sex showed significantly worse lower leg gait (R2 = 0.18). Higher BMI was significantly associated with reduced upper leg function for non-ROA patients (R2 = 0.05); ROA patients with male sex, higher BMI and less MRI synovitis showed significantly worse upper leg gait (R2 = 0.12). CONCLUSION Structural OA pathology was significantly associated with gait in patients with clinical knee OA, though BMI may be more important. While associations were not strong, these results provide a significant association between OA symptoms (gait) and joint structure.
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Affiliation(s)
- M P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, HP G02.228 Heidelberglaan, 100 3584, CX, Utrecht, The Netherlands.
| | - D Hodgins
- Dynamic Metrics Limited, Codicote, UK
| | - S C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, HP G02.228 Heidelberglaan, 100 3584, CX, Utrecht, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - F J Blanco
- Departamento de Fisioterapia Y Medicina, Grupo de Investigación de Reumatología (GIR), INIBIC - Complejo Hospitalario Universitario de A Coruña, SERGAS. Centro de Investigación CICA, Universidad de A Coruña, A Coruña, Spain. Servicio de Reumatologia, INIBIC- Universidade de A Coruña, A Coruña, Spain
| | - I K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - F Berenbaum
- Department of Rheumatology, AP-HP Saint-Antoine Hospital, Paris, France
- INSERM, Sorbonne University, Paris, France
| | - F Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria
- Chondrometrics GmbH, Freilassing, Germany
| | - F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Universitätsklinikum Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - W Wirth
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria
- Chondrometrics GmbH, Freilassing, Germany
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Paterson KL, Metcalf BR, Campbell PK, Bennell KL, Li P, De Silva AP, Hinman RS. Associations between static foot posture, dynamic in-shoe plantar foot forces and knee pain in people with medial knee osteoarthritis: A cross-sectional exploratory study. Osteoarthritis Cartilage 2024; 32:1339-1345. [PMID: 38986834 DOI: 10.1016/j.joca.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE To investigate relationships between static foot posture, dynamic plantar foot forces and knee pain in people with medial knee osteoarthritis (OA). DESIGN Data from 164 participants with symptomatic, moderate to severe radiographic medial knee OA were analysed. Knee pain was self-reported using a numerical rating scale (NRS; scores 0-10; higher scores worse) and the Knee Injury and Osteoarthritis Outcome Score pain subscale (KOOS; scores 0-100; lower scores worse). Static foot posture was assessed using clinical tests (foot posture index, foot mobility magnitude, navicular drop). Dynamic plantar foot forces (lateral, medial, whole foot, medial-lateral ratio, arch index) were measured using an in-shoe plantar pressure system while walking. Relationships between foot posture and plantar forces (independent variables) and pain (dependent variables) were evaluated using linear regression models, unadjusted and adjusted for sex, walking speed, Kellgren & Lawrence grade, shoe category, and body mass (for dynamic plantar foot forces). RESULTS No measure of static foot posture was associated with any knee pain measure. Higher medial-lateral foot force ratio at midstance, and a higher arch index during overall stance, were weakly associated with higher knee pain on the NRS (regression coefficient = 0.69, 95% confidence interval (CI) 0.09 to 1.28) and KOOS (coefficient=3.03, 95% CI 0.71 to 5.35) pain scales, respectively. CONCLUSION Dynamic plantar foot forces, but not static foot posture, were associated with knee pain in people with medial knee OA. However, the amount of pain explained by increases in plantar foot force was small; thus, these associations are unlikely to be clinically meaningful.
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Affiliation(s)
- Kade L Paterson
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia.
| | - Ben R Metcalf
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Penny K Campbell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Peixuan Li
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Anurika P De Silva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
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Raza A, Sekiguchi Y, Yaguchi H, Honda K, Fukushi K, Huang C, Ihara K, Nozaki Y, Nakahara K, Izumi SI, Ebihara S. Gait classification of knee osteoarthritis patients using shoe-embedded internal measurement units sensor. Clin Biomech (Bristol, Avon) 2024; 117:106285. [PMID: 38901396 DOI: 10.1016/j.clinbiomech.2024.106285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/14/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Knee osteoarthritis negatively affects the gait of patients, especially that of elderly people. However, the assessment of wearable sensors in knee osteoarthritis patients has been under-researched. During clinical assessments, patients may change their gait patterns under the placebo effect, whereas wearable sensors can be used in any environment. METHODS Sixty patients with knee osteoarthritis and 20 control subjects were included in the study. Wearing shoes with an IMU sensor embedded in the insoles, the participants were required to walk along a walkway. The sensor data were collected during the gait. To discriminate between healthy and knee osteoarthritis patients and to classify different subgroups of knee osteoarthritis patients (patients scheduled for surgery vs. patients not scheduled for surgery; bilateral knee osteoarthritis diagnosis vs. unilateral knee osteoarthritis diagnosis), we used a machine learning approach called the support vector machine. A total of 88 features were extracted and used for classification. FINDINGS The patients vs. healthy participants were classified with 71% accuracy, 85% sensitivity, and 56% specificity. The "patients scheduled for surgery" vs. "patients not scheduled for surgery" were classified with 83% accuracy, 83% sensitivity, and 81% specificity. The bilateral knee osteoarthritis diagnosis vs. unilateral knee osteoarthritis diagnosis was classified with 81% accuracy, 75% sensitivity, and 79% specificity. INTERPRETATION Gait analysis using wearable sensors and machine learning can discriminate between healthy and knee osteoarthritis patients and classify different subgroups with reasonable accuracy, sensitivity, and specificity. The proposed approach requires no complex gait factors and is not limited to controlled laboratory settings.
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Affiliation(s)
- Ahmed Raza
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Haruki Yaguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Kenichiro Fukushi
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Chenhui Huang
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Kazuki Ihara
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Yoshitaka Nozaki
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Kentaro Nakahara
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Graduate School of Biomedical Engineering, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Satoru Ebihara
- Department of Internal Medicine & Rehabilitation Science, Disability Sciences, Tohoku University Graduate School of Medicine,1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Tsekoura M, Billis E, Matzaroglou C, Tsepis E, Gliatis J. Association between Chronic Pain and Sarcopenia in Greek Community-Dwelling Older Adults: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1303. [PMID: 38998838 PMCID: PMC11241295 DOI: 10.3390/healthcare12131303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
(1) Background: Sarcopenia and chronic pain are prevalent syndromes among older adults that negatively affect their quality of life. The present study aimed to investigate the relationship between chronic pain and sarcopenia among Greek community-dwelling older adults. (2) Methods: Older adults >60 years of age were enrolled in this descriptive, cross-sectional study. Sarcopenia status was assessed according to the EWGSOP2 2019 algorithm. This assessment included the evaluation of muscle strength, body composition and gait speed. Pain location and pain characteristics were assessed using a self-reported questionnaire. Pain severity was assessed via the visual analog scale. The participants were also asked to fill out the SARC-F, the Hospital Anxiety and Depression Scale (HADS) and the Falls Efficacy Scale-International (FES-I) questionnaire. (3) Results: This study included 314 participants with a mean age of 71.3 ± 7.4 years. The prevalence of sarcopenia was 19.4 (n = 61), and 44.26% of the sarcopenic participants recorded chronic pain. Chronic pain was associated with sarcopenia, comorbidities, the number of drugs and HADS. (4) Conclusions: The results demonstrated a high percentage of chronic pain in the sarcopenic population. The results also highlight the importance of the detection of chronic pain in older patients with sarcopenia in order to develop effective preventive and therapeutic strategies.
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Affiliation(s)
- Maria Tsekoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Rio, Greece
| | - Evdokia Billis
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Rio, Greece
| | - Charalampos Matzaroglou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Rio, Greece
| | - Elias Tsepis
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Rio, Greece
| | - John Gliatis
- Department of Orthopaedics, School of Medicine, University of Patras, 26504 Patra, Greece
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Charlton JM, Chang E, Hou SW, Lo E, McClure E, Plater C, Wong S, Hunt MA. Moving in pain - A preliminary study evaluating the immediate effects of experimental knee pain on locomotor biomechanics. PLoS One 2024; 19:e0302752. [PMID: 38941337 PMCID: PMC11213337 DOI: 10.1371/journal.pone.0302752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/06/2024] [Indexed: 06/30/2024] Open
Abstract
Pain changes how we move, but it is often confounded by other factors due to disease or injury. Experimental pain offers an opportunity to isolate the independent effect of pain on movement. We used cutaneous electrical stimulation to induce experimental knee pain during locomotion to study the short-term motor adaptions to pain. While other models of experimental pain have been used in locomotion, they lack the ability to modulate pain in real-time. Twelve healthy adults completed the single data collection session where they experienced six pain intensity conditions (0.5, 1, 2, 3, 4, 5 out of 10) and two pain delivery modes (tonic and phasic). Electrodes were placed over the lateral infrapatellar fat pad and medial tibial condyle to deliver the 10 Hz pure sinusoid via a constant current electrical stimulator. Pain intensity was calibrated prior to each walking bout based on the target intensity and was recorded using an 11-point numerical rating scale. Knee joint angles and moments were recorded over the walking bouts and summarized in waveform and discrete outcomes to be compared with baseline walking. Knee joint angles changed during the swing phase of gait, with higher pain intensities resulting in greater knee flexion angles. Minimal changes in joint moments were observed but there was a consistent pattern of decreasing joint stiffness with increasing pain intensity. Habituation was limited across the 30-90 second walking bouts and the electrical current needed to deliver the target pain intensities showed a positive linear relationship. Experimental knee pain shows subtle biomechanical changes and favourable habituation patterns over short walking bouts. Further exploration of this model is needed in real-world walking conditions and over longer timeframes to quantify motor adaptations.
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Affiliation(s)
- Jesse M. Charlton
- School of Kinesiology, Faculty of Education, The University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Motion Analysis and Biofeedback Laboratory, The University of British Columbia, Vancouver, BC, Canada
| | - Elyott Chang
- Motion Analysis and Biofeedback Laboratory, The University of British Columbia, Vancouver, BC, Canada
- Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Sabrina W. Hou
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ernest Lo
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Emily McClure
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Cole Plater
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Samantha Wong
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Michael A. Hunt
- Motion Analysis and Biofeedback Laboratory, The University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Sohrabi M, Torkaman G, Bahrami F. Comparing Knee Kinetics and Kinematics in Healthy Individuals and Those With Knee Osteoarthritis, With and Without Flat Feet. J Appl Biomech 2024; 40:232-240. [PMID: 38608717 DOI: 10.1123/jab.2023-0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/14/2024]
Abstract
Individuals with knee osteoarthritis (KOA) and flat feet are more likely to experience increased pain and cartilage damage. This study aimed to investigate the knee kinetics, kinematics, pain, and physical function in individuals with moderate symptomatic KOA, in comparison to asymptomatic control participants. Thirty volunteers with moderate KOA (with flat feet n = 15, with normal feet n = 15) and 30 asymptomatic people (with flat feet n = 15, with normal feet n = 15) were evaluated. The knee adduction angular impulse, knee flexion moment, knee flexion angular impulse, and knee flexion angle were measured during level walking. The pain was assessed in patients with KOA. The study found that individuals with KOA had a significant increase in the knee adduction angular impulse compared with the asymptomatic people (P < .05). The KOA with flat feet group had significantly lower knee flexion moment, knee flexion angular impulse, and knee flexion angle values than the KOA with normal feet group (P < .05). Furthermore, the KOA with flat feet group had a higher pain score than the KOA with normal feet group. Individuals with osteoarthritis and flat feet had lower knee flexion moments which may indicate reduced knee force exerted through compensatory mechanisms. Despite this reduction, they reported significantly higher levels of pain compared with those without flat feet, a finding that warrants further investigation in future studies.
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Affiliation(s)
- Maryam Sohrabi
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Giti Torkaman
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fariba Bahrami
- Human Motor Control and Computational Neuroscience Lab, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
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Wyatt FW, Al-Dadah O. Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: A comparison of clinical and radiological outcomes. World J Orthop 2024; 15:444-456. [PMID: 38835690 PMCID: PMC11145972 DOI: 10.5312/wjo.v15.i5.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/05/2024] [Accepted: 04/12/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are well-established operative interventions in the treatment of knee osteoarthritis. However, which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate. Simultaneously, there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes, preoperatively and following HTO or UKA. AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis: Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this. METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA (n = 23) and HTO (n = 19) to treat medial compartment knee osteoarthritis. Patient-reported outcome measures (PROMs) were collected to evaluate clinical outcome. These included two disease-specific (Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score) and two generic (EQ-5D-5L, Short Form-12) PROMs. The radiographic parameters of knee alignment assessed were the: Hip-knee-ankle angle, mechanical axis deviation and angle of Mikulicz line. RESULTS Statistical analyses demonstrated significant (P < 0.001), preoperative to postoperative, improvements in the PROM scores of both groups. There were, however, no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group. Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively (P < 0.05). Postoperatively, two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters (hip-knee-ankle angle, mechanical axis deviation) within the HTO group; yet no such associations were observed within the UKA group. CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis. Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively; however, a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.
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Affiliation(s)
- Frederick William Wyatt
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, United Kingdom
| | - Oday Al-Dadah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, United Kingdom
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Wasser JG, Hendershot BD, Acasio JC, Krupenevich RL, Pruziner AL, Miller RH, Goldman SM, Valerio MS, Senchak LT, Murphey MD, Heltzel DA, Fazio MG, Dearth CL, Hager NA. A Comprehensive, Multidisciplinary Assessment for Knee Osteoarthritis Following Traumatic Unilateral Lower Limb Loss in Service Members. Mil Med 2024; 189:581-591. [PMID: 35803867 DOI: 10.1093/milmed/usac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is a primary source of long-term disability and decreased quality of life (QoL) in service members (SM) with lower limb loss (LL); however, it remains difficult to preemptively identify and mitigate the progression of KOA and KOA-related symptoms. The objective of this study was to explore a comprehensive cross-sectional evaluation, at the baseline of a prospective study, for characterizing KOA in SM with traumatic LL. MATERIALS AND METHODS Thirty-eight male SM with traumatic unilateral LL (23 transtibial and 15 transfemoral), 9.5 ± 5.9 years post-injury, were cross-sectionally evaluated at initial enrollment into a prospective, longitudinal study utilizing a comprehensive evaluation to characterize knee joint health, functionality, and QoL in SM with LL. Presences of medial, lateral, and/or patellofemoral articular degeneration within the contralateral knee were identified via magnetic resonance imaging(for medically eligible SM; Kellgren-Lawrence Grade [n = 32]; and Outerbridge classification [OC; n = 22]). Tri-planar trunk and pelvic motions, knee kinetics, along with temporospatial parameters, were quantified via full-body gait evaluation and inverse dynamics. Concentrations of 26 protein biomarkers of osteochondral tissue degradation and inflammatory activity were identified via serum immunoassays. Physical function, knee symptoms, and QoL were collected via several patient reported outcome measures. RESULTS KOA was identified in 12 of 32 (37.5%; KL ≥ 1) SM with LL; however, 16 of 22 SM presented with patellofemoral degeneration (72.7%; OC ≥ 1). Service members with versus without KOA had a 26% reduction in the narrowest medial tibiofemoral joint space. Biomechanically, SM with versus without KOA walked with a 24% wider stride width and with a negative correlation between peak knee adduction moments and minimal medial tibiofemoral joint space. Physiologically, SM with versus without KOA exhibited elevated concentrations of pro-inflammatory biomarker interleukin-7 (+180%), collagen breakdown markers collagen II cleavage (+44%), and lower concentrations of hyaluronic acid (-73%) and bone resorption biomarker N-telopeptide of Type 1 Collagen (-49%). Lastly, there was a negative correlation between patient-reported contralateral knee pain severity and patient-reported functionality and QoL. CONCLUSIONS While 37.5% of SM with LL had KOA at the tibiofemoral joint (KL ≥ 1), 72.7% of SM had the presence of patellofemoral degeneration (OC ≥ 1). These findings demonstrate that the patellofemoral joint may be more susceptible to degeneration than the medial tibiofemoral compartment following traumatic LL.
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Affiliation(s)
- Joseph G Wasser
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Brad D Hendershot
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Julian C Acasio
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Rebecca L Krupenevich
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Alison L Pruziner
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ross H Miller
- Department of Kinesiology, University of Maryland, College Park, MD 20742, USA
| | - Stephen M Goldman
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Michael S Valerio
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Lien T Senchak
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Mark D Murphey
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- American Institute for Radiologic Pathology, Silver Spring, MD 20910, USA
| | - David A Heltzel
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Michael G Fazio
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Christopher L Dearth
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Nelson A Hager
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Anan M, Tokuda K, Tanimoto K, Sawada T. The relationship between knee flexion excursion and mechanical stress during gait in medial knee osteoarthritis. Clin Biomech (Bristol, Avon) 2024; 112:106180. [PMID: 38219456 DOI: 10.1016/j.clinbiomech.2024.106180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND A decrease in knee flexion excursion during the loading response may affect not only quadriceps muscle weakness, pain, and inflammatory symptoms, but also lead to physical function decline and activity limitation. The aim of this investigation was to clarify the relationship between knee flexion excursion during the loading response and mechanical stress on the knee joint, muscle strength, pain, and physical function in patients with knee osteoarthritis. METHODS Twenty patients diagnosed with medial knee osteoarthritis. The participants walked along a 10 m corridor in the laboratory at a comfortable pace. The kinematic and kinetic data were collected using a 3D motion analysis system. We employed to control for gait speed and age while examining the relationship between knee flexion excursion during the loading response and mechanical stress on the knee joint, muscle strength, pain, and physical function. FINDINGS Knee flexion excursion showed a significant positive correlation with the peak and angular impulse of knee flexion moment. In the partial correlation coefficients controlling for age and gait speed, significant negative correlations were found between knee flexion excursion and knee adduction moment angular impulse. INTERPRETATION It can be inferred that gait with reduced knee flexion movement during the loading response in patients with knee osteoarthritis may result in increased mechanical stress on the knee joint in the frontal plane. Exercise interventions aimed at increasing knee flexion excursion may result in a reduction in disease progression.
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Affiliation(s)
- Masaya Anan
- Physical Therapy Course, Faculty of Welfare and Health Science, Oita University, 700, Dannoharu, Oita-shi, Oita 870-1192, Japan.
| | - Kazuki Tokuda
- Department of Physical Therapy, Kurume Rehabilitation Institute, 1541 Mizuhara, Hirokawa-cho, Yame-gun, Fukuoka 834-0102, Japan
| | - Kenji Tanimoto
- Department of Rehabilitation, Mori Orthopaedic Clinic, 1-3-16 Hikarimachi Higashi-ku, Hiroshima-shi, Hiroshima 732-0052, Japan
| | - Tomonori Sawada
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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10
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Hart HF, Birmingham TB, Sritharan P, Primeau C, King MG, Fischer LK. Sex-related differences in gait characteristics and their associations with symptoms in individuals with patellofemoral osteoarthritis. Gait Posture 2024; 107:35-41. [PMID: 37734189 DOI: 10.1016/j.gaitpost.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Patellofemoral osteoarthritis (OA) is an important subgroup of knee OA. However, the influence of sex on gait characteristics in patients with patellofemoral OA is unknown. RESEARCH QUESTION Compare gait characteristics in females and males with patellofemoral OA and investigate their associations with patellofemoral joint-related symptoms and limitations. METHODS Mixed effects polynomial regression models compared knee flexion-extension and adduction moments, knee flexion angles, and vertical ground reaction forces over 100% of stance between 26 females and 22 males with patellofemoral OA, with and without adjustment for walking speed and body mass. Multivariable linear regression models were then used to investigate the associations of gait characteristics with symptoms and limitations measured with the Knee injury and Osteoarthritis Outcome Score Patellofemoral Pain and Osteoarthritis (KOOS-PF) Subscale. Models included a sex-by-gait interaction term, and if significant, separate models were built for females and males. RESULTS While controlling for walking speed and body mass, females had lower knee flexion moment (6-19% and 97-100% of stance), knee extension moment (45-86% of stance), knee adduction moment (3-37% and 69-99% of stance), vertical ground reaction force (1-97% of stance) and knee flexion angle (90-100% of stance) compared with males, when fitted over 100% of stance. Lower cadence, lower knee flexion angular impulse, and higher peak knee flexion angle were associated with worse KOOS-PF scores. Associations were not modified by sex. SIGNIFICANCE There are distinct sex-based differences in gait characteristics throughout stance with patellofemoral OA when adjusting for body mass and walking speed. Lower cadence and knee flexion angular impulse, and higher peak knee flexion angle were associated with more extreme patellofemoral joint-related symptoms and limitations.
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Affiliation(s)
- Harvi F Hart
- School of Physical Therapy, Faculty of Health Sciences, Western University, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, Ontario, Canada
| | - Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Victoria, Australia
| | - Codie Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, Ontario, Canada
| | - Matthew G King
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Victoria, Australia
| | - Lisa K Fischer
- Fowler Kennedy Sport Medicine Clinic, Western University, Ontario, Canada
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11
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Clancy CE, Gatti AA, Ong CF, Maly MR, Delp SL. Muscle-driven simulations and experimental data of cycling. Sci Rep 2023; 13:21534. [PMID: 38057337 PMCID: PMC10700567 DOI: 10.1038/s41598-023-47945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
Muscle-driven simulations have provided valuable insights in studies of walking and running, but a set of freely available simulations and corresponding experimental data for cycling do not exist. The aim of this work was to develop a set of muscle-driven simulations of cycling and to validate them by comparison with experimental data. We used direct collocation to generate simulations of 16 participants cycling over a range of powers (40-216 W) and cadences (75-99 RPM) using two optimization objectives: a baseline objective that minimized muscle effort and a second objective that additionally minimized tibiofemoral joint forces. We tested the accuracy of the simulations by comparing the timing of active muscle forces in our baseline simulation to timing in experimental electromyography data. Adding a term in the objective function to minimize tibiofemoral forces preserved cycling power and kinematics, improved similarity between active muscle force timing and experimental electromyography, and decreased tibiofemoral joint reaction forces, which better matched previously reported in vivo measurements. The musculoskeletal models, muscle-driven simulations, simulation software, and experimental data are freely shared at https://simtk.org/projects/cycling_sim for others to reproduce these results and build upon this research.
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Affiliation(s)
- Caitlin E Clancy
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Anthony A Gatti
- Department of Radiology, Stanford University, Stanford, CA, USA.
| | - Carmichael F Ong
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Monica R Maly
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Scott L Delp
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
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12
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Aydemir B, Huang CH, Foucher KC. Gait speed and kinesiophobia explain physical activity level in adults with osteoarthritis: A cross-sectional study. J Orthop Res 2023; 41:2629-2637. [PMID: 37254645 PMCID: PMC10926713 DOI: 10.1002/jor.25624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/16/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023]
Abstract
Identifying potential contributing factors for physical inactivity in people with knee osteoarthritis is vital for designing practical activity promoting interventions. Walking is a common activity, but it is unknown how gait characteristics may influence physical activity and if psychological factors, specifically fear of movement (kinesiophobia), contribute to this relationship. The aim of our study was to investigate the contributions of select gait parameters and kinesiophobia to activity levels. Cross-sectional data from 40 participants (F 24|M 16; age 57.6 ± 8.9 years; BMI 34.7 ± 7.0 kg/m2 ) with uni- or bilateral knee osteoarthritis were included. Physical activity and kinesiophobia were assessed by self-report using the University of California, Los Angeles activity rating scale, and Tampa scale for kinesiophobia, respectively. Gait parameters were collected with three-dimensional gait analysis while participants walked on an instrumented split-belt treadmill at a self-selected speed. Higher peak sagittal plane joint moments at the ankle (ρ = 0.418, p = 0.007), and hip (ρ = 0.348, p = 0.028), faster self-selected gait speed (ρ = 0.553, p < 0.001), and less kinesiophobia or fear of movement (ρ = -0.695, p < 0.001) were independently related to higher physical activity level in adults with knee osteoarthritis. In hierarchical regression models, after accounting for covariates, only self-selected gait speed, and kinesiophobia significantly contributed to explaining the variation in physical activity level. Statement of clinical significance: Interventions aimed at improving physical activity participation in those with lower limb osteoarthritis should consider assessing the contribution of pain-related fear of movement.
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Affiliation(s)
- Burcu Aydemir
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chun-Hao Huang
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Kharma C. Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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13
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Gonzalez FF, Leporace G, Franciozi C, Cockrane M, Metsavaht L, Carpes FP, Chahla J, Luzo M. Clinical and radiographic characterization of three-dimensional gait profiles of patients with knee osteoarthritis. Knee 2023; 44:211-219. [PMID: 37672913 DOI: 10.1016/j.knee.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/25/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Previous authors have utilized gait kinematics to categorize knee osteoarthritis patients into four distinct profiles: (1) flexed knee; (2) externally rotated knee; (3) stiff knee; and (4) knee varus thrust and rotational rigidity. However, the relationship between these gait profiles and patients' characteristics remains poorly understood. Thus, this study aimed to investigate whether differences in clinical and radiographic characteristics were associated with these four gait profiles. METHODS This cross-sectional study used available data from a previous biomechanical study. Data on the four gait profiles were collected from 42 patients with advanced knee osteoarthritis. Three-dimensional kinematics of the knee was recorded during gait using an optoelectronic system. Subjects were evaluated for knee strength, range of motion, tibial slope, femorotibial angle, radiographic severity, anthropometric measurements, and patient-reported outcomes. Multiple comparisons were made using Dunn's test. The level of significance was set at 5%, and the effect size was calculated. FINDINGS Body mass index (BMI) was the only variable associated with a specific gait profile: profile 4 (P = 0.01; effect size = P1 × P4: -0.62; P2 × P4: -0.41; P3 × P4: -0.40). INTERPRETATION Our findings suggest that most clinical and radiographic characteristics commonly measured in clinical practice did not differ significantly among knee osteoarthritis patients with the four different gait profiles. The only exception was a higher BMI noted in those with gait profile 4; however, it remains unclear whether it can cause varus thrust or rotation rigidity. The incorporation of three-dimensional motion analysis to identify gait profiles provided clinical insights beyond the limitations of traditional clinical assessments.
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Affiliation(s)
- Felipe F Gonzalez
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, IL, USA; Brazil Institute of Health Technologies (Instituto Brasil de Tecnologias da Saúde), Rio de Janeiro, Brazil; Post Graduation Program of Clinical Radiology, Escola Paulista de Medicina, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil.
| | - Gustavo Leporace
- Brazil Institute of Health Technologies (Instituto Brasil de Tecnologias da Saúde), Rio de Janeiro, Brazil; Post Graduation Program of Clinical Radiology, Escola Paulista de Medicina, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
| | - Carlos Franciozi
- Post Graduation Program of Clinical Radiology, Escola Paulista de Medicina, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
| | - Marcos Cockrane
- Department of Orthopedic Surgery, Galeão Air Force Hospital (Hospital de Força Aérea do Galeão), Rio de Janeiro, Brazil
| | - Leonardo Metsavaht
- Brazil Institute of Health Technologies (Instituto Brasil de Tecnologias da Saúde), Rio de Janeiro, Brazil; Post Graduation Program of Clinical Radiology, Escola Paulista de Medicina, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
| | - Felipe P Carpes
- Laboratory of Neuromechanics, Federal University of Pampa (Universidade Federal de Pampa), Uruguaiana, Brazil
| | - Jorge Chahla
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, IL, USA
| | - Marcus Luzo
- Post Graduation Program of Clinical Radiology, Escola Paulista de Medicina, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
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Sharifi-Renani M, Mahoor MH, Clary CW. BioMAT: An Open-Source Biomechanics Multi-Activity Transformer for Joint Kinematic Predictions Using Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2023; 23:5778. [PMID: 37447628 DOI: 10.3390/s23135778] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Abstract
Through wearable sensors and deep learning techniques, biomechanical analysis can reach beyond the lab for clinical and sporting applications. Transformers, a class of recent deep learning models, have become widely used in state-of-the-art artificial intelligence research due to their superior performance in various natural language processing and computer vision tasks. The performance of transformer models has not yet been investigated in biomechanics applications. In this study, we introduce a Biomechanical Multi-activity Transformer-based model, BioMAT, for the estimation of joint kinematics from streaming signals of multiple inertia measurement units (IMUs) using a publicly available dataset. This dataset includes IMU signals and the corresponding sagittal plane kinematics of the hip, knee, and ankle joints during multiple activities of daily living. We evaluated the model's performance and generalizability and compared it against a convolutional neural network long short-term model, a bidirectional long short-term model, and multi-linear regression across different ambulation tasks including level ground walking (LW), ramp ascent (RA), ramp descent (RD), stair ascent (SA), and stair descent (SD). To investigate the effect of different activity datasets on prediction accuracy, we compared the performance of a universal model trained on all activities against task-specific models trained on individual tasks. When the models were tested on three unseen subjects' data, BioMAT outperformed the benchmark models with an average root mean square error (RMSE) of 5.5 ± 0.5°, and normalized RMSE of 6.8 ± 0.3° across all three joints and all activities. A unified BioMAT model demonstrated superior performance compared to individual task-specific models across four of five activities. The RMSE values from the universal model for LW, RA, RD, SA, and SD activities were 5.0 ± 1.5°, 6.2 ± 1.1°, 5.8 ± 1.1°, 5.3 ± 1.6°, and 5.2 ± 0.7° while these values for task-specific models were, 5.3 ± 2.1°, 6.7 ± 2.0°, 6.9 ± 2.2°, 4.9 ± 1.4°, and 5.6 ± 1.3°, respectively. Overall, BioMAT accurately estimated joint kinematics relative to previous machine learning algorithms across different activities directly from the sequence of IMUs signals instead of time-normalized gait cycle data.
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Affiliation(s)
| | - Mohammad H Mahoor
- Computer Vision and Social Robotics Laboratory, University of Denver, Denver, CO 80208, USA
| | - Chadd W Clary
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO 80208, USA
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15
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Lisee C, Bjornsen E, Berkoff D, Blake K, Schwartz T, Horton WZ, Pietrosimone B. Changes in biomechanics, strength, physical function, and daily steps after extended-release corticosteroid injections in knee osteoarthritis: a responder analysis. Clin Rheumatol 2023:10.1007/s10067-023-06568-x. [PMID: 36929315 DOI: 10.1007/s10067-023-06568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION/OBJECTIVE To determine changes in gait biomechanics, quadricep strength, physical function, and daily steps after an extended-release corticosteroid knee injection at 4 and 8 weeks post-injection in individuals with knee osteoarthritis as well as between responders and non-responders based on changes in self-reported knee function. METHOD The single-arm, clinical trial included three study visits (baseline, 4 weeks, and 8 weeks post-injection), where participants received an extended-release corticosteroid injection following the baseline visit. Time-normalized vertical ground reaction force (vGRF), knee flexion angle (KFA), knee abduction moment (KAM), and knee extension moment (KEM) waveforms throughout stance were collected during gait biomechanical assessments. Participants also completed quadricep strength, physical function (chair-stand, stair-climb, 20-m fast-paced walk) testing, and free-living daily step assessment for 7 days following each visit. RESULTS All participants demonstrated increased KFA excursion (i.e., greater knee extension angle at heel strike and KFA at toe-off), increased KEM during early stance, improved physical function (all p < 0.001), and increased quadricep strength at 4 and 8 weeks. KAM increased throughout most of stance at 4 and 8 weeks post-injection (p < 0.001) but appears to be driven by gait changes in non-responders. Non-responders demonstrated lesser vGRF during late stance and lesser KEM and KFA throughout stance compared to responders at baseline. CONCLUSIONS Extended-release corticosteroid injections demonstrated short-term improvements in gait biomechanics, quadricep strength, and physical function for up to 4 weeks. However, non-responders demonstrated gait biomechanics associated with osteoarthritis progression prior to the corticosteroid injection, suggesting that non-responders demonstrate more deleterious gait biomechanics prior to corticosteroid injection. Key Points • Individuals with knee osteoarthritis who were treated with extended-release corticosteroid injections demonstrated improvements in gait biomechanics and physical function for 8 weeks. • Individuals with knee osteoarthritis, who walked with aberrant walking biomechanics before treatment, failed to respond to extended-release corticosteroid treatment. • Future research should determine the mechanisms contributing to the short-term changes in gait biomechanics and physical function such as reduced inflammation.
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Affiliation(s)
- Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA.
| | - Elizabeth Bjornsen
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA
| | - David Berkoff
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen Blake
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - W Zachary Horton
- Department of Statistics, University of California Santa Cruz, Santa Cruz, CA, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Yokoyama M, Iijima H, Kubota K, Kanemura N. Exploring the modification factors of exercise therapy on biomechanical load in patients with knee osteoarthritis: a systematic review and meta-analysis. Clin Rheumatol 2023:10.1007/s10067-023-06553-4. [PMID: 36879173 DOI: 10.1007/s10067-023-06553-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
The objective of this systematic review and meta-analysis is to clarify the effect of exercise therapy on the first peak knee adduction moment (KAM), as well as other biomechanical loads in patients with knee osteoarthritis (OA), and identify physical characteristics that influence differences in biomechanical load after exercise therapy. The data sources are PubMed, PEDro, and CINAHL, from study inception to May 2021. The eligibility criteria include studies evaluating the first peak (KAM), peak knee flexion moment (KFM), maximal knee joint compression force (KCF), or co-contraction during walking before and after exercise therapy in patients with knee OA. The risk of bias was independently assessed by two reviewers using PEDro and NIH scales. Among 11 RCTs and nine non-RCTs, 1119 patients with knee OA were included (average age: 63.7 years). As the results of meta-analysis, exercise therapy tended to increase the first peak KAM (SMD 0.11; 95% CI: -0.03-0.24), peak KFM (SMD 0.13; 95% CI: -0.03-0.29), and maximal KCF (SMD 0.09; 95% CI -0.05-0.22). An increased first peak KAM was significantly associated with a larger improvement in knee muscle strength and WOMAC pain. However, the quality of evidence regarding the biomechanical loads was low-to-moderate according to the GRADE approach. The improvement in pain and knee muscle strength may mediate the increase in first peak KAM, suggesting difficulty in balancing symptom relief and biomechanical load reduction. Therefore, exercise therapy may satisfy both aspects simultaneously when combined with biomechanical interventions, such as a valgus knee brace or insoles. Registration: PROSPERO (CRD42021230966).
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Affiliation(s)
- Moeka Yokoyama
- Sportology Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Hirotaka Iijima
- Graduate School of Medicine/Institute for Advanced Research, Nagoya University, Nagoya, Japan
| | - Keisuke Kubota
- Research & Development Center, Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Saitama, Japan.
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Bradley PX, Thomas KN, Kratzer AL, Robinson AC, Wittstein JR, DeFrate LE, McNulty AL. The Interplay of Biomechanical and Biological Changes Following Meniscus Injury. Curr Rheumatol Rep 2023; 25:35-46. [PMID: 36479669 PMCID: PMC10267895 DOI: 10.1007/s11926-022-01093-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Meniscus injury often leads to joint degeneration and post-traumatic osteoarthritis (PTOA) development. Therefore, the purpose of this review is to outline the current understanding of biomechanical and biological repercussions following meniscus injury and how these changes impact meniscus repair and PTOA development. Moreover, we identify key gaps in knowledge that must be further investigated to improve meniscus healing and prevent PTOA. RECENT FINDINGS Following meniscus injury, both biomechanical and biological alterations frequently occur in multiple tissues in the joint. Biomechanically, meniscus tears compromise the ability of the meniscus to transfer load in the joint, making the cartilage more vulnerable to increased strain. Biologically, the post-injury environment is often characterized by an increase in pro-inflammatory cytokines, catabolic enzymes, and immune cells. These multi-faceted changes have a significant interplay and result in an environment that opposes tissue repair and contributes to PTOA development. Additionally, degenerative changes associated with OA may cause a feedback cycle, negatively impacting the healing capacity of the meniscus. Strides have been made towards understanding post-injury biological and biomechanical changes in the joint, their interplay, and how they affect healing and PTOA development. However, in order to improve clinical treatments to promote meniscus healing and prevent PTOA development, there is an urgent need to understand the physiologic changes in the joint following injury. In particular, work is needed on the in vivo characterization of the temporal biomechanical and biological changes that occur in patients following meniscus injury and how these changes contribute to PTOA development.
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Affiliation(s)
- Patrick X Bradley
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Karl N Thomas
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Avery L Kratzer
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Allison C Robinson
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Louis E DeFrate
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA.
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
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18
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Althomali OW, Starbuck C, Alarifi S, Alsaqri KK, Mohammad WS, Elsais WM, Jones R. The effect of foot position during static calibration trials on knee kinematic and kinetics during walking. Gait Posture 2023; 99:133-138. [PMID: 36435067 DOI: 10.1016/j.gaitpost.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/14/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gait analysis has been used extensively for computing knee kinematics and kinetics, in particular, in healthy and impaired individuals. One variable assessed is the external knee adduction moment (EKAM). Variations in EKAM values between investigations may be caused by changes in static standing position, especially foot placement angles which may increase or reduce any differences seen. PURPOSE OF THE STUDY The current study aimed to explore the influence of static trial foot position on knee kinematic and kinetic variables during walking. METHODS Twelve healthy male participants completed three different static standing trials; 1) 20-degrees toe-in, 2) 0° and 3) 20-degrees toe-out before walking at their own pace during a lower limb kinematics and kinetics assessment. First and second peak EKAM was compared between static foot position trials, as well other knee kinematic and kinetic outcomes. Repeated measures ANOVA was used with post hoc pairwise comparison to determine the differences between static foot position trials. RESULTS The first peak of EKAM was significantly smaller in the 20o toe-out angle, than the 20o toe-in angle (p = 0.04-8.16% reduction). Furthermore, significant changes were found in peak knee kinematics and kinetics variables (adduction angle, external rotation angle, knee flexion moment external rotation moment, abduction angle and internal rotation angle) in the different positions. CONCLUSION Modification in static foot position between study visits may result in changes especially in the 1st peak EKAM and other kinematics and kinetics variables during walking. Therefore, standardisation of static foot position should be utilised in longitudinal studies to ensure changes in EKAM are not masked or accentuated between assessments.
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Affiliation(s)
- Omar W Althomali
- Department of Physiotherapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia.
| | - Chelsea Starbuck
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK; The Manchester Institute of Health and Performance, Manchester, UK; Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, UK
| | - Saud Alarifi
- Department of Physiotherapy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khalid K Alsaqri
- Department of Physiotherapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | - Walaa S Mohammad
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia; Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walaa M Elsais
- Physical Therapy Department, College of Allied Medical Sciences, Isra University, Amman, Jordan
| | - Richard Jones
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK; The Manchester Institute of Health and Performance, Manchester, UK
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Bacon KL, Felson DT, Jafarzadeh SR, Kolachalama VB, Hausdorff JM, Gazit E, Segal NA, Lewis CE, Nevitt MC, Kumar D. Relation of gait measures with mild unilateral knee pain during walking using machine learning. Sci Rep 2022; 12:22200. [PMID: 36564397 PMCID: PMC9789148 DOI: 10.1038/s41598-022-21142-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Gait alterations in those with mild unilateral knee pain during walking may provide clues to modifiable alterations that affect progression of knee pain and osteoarthritis (OA). To examine this, we applied machine learning (ML) approaches to gait data from wearable sensors in a large observational knee OA cohort, the Multicenter Osteoarthritis (MOST) study. Participants completed a 20-m walk test wearing sensors on their trunk and ankles. Parameters describing spatiotemporal features of gait and symmetry, variability and complexity were extracted. We used an ensemble ML technique ("super learning") to identify gait variables in our cross-sectional data associated with the presence/absence of unilateral knee pain. We then used logistic regression to determine the association of selected gait variables with odds of mild knee pain. Of 2066 participants (mean age 63.6 [SD: 10.4] years, 56% female), 21.3% had mild unilateral pain while walking. Gait parameters selected in the ML process as influential included step regularity, sample entropy, gait speed, and amplitude dominant frequency, among others. In adjusted cross-sectional analyses, lower levels of step regularity (i.e., greater gait variability) and lower sample entropy(i.e., lower gait complexity) were associated with increased likelihood of unilateral mild pain while walking [aOR 0.80 (0.64-1.00) and aOR 0.79 (0.66-0.95), respectively].
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Affiliation(s)
- Kathryn L Bacon
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA.
| | - David T Felson
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
| | - S Reza Jafarzadeh
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
| | - Vijaya B Kolachalama
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
| | | | - Eran Gazit
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Neil A Segal
- University of Kansas Medical Center, Kansas City, USA
| | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Deepak Kumar
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
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20
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Wylde MJ, Callaway AJ, Williams JM, Yap J, Leow S, Low CY. Limb specific training magnitude and asymmetry to discriminate between athletes with and without unilateral or bilateral injury history. Phys Ther Sport 2022; 56:76-83. [DOI: 10.1016/j.ptsp.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
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21
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Tung EV, Marriott KA, Laing AC, Mourtzakis M, Maly MR. The relationship between muscle capacity utilization during gait and pain in people with symptomatic knee osteoarthritis. Gait Posture 2022; 94:58-66. [PMID: 35247826 DOI: 10.1016/j.gaitpost.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle capacity utilization reflects the percentage of maximal knee extensor strength required to complete physical activities. RESEARCH QUESTION Is pain associated with muscle capacity utilization during walking in older adults with knee osteoarthritis? Secondarily, is muscle capacity utilization in older adults with knee osteoarthritis sex-specific? METHODS Twenty-three participants (15 females) with symptomatic knee OA completed this study [age 67 ( ± 8) years, body mass index 29.7 ( ± 3.9) kg/m2, gait speed during the Six Minute Walk test 1.25 ( ± 0.25) m/s]. Pain was measured using the Knee injury and Osteoarthritis Outcome Score. Muscle capacity utilization was quantified as the peak external knee flexor moment during level walking normalized to knee extensor maximum voluntary isometric contraction. The knee flexor moment was calculated from kinematic and kinetic data during barefoot level walking at a self-selected speed and at 1.1 m/s. Knee extensor maximum voluntary isometric contraction was measured on a dynamometer. Multiple linear regressions were used to determine the relationship between pain and muscle capacity utilization after adjusting for age, sex, body mass index, and gait speed. Independent sample t-tests examined sex differences. RESULTS Pain was not associated with muscle capacity utilization during self-selected and standardized walking speeds (p = 0.38 and p = 0.36, respectively). Females did not require a greater muscle capacity utilization than males to complete gait at self-selected and standardized speeds (p = 0.28, and p = 0.40, respectively). SIGNIFICANCE Muscle capacity utilization was not associated with pain during walking in people with knee osteoarthritis. Future work should explore more challenging activities of daily living in knee OA.
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Affiliation(s)
- Emma V Tung
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Kendal A Marriott
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Andrew C Laing
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Marina Mourtzakis
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Monica R Maly
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
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22
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Banger MS, Doonan J, Jones BG, MacLean AD, Rowe PJ, Blyth MJG. Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial. Bone Joint J 2022; 104-B:433-443. [PMID: 35360949 DOI: 10.1302/0301-620x.104b4.bjj-2021-0837.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery. METHODS A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model. RESULTS Both interventions were shown to be effective treatment options, with no significant differences shown between interventions for the primary outcome of this study (18/35 (51.4%) biphasic TKA patients vs 20/31 (64.5%) biphasic bi-UKA patients; p = 0.558). All outcomes were compared to an age-matched, healthy cohort that outperformed both groups, indicating residual deficits exists following surgery. Logistic regression analysis of primary outcome with secondary outcomes indicated that the most significant predictor of postoperative biphasic knee moments was preoperative knee moment profile and trochlear degradation (Outerbridge) (R2 = 0.381; p = 0.002, p = 0.046). A separate regression of alignment against primary outcome indicated significant bi-UKA femoral and tibial axial alignment (R2 = 0.352; p = 0.029), and TKA femoral sagittal alignment (R2 = 0.252; p = 0.016). The bi-UKA group showed a significant increased ability in the proprioceptive joint position test, but no difference was found in more dynamic testing of proprioception. CONCLUSION Robotic arm-assisted bi-UKA demonstrated equivalence to TKA in achieving a biphasic gait pattern after surgery for osteoarthritis of the knee. Both treatments are successful at improving gait, but both leave the patients with a functional limitation that is not present in healthy age-matched controls. Cite this article: Bone Joint J 2022;103-B(4):433-443.
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Affiliation(s)
- Matthew S Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Bryn G Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Angus D MacLean
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Philip J Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Mark J G Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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23
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Robbins SM, Wolfe R, Chang YY, Lavoie M, Preston E, Hazel EM. Inter-segmental coordination amplitude and variability differences during gait in patients with Ehlers-Danlos syndrome and healthy adults. Clin Biomech (Bristol, Avon) 2022; 94:105515. [PMID: 34736750 DOI: 10.1016/j.clinbiomech.2021.105515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited research examining gait and inter-segmental coordination in patients with Ehlers-Danlos syndrome. The objective was to compare lower extremity inter-segmental coordination amplitude and variability during gait between patients with Ehlers-Danlos syndrome and healthy adults. METHODS This cross-sectional study included participants with Ehlers-Danlos syndrome (n = 13) and healthy adults (n = 14). Gait data were acquired using a motion capture system and force plates. Participants ambulated at self-selected speeds for five trials. Inter-segmental coordination was quantified using continuous relative phase, which examined the dynamic interaction between the thigh-shank and shank-foot paired segments (i.e. phase space relation). A 2-way mixed analysis of variance examined the effects of groups (Ehlers-Danlos and healthy) and gait phases (stance and swing phase) on inter-segmental coordination amplitude and between-trial variability. Effect sizes were calculated using Cohen's d. FINDINGS The Ehlers-Danlos group had greater inter-segmental coordination variability compared to the healthy group for foot-shank and shank-thigh segment pairs in the sagittal plane over stance and swing phases (P = 0.04; small to large effect sizes). The Ehlers-Danlos group also had greater variability in the frontal plane at the foot-shank segment pair during stance phase (P = 0.03; large effect). There were no differences in inter-segmental coordination amplitude between groups (P = 0.06 to 0.85). INTERPRETATION Patients with Ehlers-Danlos syndrome have more variability between gait trials in lower limb motor coordination than healthy adults. This may be related to the impaired proprioception, reduced strength, pain, or slower gait speed seen in this population.
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Affiliation(s)
- Shawn M Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, Montreal, Quebec, Canada.
| | - Russell Wolfe
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Yu-Yao Chang
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
| | - Mathilde Lavoie
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
| | - Emma Preston
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
| | - Elizabeth M Hazel
- McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
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24
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Yang C, Best TM, Liu H, Yu B. Knee biomechanical factors associated with patellofemoral pain in recreational runners. Knee 2022; 35:87-97. [PMID: 35255371 DOI: 10.1016/j.knee.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/06/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common injury among runners. Knee biomechanical factors associated with PFP, however, remain unclear. The purpose of this study was to determine possible associations between knee biomechanics and symptoms of PFP in recreational runners. METHODS Fifteen male and 15 female recreational runners with PFP were enrolled as the PFP group, 30 matched runners without PFP were recruited as the control group. The PFP group was tested running with and without knee pain, while the control group had only one running test. Reflective marker coordinates and ground reaction force data were collected in each test. Knee kinematics and kinetics during running were reduced and compared between groups (PFP group without knee pain and control group) and between pain conditions (PFP group with knee pain and without knee pain), as well as between sexes. RESULTS Female and male participants with PFP had an increased peak knee valgus angle when running without pain compared to matched controls (P = 0.001), and to themselves when running with pain (P = 0.001). Male participants with PFP also had an increased peak knee flexion angle when running without pain compared to matched controls (P = 0.008), however did not decrease their peak knee flexion angle when running with pain (P = 0.245). No significant main effect of group or pain condition on any peak knee joint moment during running was detected (P ≥ 0.175). CONCLUSIONS Increased peak knee valgus angle during running appears to be a critical biomechanical factor associated with PFP in recreational runners, while decreasing knee valgus angle during running may be an adaptation to reduce symptoms of PFP. Increased peak knee flexion angle during running appears to be another biomechanical factor associated with PFP that is sex specific for male recreational runners.
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Affiliation(s)
- Chen Yang
- School of Sports and Health, Nanjing Sport Institute, Nanjing 210014, China
| | - Thomas M Best
- UHealth Sports Medicine Institute, University of Miami, Miami, FL 33136, USA
| | - Hui Liu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China.
| | - Bing Yu
- Center for Human Movement Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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25
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Fazeli MS, McIntyre L, Huang Y, Chevalier X. Intra-articular placebo effect in the treatment of knee osteoarthritis: a survey of the current clinical evidence. Ther Adv Musculoskelet Dis 2022; 14:1759720X211066689. [PMID: 35126683 PMCID: PMC8808023 DOI: 10.1177/1759720x211066689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/23/2021] [Indexed: 01/06/2023] Open
Abstract
Knee osteoarthritis (KOA) is a debilitating disease characterized by chronic pain, stiffness, and decreased mobility. Intra-articular injectable therapies show good clinical efficacy in improving symptoms; however, these therapies and their comparators (intra-articular saline) have been associated with a large underlying placebo effect. We aimed to describe the existing evidence on the challenges, hypotheses, and potential solutions to mitigate the intra-articular placebo effect in clinical trials in KOA. A targeted literature review was conducted by searching Embase, MEDLINE®, and CENTRAL using predefined study selection criteria. All eligible studies identified were extracted for relevant data, and results were narratively summarized. Forty-three studies were included following screening. Challenges associated with the intra-articular placebo effect included its ability to mask the comparative efficacy of active treatments in trials (n = 7 studies), long-lasting effects (up to 6 months; n = 3), and substantial variation of placebo effect sizes across populations (n = 3). Hypotheses for the mechanism of the placebo effect included aspiration of synovial fluid during administration (n = 6) and dilution of inflammatory mediators (n = 2). Factors affecting the placebo effect size were more invasive routes of administration (e.g., injection versus oral; n = 4) and patient expectations (n = 2). Proposed solutions included the suggestion for readers to weigh the relevance of clinical trial evidence against the presence of large underlying placebo effects (n = 9), discontinuation of intra-articular saline as an appropriate placebo (n = 5), and inclusion of 'no treatment' or sham injection as a control (n = 4). The intra-articular placebo effect is a well-documented occurrence in KOA clinical trials, and it is suggested that it be accounted for when designing randomized controlled trials. Awareness and understanding of the intra-articular placebo effect in KOA are required for fair interpretation of clinical trial evidence.
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Affiliation(s)
- Mir Sohail Fazeli
- Evidinno Outcomes Research Inc., 1750 Davie Street, Suites 601 & 602, Vancouver, BC V6G 1W3, Canada
| | | | - Yili Huang
- Northwell Health, New Hyde Park, NY, USA
| | - Xavier Chevalier
- Hôpital Henri Mondor, Université Paris XII, UPEC, Créteil, France
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26
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A Review of the Relationships Between Knee Pain and Movement Neuromechanics. J Sport Rehabil 2021; 31:684-693. [PMID: 34942599 DOI: 10.1123/jsr.2021-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Knee injury and disease are common, debilitating, and expensive. Pain is a chief symptom of knee injury and disease and likely contributes to arthrogenic muscle inhibition. Joint pain alters isolated motor function, muscular strength, and movement biomechanics. Because knee pain influences biomechanics, it likely also influences long-term knee joint health. OBJECTIVE The purpose of this article is 2-fold: (1) review effects of knee pain on lower-extremity muscular activation and corresponding biomechanics and (2) consider potential implications of neuromechanical alterations associated with knee pain for long-term knee joint health. Experimental knee pain is emphasized because it has been used to mimic clinical knee pain and clarify independent effects of knee pain. Three common sources of clinical knee pain are also discussed: patellofemoral pain, anterior cruciate ligament injury and reconstruction, and knee osteoarthritis. DATA SOURCES The PubMed, Web of Science, and SPORTDiscus databases were searched for articles relating to the purpose of this article. CONCLUSION Researchers have consistently reported that knee pain alters neuromuscular activation, often in the form of inhibition that likely occurs via voluntary and involuntary neural pathways. The effects of knee pain on quadriceps activation have been studied extensively. Knee pain decreases voluntary and involuntary quadriceps activation and strength and alters the biomechanics of various movement tasks. If allowed to persist, these neuromechanical alterations might change the response of articular cartilage to joint loads during movement and detrimentally affect long-term knee joint health. Physical rehabilitation professionals should consider neuromechanical effects of knee pain when treating knee injury and disease. Resolution of joint pain can likely help to restore normal movement neuromechanics and potentially improve long-term knee joint health and should be a top priority.
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27
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Gait Alterations in Knee Osteoarthritis. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Seeley MK, Denning WM, Park J, Croft K, Horton WZ, Hopkins JT. Anterior knee pain independently alters landing and jumping biomechanics. Clin Biomech (Bristol, Avon) 2021; 89:105458. [PMID: 34455339 DOI: 10.1016/j.clinbiomech.2021.105458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/27/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
Background Biomechanical effects of anterior knee pain are difficult to distinguish from effects of other factors also related to knee injury (e.g., joint effusion). The purpose of this study was to evaluate independent effects of anterior knee pain on landing and jumping biomechanics. Methods Thirteen healthy participants performed a land and jump movement task, under three experimental conditions (pre-pain, pain, and post-pain), during one data collection session. One 1-ml injection of hypertonic saline into the infrapatellar fat pad was used to induce experimental anterior knee pain during the pain condition. Participant-perceived anterior knee pain was measured every 2 min throughout data collection. Landing and jumping biomechanics were measured and compared between the experimental conditions using a functional statistical approach. Findings The aforementioned injection increased mean participant-perceived anterior knee pain, from zero during the pre-pain condition to 2.6 ± 0.71 cm during the pain condition. Vertical ground reaction force, knee flexion angle, and internal knee extension moment decreased by approximately 0.100 body weights, 3°, and 0.010 Nm/body weight × body height, respectively, between the pre-pain and pain conditions. Conversely, hip flexion angle and internal hip extension moment increased by approximately 3° and 0.006 Nm/body weight × body height, respectively, between the pre-pain and pain conditions. Several biomechanical changes persisted after anterior knee pain abatement (the post-pain condition). Interpretation Anterior knee pain alters landing and jumping biomechanics, independent of other injury-related factors. These altered biomechanics likely change knee joint loading patterns and might increase risk for chronic knee joint injury and/or pathology.
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Affiliation(s)
- Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA.
| | - W Matt Denning
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin 17104, Korea
| | - Kaitland Croft
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
| | - W Zachary Horton
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
| | - J Ty Hopkins
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
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29
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Huang C, Chan PK, Chiu KY, Yan CH, Yeung SS, Fu SN. Exploring the relationship between pain intensity and knee moments in participants with medial knee osteoarthritis: a cross-sectional study. BMC Musculoskelet Disord 2021; 22:685. [PMID: 34384397 PMCID: PMC8361612 DOI: 10.1186/s12891-021-04587-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background High biomechanical loading is believed to be a risk factor to pain in people with knee osteoarthritis (OA), but controversial findings have been reported on the relationship between external knee adduction moment (KAM) and pain. A more comprehensive analysis considering other factor such as external knee flexion moment (KFM) could help better reveal this relationship. This study explored the relationship between external knee adduction moment and pain intensity in participants with knee osteoarthritis (OA) using an integrated path analysis model. Methods This was a cross-sectional study based on laboratory setting. Forty-seven participants with clinical and radiographic medial knee OA were analyzed for their external knee adduction moment (KAM) and knee flexion moment (KFM) during walking using a motion analysis system. Pain intensity was measured by visual analogue scale (VAS) and the pain subscale of the Knee Injury and Osteoarthritis Outcome Score. Varus/valgus alignment was captured and quantified using a bi-planar X-ray system. Using a path analysis model, the relationships between pain intensity, KAM, KFM, OA radiographic severity, knee varus angle and walking speed were examined. Results The proposed path model met the goodness-of-fit criteria. Based on this model, KAM had a negative effect on VAS pain indirectly through the mediation of KFM. The model indicated KAM and KFM were negatively related to one another; and KFM was positively related to VAS. The KAM index, defined as (KAM/ (KAM + KFM)), was negatively related to VAS. Conclusions Path analysis enabled the construction of a more integrated pathokinematic framework for people with knee OA. The KAM index which reflected the load sharing on the frontal and sagittal planes also revealed its relationship with pain. Re-distribution of mechanical loading from frontal to sagittal plane might be a strategy for pain avoidance associated with mechanical irritation.
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Affiliation(s)
- Chen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Ping-Keung Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kwong-Yuen Chiu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Chun-Hoi Yan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Shun-Shing Yeung
- Physiotherapy Department, MacLehose Medical Rehabilitation Centre, Hong Kong, China
| | - Siu N Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
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30
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Costello KE, Felson DT, Neogi T, Segal NA, Lewis CE, Gross KD, Nevitt MC, Lewis CL, Kumar D. Ground reaction force patterns in knees with and without radiographic osteoarthritis and pain: descriptive analyses of a large cohort (the Multicenter Osteoarthritis Study). Osteoarthritis Cartilage 2021; 29:1138-1146. [PMID: 33757856 PMCID: PMC8319033 DOI: 10.1016/j.joca.2021.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/22/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare ground reaction force patterns (GRF) during walking among legs defined by presence or absence of knee pain and/or radiographic knee osteoarthritis (ROA). METHOD Principal component analysis extracted major modes of variation (PCs) in GRF data from the Multicenter Osteoarthritis Study during self-paced walking. Legs were categorized as pain + ROA (n = 168), ROA only (n = 303), pain only (n = 476), or control (n = 1877). Relationships between group and GRF PCs were examined using Generalized Estimating Equations, adjusted for age, sex, body mass index, race, and clinic site with and without additional adjustment for gait speed. RESULTS With or without speed adjustment, pain + ROA had flatter vertical GRF waveforms than control (speed adjusted PC2 difference [95%CI]: -66 [-113,-20]), pain + ROA and ROA only had higher lateral GRF at impact and greater mid-stance medial GRF than control (speed adjusted PC3 difference: 9 [3,16] and 6 [2,10], respectively), and ROA only had higher early vs late medial GRF than control (speed adjusted PC2 difference: 7 [2,13]). Pain only had flatter vertical GRF waveforms and a smaller difference between anterior and posterior GRF than control only without speed adjustment. CONCLUSION In this large sample, sustained mid-stance loading and higher impact loads were identified in legs with ROA or ROA and pain, even when adjusting for differences in gait speed and other confounders. While it remains to be seen whether these features precede or result from ROA and pain, the presence of these patterns in the speed-adjusted models could have implications on gait interventions aimed to change joint loading.
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Affiliation(s)
- Kerry E. Costello
- Boston University, Boston, MA,Boston University School of Medicine, Boston, MA
| | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, MA
| | - Neil A. Segal
- University of Kansas Medical Center, Kansas City, KS,The University of Iowa, Iowa City, IA
| | | | | | | | - Cara L. Lewis
- Boston University, Boston, MA,Boston University School of Medicine, Boston, MA
| | - Deepak Kumar
- Boston University, Boston, MA,Boston University School of Medicine, Boston, MA
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31
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Are there different gait profiles in patients with advanced knee osteoarthritis? A machine learning approach. Clin Biomech (Bristol, Avon) 2021; 88:105447. [PMID: 34428731 DOI: 10.1016/j.clinbiomech.2021.105447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/29/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Determine whether knee kinematics features analyzed using machine-learning algorithms can identify different gait profiles in knee OA patients. METHODS 3D gait kinematic data were recorded from 42 patients (Kellgren-Lawrence stages III and IV) walking barefoot at individual maximal gait speed (0.98 ± 0.34 m/s). Principal component analysis, self-organizing maps, and k-means were applied to the data to identify the most relevant and discriminative knee kinematic features and to identify gait profiles. FINDINGS Four different gait profiles were identified and clinically characterized as type 1: gait with the knee in excessive varus and flexion (n = 6, 14%, increased knee adduction and increased maximum and minimum knee flexion, p < 0.01); type 2: gait with knee external rotation, either in varus or valgus (n = 11, 26%, excessive maximum and minimum external rotation, p < 0.001); type 3: gait with a stiff knee (n = 17, 40%, decreased knee flexion range of motion, p < 0.001); and type 4: gait with knee varus 'thrust' and decreased rotation (n = 8, 19%, increased and reduced range of motion in the coronal and transverse plane, respectively, p < 0.05). INTERPRETATION In a group of patients with homogeneous Kellgren-Lawrence classification of knee OA, gait kinematics data permitted to identify four different gait profiles. These gait profiles can be a valuable tool for helping surgical decisions and treatment. To allow generalization, further studies should be carried with a larger and heterogeneous population.
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Hecht JT, Veerisetty AC, Wu J, Coustry F, Hossain MG, Chiu F, Gannon FH, Posey KL. Primary Osteoarthritis Early Joint Degeneration Induced by Endoplasmic Reticulum Stress Is Mitigated by Resveratrol. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1624-1637. [PMID: 34116024 DOI: 10.1016/j.ajpath.2021.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 01/11/2023]
Abstract
Increasing numbers of people are living with osteoarthritis (OA) due to aging and obesity, creating an urgent need for effective treatment and preventions. Two top risk factors for OA, age and obesity, are associated with endoplasmic reticulum (ER) stress. The I-ERS mouse, an ER stress-driven model of primary OA, was developed to study the role of ER stress in primary OA susceptibility. The I-ERS mouse has the unique ability to induce ER stress in healthy adult articular chondrocytes and cartilage, driving joint degeneration that mimics early primary OA. In this study, ER stress-induced damage occurred gradually and stimulated joint degeneration with OA characteristics including increased matrix metalloproteinase activity, inflammation, senescence, chondrocyte death, decreased proteoglycans, autophagy block, and gait dysfunction. Consistent with human OA, intense exercise hastened and increased the level of ER stress-induced joint damage. Notably, loss of a critical ER stress response protein (CHOP) largely ameliorated ER stress-stimulated OA outcomes including preserving proteoglycan content, reducing inflammation, and relieving autophagy block. Resveratrol diminished ER stress-induced joint degeneration by decreasing CHOP, TNFα, IL-1β, MMP-13, pS6, number of TUNEL-positive chondrocytes, and senescence marker p16 INK4a. The finding, that a dietary supplement can prevent ER stressed-induced joint degeneration in mice, provides a preclinical foundation to potentially develop a prevention strategy for those at high risk to develop OA.
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Affiliation(s)
- Jacqueline T Hecht
- Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas; McGovern Medical School, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Alka C Veerisetty
- Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Juliana Wu
- Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas; Department of BioSciences, Rice University, Houston, Texas
| | - Francoise Coustry
- Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Mohammad G Hossain
- Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Frankie Chiu
- Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Francis H Gannon
- Departments of Pathology & Immunology and Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Karen L Posey
- Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
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Yabas M, Orhan C, Er B, Tuzcu M, Durmus AS, Ozercan IH, Sahin N, Bhanuse P, Morde AA, Padigaru M, Sahin K. A Next Generation Formulation of Curcumin Ameliorates Experimentally Induced Osteoarthritis in Rats via Regulation of Inflammatory Mediators. Front Immunol 2021; 12:609629. [PMID: 33776996 PMCID: PMC7994281 DOI: 10.3389/fimmu.2021.609629] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Osteoarthritis (OA) is a chronic and debilitating disease of the knee joint. OA of the knee is initiated by physical damage and accumulated oxidative stress, followed by an exaggerated inflammation leading to cartilage damage. Currently, no effective and safe therapeutic option capable of restoring articular cartilage tissue and joint architecture is available. We here report a novel and highly bioavailable formulation of curcumin, labeled as Next Generation Ultrasol Curcumin (NGUC), which was 64.7 times more bioavailable than natural 95% curcumin extract as demonstrated in rat bioavailability studies. We further investigated the protective effect of NGUC against monosodium iodoacetate (MIA)‐induced knee OA in rats. Analysis of X-ray and histopathological images revealed that NGUC supplementation restored joint architecture and reduced swelling of joints induced by MIA. NGUC treatment caused a significant reduction in the levels of inflammatory mediators such as TNF-α, IL-1β, IL-6, COMP, and CRP, and expressions of MMP-3, 5-LOX, COX-2, and NFκB in synovial tissue of rats with MIA-induced OA. NGUC also decreased serum MDA level and increased the levels of antioxidant enzymes SOD, CAT, and GPX. Thus, our results indicate that a novel formulation of curcumin with enhanced bioavailability effectively ameliorates the pathophysiology of OA.
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Affiliation(s)
- Mehmet Yabas
- Department of Genetics and Bioengineering, Trakya University, Edirne, Turkey
| | - Cemal Orhan
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Besir Er
- Department of Biology, Faculty of Science, Firat University, Elazig, Turkey
| | - Mehmet Tuzcu
- Department of Biology, Faculty of Science, Firat University, Elazig, Turkey
| | - Ali Said Durmus
- Department of Surgery, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | | | - Nurhan Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Prakash Bhanuse
- Research&Development, OmniActive Health Technologies, Mumbai, India
| | | | | | - Kazim Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
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Štefan L, Kasović M, Zvonar M. Gait Speed as a Screening Tool for Foot Pain and the Risk of Falls in Community-Dwelling Older Women: A Cross-Sectional Study. Clin Interv Aging 2020; 15:1569-1574. [PMID: 32943857 PMCID: PMC7481277 DOI: 10.2147/cia.s260931] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The main purpose of the study was to establish a gait speed cut-off value to predict foot pain and the risk of falls among community-dwelling older adults. PATIENTS AND METHODS In this cross-sectional study, one-hundred and twenty White older women speaking Croatian (mean ± SD age 71.02 ± 6.78 years, height 161.77 ± 6.23 cm, weight 70.29 ± 12.97 kg, body mass index 26.79 ± 4.42 kg/m2) were recruited. The prevalence of foot pain was assessed by a single-item question and the risk of falls by the Downtown Fall Risk Index with a proposed cut-off value of "low risk" (<3 points) vs "high risk" (≥3 points) of falls. Self-selected gait speed (the independent variable) was estimated with a pressure platform (Zebris Company, Munich, Germany). RESULTS Mean gait speed was 0.95 m/s. Of the total sample, 53.30% and 33.30% reported foot pain and had higher risk of falls. For foot pain and the risk of falls, gait speed cut-off values were 0.88 m/s and 0.85 m/s (area under the curve = 0.80 and 0.83, standard error = 0.043 and 0.043, p < 0.001). Sensitivity for foot pain and the risk of falls was 66.20% and 85.90% and specificity was 84.80% and 69.00%. Slower gait speed was associated with higher prevalence of foot pain (OR = 10.92, 95% CI 4.28 to 27.89, p < 0.001) and higher risk of falls (OR = 13.59, 95% CI 5.45 to 33.87, p < 0.001). CONCLUSION Proposed gait speed values of 0.88 m/s and 0.85 m/s may be used in clinical settings to predict foot pain and the risk of falls among community-dwelling older women.
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Affiliation(s)
- Lovro Štefan
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Mario Kasović
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, Zagreb, Croatia
- Faculty of Sports Studies, Department of Sports Motorics, Masaryk University, Brno, Czech Republic
| | - Martin Zvonar
- Faculty of Sports Studies, Department of Sports Motorics, Masaryk University, Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
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Fischer AG, Erhart-Hledik JC, Asay JL, Chu CR, Andriacchi TP. Utilizing the somatosensory system via vibratory stimulation to mitigate knee pain during walking: Randomized clinical trial. Gait Posture 2020; 80:37-43. [PMID: 32485422 DOI: 10.1016/j.gaitpost.2020.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pain and proprioception deficits are often associated with knee pathologies and resultant quadriceps muscle inhibition. There is a need for new approaches to mitigate active knee pain and restore muscle function during walking. Activating properties of the somatosensory system with common pain and sensory pathways offers a novel opportunity to enhance quadriceps function during walking. RESEARCH QUESTION Conduct a controlled clinical trial that investigates the effects of applying intermittent vibrational cutaneous stimulation during walking on knee pain and symptoms and their correlations to gait parameters. METHODS This longitudinal controlled cross-over clinical study included thirty-two patients randomly and blindly assigned to active Treatment A and passive Treatment B for 4 weeks with a 2-week washout period between treatments. RESULTS Subjects when wearing active Treatment A for 4 weeks had significant (p = 0.04) improvement in patient reported outcomes, while they had no significant differences with passive Treatment B (p > 0.7) compared to the no treatment condition. For Treatment A, subjects with low knee flexion moment and knee flexion angle in no-treatment condition exhibited the greatest increase in knee flexion moment/angle in the active treatment condition (R > 0.57, p < 0.001). These changes in gait measures were correlated significantly to changes in pain. SIGNIFICANCE This clinical trial indicates that knee pain can be reduced, and gait improved in a manner that enhances quadriceps function by applying intermittent cutaneous stimulation during gait in patients following knee injury or disease. The correlation between decreased pain and improved gait suggests that rehabilitation and exercise therapy may benefit from this treatment.
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Affiliation(s)
- Arielle G Fischer
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA.
| | - Jennifer C Erhart-Hledik
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; Palo Alto Veterans Hospital, Palo Alto, CA, USA
| | - Jessica L Asay
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; Palo Alto Veterans Hospital, Palo Alto, CA, USA
| | - Constance R Chu
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; Palo Alto Veterans Hospital, Palo Alto, CA, USA
| | - Thomas P Andriacchi
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
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Krajewski KT, Dever DE, Johnson CC, Rawcliffe AJ, Ahamed NU, Flanagan SD, Mi Q, Anderst WJ, Connaboy C. Load carriage magnitude and locomotion strategy alter knee total joint moment during bipedal ambulatory tasks in recruit-aged women. J Biomech 2020; 105:109772. [PMID: 32279931 DOI: 10.1016/j.jbiomech.2020.109772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/09/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
Knee osteoarthritis (OA) is prevalent among female soldiers, resulting in limited duty and long term adverse ambulatory effects. A proposed mechanism to the development of knee OA is the assiduous execution of load carriage tasks. Soldiers are often required to maintain a walking gait with load at velocities beyond their gait transition velocity (GTV) known as forced marching. The primary aim of this investigation is to determine the interactive effects of load magnitude and locomotion pattern on relative knee total joint moment (KTJM) in healthy recruit-aged women. The secondary aims are to determine knee total joint moment limb differences and to determine the interactive effect of load magnitude and locomotion pattern on the percent contributions of each plane of motion moment. Individuals were tasked with running and forced marching at 10% above their GTV at body weight (BW) and with an additional 25% and 45% of their BW. KTJM was analyzed at two specific gait events of heel-strike and mid-stance. At heel-strike, forced marching exhibited greater KTJM compared to run for all load conditions but running had greater KTJM than forced marching at mid-stance. The forced marching pattern exhibited larger KTJM for the dominant limb at both gait events compared to running. Lastly, at mid-stance the knee adduction moment percent (KAM%) contribution was greater for forced marching compared to running. The forced marching pattern demonstrates joint kinetics that may be more deleterious with prolonged exposure. Likewise, forced marching induced KAM% similar to those already suffering from knee OA.
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Affiliation(s)
- Kellen T Krajewski
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dennis E Dever
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Camille C Johnson
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alex J Rawcliffe
- HQ Army Recruiting and Initial Training Command, Department of Occupation Medicine, Ministry of Defence, UK
| | - Nizam U Ahamed
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn D Flanagan
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qi Mi
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chris Connaboy
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.
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Andriacchi TP, Griffin TM, Loeser RF, Chu CR, Roos EM, Hawker GA, Erhart-Hledik JC, Fischer AG. Bridging Disciplines as a pathway to Finding New Solutions for Osteoarthritis a collaborative program presented at the 2019 Orthopaedic Research Society and the Osteoarthritis Research Society International. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100026. [DOI: 10.1016/j.ocarto.2020.100026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 01/18/2023] Open
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DUICA L, SZAKÁCS J, SILIȘTEANU Sînziana Călina. Study on the correlation between knee osteoarthritis and anxiety in patients aged over 55. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction. Osteoarthritis, which is a cause of chronic pain and disability with manifestation in any joint, with greater frequency in the joints of the lower limbs, upper limbs, but also at the spine level , affects around 250 million people in the entire world. This condition affects around 10% of the global population (18) and has an impressive impact on people, as it is one of the first 5 causes of disability. Material and method. The objectives of the treatment made by the patients diagnosed with knee osteoarthritis were: pain reduction, increased joint amplitude, increased muscle strength, increased muscle tone, increased quality of life and reintegration into the family and social environment. In the study, there were discussed demographic data regarding the patients. In order to assess the pain parameter, the VAS scale was used, as well as WOMAC subscales. To assess the quality of life of patients with knee osteoarthritis, the QOL scale (Quality of Life) was used. Anxiety was assessed with the help of a test that comprises the evaluation of symptoms at the cognitive, behavioral and physical level. Results and discussions. The pain was evaluated on the VAS scale, having a statistically significant evolution for the evaluation moments. Also with the help of the WOMAC index, two other parameters were evaluated, namely joint rigidity and functional capacity, the results being statistically significant in the 3 evaluation moments. The patients’ anxiety was evaluated with the help of the anxiety test; the results obtained were statistically significant at the 3 evaluation moments. Conclusions. It is vital that the recovery treatment in osteoarthritis be individualized and adapted to the age group. In our group, it enabled the reduction of pain and anxiety, the increase of the functional capacity and the quality of the patients’ lives.Taking into account the fact that the most affected group in the study group was the active professional one, we can evaluate the size of the recovery and the social, family and professional integration for these patients.
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Affiliation(s)
- Lavinia DUICA
- 1 Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, România 2 Hospital of Psychiatry „Doctor Gheorghe Preda” Sibiu, Romania
| | - Juliánna SZAKÁCS
- 3George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Faculty of Medicine, Department of Biophysics
| | - SILIȘTEANU Sînziana Călina
- 4 Railway Hospital Iasi - Specialty Ambulatory of Suceava 5 "Stefan cel Mare" University of Suceava FEFS-DSDU
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The Relationship between Knee Adduction Moment and Knee Osteoarthritis Symptoms according to Static Alignment and Pelvic Drop. BIOMED RESEARCH INTERNATIONAL 2020; 2019:7603249. [PMID: 31950053 PMCID: PMC6948304 DOI: 10.1155/2019/7603249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/31/2019] [Accepted: 10/21/2019] [Indexed: 02/05/2023]
Abstract
Objectives To investigate the relationship between external knee adduction moment (KAM) and knee osteoarthritis (OA) symptoms according to static alignment and pelvic drop. Methods Ninety-five participants with symptomatic knee OA were included. Radiographic severity was graded by Kellgren and Lawrence (KL) scale. The hip-knee-ankle (HKA) angle was used to assess limb alignment from a full-length lower-limb radiograph. KAM-related variables (peak KAM and KAM impulse) and pelvic drop angle were determined from 3D gait analysis. Symptoms were assessed via visual analog scale (VAS) for pain and hospital for special surgery (HSS) score for physical function. The relationship between KAM and symptoms was evaluated according to radiographic severity and pelvic drop using linear models. Results According to the more affected knee in the varus group, both the two KAM-related measures (peak KAM and KAM impulse) were positively associated with greater VAS pain and were negatively associated with HSS score. Only peak KAM was correlated with VAS and HSS in the valgus group. VAS pain score of the more affected knee was positively correlated with pelvic drop angle. Stratified by pelvic drop angle, KAM-related variables were more positively associated with VAS pain and negatively associated with HSS score for patients with pelvic drop angle ≤3 degrees. The relationships between KAM and symptoms according to radiographic disease severity remained confusing. Conclusions Static alignment and pelvic drop angle significantly affected relationships between KAM-related variables and knee OA symptoms, which may explain the confusing results as shown by previous studies.
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Zhang X, Deng XH, Song Z, Croen B, Carballo CB, Album Z, Zhang Y, Bhandari R, Rodeo SA. Matrix Metalloproteinase Inhibition With Doxycycline Affects the Progression of Posttraumatic Osteoarthritis After Anterior Cruciate Ligament Rupture: Evaluation in a New Nonsurgical Murine ACL Rupture Model. Am J Sports Med 2020; 48:143-152. [PMID: 31756130 DOI: 10.1177/0363546519887158] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Doxycycline has broad-spectrum activity as a matrix metalloproteinase (MMP) inhibitor and thus could reduce the progression of posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) rupture. HYPOTHESIS Doxycycline would inhibit progression of PTOA in a murine ACL rupture model. STUDY DESIGN Controlled laboratory study. METHODS For the in vitro study, cadaveric C57BL/6 male mice knees (N = 108) were used for the development of a nonsurgical ACL rupture model. For the in vivo study, 24 C57BL/6 male mice then underwent ACL rupture with our manual procedure and were divided into 4 groups: untreated control; doxycycline, 10 mg/kg/d; doxycycline, 50 mg/kg/d; and doxycycline, 100 mg/kg/d. Doxycycline was administered in drinking water beginning immediately after ACL rupture. Radiographic imaging and paw prints were evaluated at 3, 7, 14, and 28 days. The foot length and toe spread were analyzed as measures of function. Histology and MMP-13 immunohistochemistry were done at 4 weeks. RESULTS Radiographs demonstrated anterior tibial subluxation and meniscal extrusion after ACL rupture, confirming knee joint instability without fractures. Statistically significant differences in gait were found between the intact and experimental groups. Histologic examination demonstrated cartilage damage, meniscal tears, and mild osteoarthritis after ACL rupture, similar to what occurs in human patients. Hypertrophy of the posterior horn of the medial and lateral meniscus was found, and tears of the posterior horn of the menisci were common. All doxycycline groups had a lower score than the untreated control group, indicating less cartilage damage. The posterior tibia of the untreated group had the most cartilage damage as compared with the 3 doxycycline groups, with a significant difference between the untreated and 50-mg/kg/d doxycycline groups, suggesting that the latter dose may protect against proteoglycan loss and decrease the progression of osteoarthritis. The nondoxycycline group had the highest synovial inflammation score among all groups, indicating that doxycycline has an inhibitory effect on synovitis. There was significantly lower MMP-13 expression on the tibia in the doxycycline-treated groups, with a positive correlation between doxycycline concentration and MMP-13 inhibition. CONCLUSION Modulation of MMP-13 activity by doxycycline treatment may offer a novel biological pathway to decrease the progression of PTOA after ACL rupture. CLINICAL RELEVANCE Doxycycline is an approved, readily available drug with infrequent side effects of photosensitivity and gastrointestinal symptoms. Future clinical trials could evaluate doxycycline to reduce or prevent progressive cartilage damage after ACL rupture.
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Affiliation(s)
- Xueying Zhang
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA.,Department of Sports Medicine & Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang-Hua Deng
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Zhe Song
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Brett Croen
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Camila B Carballo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Zoe Album
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Ying Zhang
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Reyna Bhandari
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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Ogawa EF, Shi L, Bean JF, Hausdorff JM, Dong Z, Manor B, McLean RR, Leveille SG. Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II. Arch Phys Med Rehabil 2019; 101:418-425. [PMID: 31634443 DOI: 10.1016/j.apmr.2019.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults. DESIGN A cross-sectional study of a population-based cohort of older adults. SETTING Urban and suburban communities in a large metropolitan area. PARTICIPANTS Community-living participants (N=302) 70 years and older recruited from a previous population-based cohort. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gait parameters including gait speed, stride length, double support and swing characteristics, and variability were assessed under single- and dual-task conditions involving cognitive challenges (eg, counting backward). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures. RESULTS Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, body mass index, medication, and vision. Decrements in gait measures related to pain were comparable with decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention. CONCLUSIONS These findings suggest that chronic pain contributes to decrements in gait, including slower gait speed, and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.
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Affiliation(s)
- Elisa F Ogawa
- New England GRECC, VA Boston Healthcare System, Boston, Massachusetts
| | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Jonathan F Bean
- New England GRECC, VA Boston Healthcare System, Boston, Massachusetts; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Zhiyong Dong
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Brad Manor
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Robert R McLean
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Flaxman TE, Shourijeh MS, Alkjær T, Krogsgaard MR, Simonsen EB, Bigham H, Benoit DL. Experimental muscle pain of the vastus medialis reduces knee joint extensor torque and alters quadriceps muscle contributions as revealed through musculoskeletal modeling. Clin Biomech (Bristol, Avon) 2019; 67:27-33. [PMID: 31071535 DOI: 10.1016/j.clinbiomech.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/28/2019] [Accepted: 04/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Voluntary activation deficit of the quadriceps muscle group is a common symptom in populations with knee joint injury. Musculoskeletal modeling and simulations can improve our understanding of pathological conditions; however, they are mathematically complex which can limit their clinical application. A practical subject-specific modeling framework is introduced to evaluate knee extensor inhibition and muscle force contributions to isometric knee joint torques in healthy adults with and without experimentally induced quadriceps muscle pain. METHODS A randomized cross-over placebo controlled study design was used. Subject-specific maximum knee joint extension torque and quadriceps electromyographic data from 13 uninjured young adults were combined in a modeling framework to determine optimal muscle strength scaling parameters and ideal torque. Strength deficit ratios (experimental torque/ideal torque) and individual muscle contribution to experimental torque was computed before and after intramuscular hypertonic (pain inducing) and isotonic (sham) saline was injected to the vastus medialis. FINDINGS Decreased experimental knee extension torque (-8%) and vastus medialis electromyography (-26%) amplitude pre- to post- hypertonic injection was observed. Correspondingly, significant decreases in the knee extensor strength deficit ratio (-18%) and percent contribution of vastus medialis to experimental torque (-24%) was observed pre- to post- hypertonic injection. No differences were observed with isotonic injections, confirming the validity of the model. INTERPRETATION Our practical method to estimate strength ratios can be easily implemented within a musculoskeletal modeling framework to improve the validity of model estimates. This, in turn, can increase our understanding of the relationship between neuromuscular deficits and functional outcomes in patient populations.
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Affiliation(s)
- Teresa E Flaxman
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada.
| | - Mohammad S Shourijeh
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada.
| | - Tine Alkjær
- Department of Neuroscience and Pharmacology, University of Copenhagen, Blegdamsvaj 3B, DK-2200 Copenhagen N, Denmark.
| | - Michael R Krogsgaard
- Section for Sportstraumatology, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark.
| | - Erik B Simonsen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Blegdamsvaj 3B, DK-2200 Copenhagen N, Denmark.
| | - Heather Bigham
- School of Human Kinetics, University of Ottawa, 125 University Pr, Ottawa, ON K1N 1A2, Canada.
| | - Daniel L Benoit
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada; School of Human Kinetics, University of Ottawa, 125 University Pr, Ottawa, ON K1N 1A2, Canada.
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A parametric study of effect of experimental tibialis posterior muscle pain on joint loading and muscle forces-Implications for patients with rheumatoid arthritis? Gait Posture 2019; 72:102-108. [PMID: 31185371 DOI: 10.1016/j.gaitpost.2019.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Foot pain and deformities are commonly encountered in patients with rheumatoid arthritis (RA). Likewise, Posterior tibial tendon dysfunction (PTTD) is commonly involved in development of foot and ankle abnormalities and has been reported with a prevalence in two-thirds of the RA patients. RESEARCH QUESTION Redundancy in the physiological function between different muscles provides the central nervous system multiple options to perform the same movement but which muscles compensate for the impairment of the tibialis posterior (TP) muscle? And how does these changes affect ankle joint loading? METHODS Experimental and computational disciplines were applied to investigate changes in muscle forces as result of induced pain in the right TP muscle. Twelve healthy subjects were enrolled in the study. Experimental pain was induced in the TP by a single ultrasound graphically guided injection of 1 mL hypertonic saline (5.0% Sodium Chloride). The participants' gait was assessed by skin marker-based motion capture and force plates. Musculoskeletal models were used to investigate compensation mechanisms systematically in the lower under extremity when TP muscle was recruited less as a consequence of the induced pain. RESULTS Experimental TP muscle pain and simulated reduced strength caused altered muscle recruitment and made the flexor digitorum longus and flexor hallucis longus muscles compensated for the impairment of the TP muscle. Further, the resultant ankle joint force was increased as the strength of the TP muscle was reduced. SIGNIFICANCE The compensation mechanism observed in the present study indicate that alterations in muscle recruitment and muscle force distribution as a result of the underlying disease inflammation itself may contribute to development of chronic foot pain and deformities in patients with RA. Further studies are required to understand the role of PTTD in occurrence of those late adverse musculoskeletal manifestations aiming at search for early preventive strategies.
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Simonsen MB, Yurtsever A, Næsborg-Andersen K, Leutscher PDC, Hørslev-Petersen K, Andersen MS, Hirata RP. Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics. Hum Mov Sci 2019; 66:98-108. [PMID: 30981150 DOI: 10.1016/j.humov.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/14/2019] [Accepted: 04/05/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Tibialis posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of tibialis posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental tibialis posterior muscle pain on gait mechanics in healthy subjects. METHODS Twelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right tibialis posterior muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale. FINDINGS Decreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation. INTERPRETATION The study has demonstrated that induced pain in the TP muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of tibialis posterior dysfunction.
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Affiliation(s)
- Morten Bilde Simonsen
- Center for Sensory-Motoric Interaction (SMI®), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, DK-9220 Aalborg East, Denmark; Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark
| | - Aysun Yurtsever
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark; Department of Rheumatology, Hjørring Hospital, Bispensgade 37, DK-9800 Hjørrring, Denmark
| | - Ketill Næsborg-Andersen
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark
| | - Peter Derek Christian Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Denmark
| | - Kim Hørslev-Petersen
- King Christian 10th Hospital for Rheumatic Diseases, University of Southern Denmark, Toldbodgade 3, DK-6300 Gråsten, Denmark
| | - Michael Skipper Andersen
- Department of Materials and Production, Aalborg University, Fibigerstraede 16, DK-9220 Aalborg East, Denmark
| | - Rogerio Pessoto Hirata
- Center for Sensory-Motoric Interaction (SMI®), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, DK-9220 Aalborg East, Denmark.
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Rabago D, Kansariwala I, Marshall D, Nourani B, Stiffler-Joachim M, Heiderscheit B. Dextrose Prolotherapy for Symptomatic Knee Osteoarthritis: Feasibility, Acceptability, and Patient-Oriented Outcomes in a Pilot-Level Quality Improvement Project. J Altern Complement Med 2019; 25:406-412. [PMID: 30688517 DOI: 10.1089/acm.2018.0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- David Rabago
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ina Kansariwala
- University of Wisconsin School of Medicine and Public Health Madison, WI
| | - David Marshall
- University of Wisconsin School of Medicine and Public Health Madison, WI
| | - Bobby Nourani
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mikel Stiffler-Joachim
- UW Neuromuscular Biomechanics Laboratory, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bryan Heiderscheit
- UW Neuromuscular Biomechanics Laboratory, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Ankle Joint and Rearfoot Biomechanics During Toe-In and Toe-Out Walking in People With Medial Compartment Knee Osteoarthritis. PM R 2019; 11:503-511. [PMID: 30195708 DOI: 10.1016/j.pmrj.2018.08.388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/25/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Toe-in and toe-out walking are 2 strategies that have been shown to be effective in reducing the knee adduction moment in people with knee osteoarthritis. However, despite a positive biomechanical impact on the knee, altering foot rotation may impart unintended forces or joint positions on the ankle that could impact joint health. The kinematic and kinetic changes at the ankle during toe-in or toe-out walking have yet to be examined. OBJECTIVE To examine ankle/rearfoot biomechanics during toe-in and toe-out walking in those with knee osteoarthritis. DESIGN Single-session repeated measures design to compare ankle biomechanics during walking with 4 different foot rotations. SETTING University motion analysis laboratory. PARTICIPANTS A convenience sample (N = 15) of males and females with a diagnosis of medial knee osteoarthritis confirmed by radiographs. METHODS Participants walked in 4 conditions guided by real-time biofeedback: (1) toe-in (+10°), (2) zero rotation (0°), (3) toe-out (-10°), and (4) toe-out (-20°). Ankle and rearfoot kinematics and kinetics were examined during barefoot over-ground walking. MAIN OUTCOME MEASURES Ankle joint angles, moments, moment impulses, and foot rotation. RESULTS Overall, toe-in compared to toe-out walking decreased (P = .03) peak rearfoot eversion (toe-in = -1.6°; 10° toe-out = -3.7°; 20° toe-out = -4.1°). Toe-in compared to toe-out walking also increased rearfoot inversion at initial contact (7.4° vs 3.1° at 10° toe-out and 1.9° at 20° toe-out; P < .001) and frontal plane rearfoot angle excursion (9.0° vs 6.8° at 10° toe-out and 6.0° at 20° toe-out; P < .006). Toe-in compared to all other conditions increased peak external ankle inversion moments (0.04 Nm/kg vs 0.02 Nm/kg at 0°, 0.02 Nm/kg at 10° toe-out, and 0.01 Nm/kg at 20° toe-out; P < .003). CONCLUSIONS Toe-in and toe-out walking require different ankle/rearfoot biomechanics, though no differences in discomfort were observed. Longer-term studies are required to properly assess these relationships in knee osteoarthritis populations. LEVEL OF EVIDENCE IV.
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Effects of Knee Osteoarthritis on Hip and Ankle Gait Mechanics. Adv Orthop 2019; 2019:9757369. [PMID: 31019809 PMCID: PMC6451827 DOI: 10.1155/2019/9757369] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/12/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Knee osteoarthritis (OA) can affect the hip and ankle joints, as these three joints operate as a kinetic/kinematic chain while walking. Purpose This study was performed to compare (1) hip and ankle joint gait mechanics between knee OA and control groups and (2) to investigate the effects of knee gait mechanics on the ipsilateral hip and ankle joint. Methods The study group included 89 patients with end-stage knee OA and 42 age- and sex-matched controls without knee pain or OA. Kinetic and kinematic parameters were evaluated using a commercial optoelectric gait analysis system. Range of motion (ROM) during gait, coronal motion arc, and peak joint moment of hip, knee, and ankle joints were investigated. Results Ankle varus moment was 50% higher in the OA group (p=0.005) and was associated with higher knee adduction moment (p<0.001). The ROM of the hip and ankle joints were significantly smaller in the OA group and were associated with limited ROM of the knee joint (both p<0.001). The coronal motion arc of the hip was smaller in the OA group and was also associated with limited motion arc of the knee (p<0.001). Conclusions Knee OA has a negative effect on the ROM, coronal motion arc, and joint moment of the ankle joint and hip joint. As knee OA is associated with increased moment of the ankle joint, attention should be paid to the ankle joint when treating patients with knee OA.
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Boyer KA, Hafer JF. Gait mechanics contribute to exercise induced pain flares in knee osteoarthritis. BMC Musculoskelet Disord 2019; 20:107. [PMID: 30871519 PMCID: PMC6419357 DOI: 10.1186/s12891-019-2493-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/05/2019] [Indexed: 01/05/2023] Open
Abstract
Background Exercise-induced pain flares represent a significant barrier for individuals with knee osteoarthritis to meet physical activity recommendations. There is a need to understand factors that contribute to pain flares and the potential for the motor system to adapt and reduce joint loading should a flare occur. The study aim was to examine the impact of a bout of exercise on self-reported pain, walking mechanics and muscle co-contraction for participants with knee osteoarthritis. Methods Thirty-six adults (17 healthy older and 19 knee osteoarthritis) participated in this study. Self-reported pain, joint mechanics and muscle co-activation during gait at two self-selected speeds were collected before and after a 20-min preferred pace treadmill walk (20MTW). Results Eight of nineteen osteoarthritis participants had a clinically significant pain flare response to the 20MTW. At baseline the participants that did not experience a pain flare had smaller knee flexion and total reaction moments compared to both the participants with pain flares (p = 0.02; p = 0.05) and controls (p < 0.001; p < 0.001). In addition, the 2nd peak knee adduction (p = 0.01) and internal rotation (p = 0.001) moments were smaller in the no flares as compared to controls. The pain flare participants differed from controls with smaller knee internal rotation moments (p = 0.03), but greater relative hamstrings (vs. quadriceps) and medial (vs. lateral) muscle activation (p = 0.04, p = 0.04) compared to both controls and no flare participants (p = 0.04, p = 0.007). Following the 20MTW there were greater decreases in the 1st and 2nd peak knee adduction (p = 0.03; p = 0.02), and internal rotation (p = 0.002) moments for the pain flare as compared to the no flare group. In addition, for the pain flare as compared to controls, greater decreases in the knee flexion (p = 0.03) and internal rotation (p = 0.005) moments were found. Conclusions Individuals who adapt their gait to reduce knee joint loads may be less susceptible to exercise-induced pain flares. This highlights a potential role of gait biomechanics in short-term osteoarthritis pain fluctuations. The results also suggest that despite the chronic nature of osteoarthritis pain, the motor system’s ability to respond to nociceptive stimuli remains intact. Electronic supplementary material The online version of this article (10.1186/s12891-019-2493-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine A Boyer
- Department of Kinesiology, University of Massachusetts-Amherst, 110 Totman Building 30 Eastman Lane, Amherst, MA, 01003, USA. .,University of Massachusetts-Amherst, Mechanical and Industrial Engineering, Amherst, USA. .,Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, USA.
| | - Jocelyn F Hafer
- Department of Kinesiology, University of Massachusetts-Amherst, 110 Totman Building 30 Eastman Lane, Amherst, MA, 01003, USA.,School of Kinesiology, University of Michigan, Central Campus Recreation Building, 401 Washtenaw Avenue, Ann Arbor, MI, 48109, USA
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Iijima H, Shimoura K, Ono T, Aoyama T, Takahashi M. Proximal gait adaptations in individuals with knee osteoarthritis: A systematic review and meta-analysis. J Biomech 2019; 87:127-141. [PMID: 30904334 DOI: 10.1016/j.jbiomech.2019.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/23/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
Clarifying proximal gait adaptations as a strategy to reduce knee joint loading and pain for individuals with knee osteoarthritis (OA) contributes to understanding the pathogenesis of multi-articular OA changes and musculoskeletal pain in other joints. We aimed to determine whether biomechanical alterations in knee OA patients during level walking is increased upper trunk lean in the frontal and sagittal planes, and subsequent alteration in external hip adduction moment (EHAM) and external hip flexion moment (EHFM). A literature search was conducted in PubMed, PEDro, CINAHL, and Cochrane CENTRAL through May 2018. Where possible, data were combined into a meta-analysis; pooled standardized mean differences (SMD) of between knee OA patients and healthy adults were calculated using a random-effect model. In total, 32 articles (2037 participants, mean age, 63.0 years) met inclusion criteria. Individuals with knee OA had significantly increased lateral trunk lean toward the ipsilateral limb (pooled SMD: 1.18; 95% CI: 0.59, 1.77) along with significantly decreased EHAM. These subjects also displayed a non-significantly increased trunk/pelvic flexion angle and EHFM. The GRADE approach judged all measures as "very low." These results may indicate that biomechanical alterations accompanying knee OA are associated with increased lateral trunk lean and ensuing alterations in EHAM. Biomechanical alterations in the sagittal plane were not evident. Biomechanical adaptations might have negative sequelae, such as secondary hip abductor muscle weakness and low back pain. Thus, investigations of negative sequelae due to proximal gait adaptations are warranted.
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Affiliation(s)
- Hirotaka Iijima
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan; Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Kanako Shimoura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Tomoko Ono
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Yokohama, Japan.
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Masaki Takahashi
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan.
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