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Shakouri A, Kamali F, Mohamadi M, Nouhi E. Lumbopelvic manipulation alone versus combined with dry needling in physically active patients with patellofemoral pain syndrome: A randomized clinical trial. J Bodyw Mov Ther 2024; 37:220-225. [PMID: 38432809 DOI: 10.1016/j.jbmt.2023.11.024] [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: 04/23/2023] [Revised: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Patellofemoral pain syndrome (PFPS) is prevalent in physically active people. The multifactorial nature of PFPS necessitates multimodal treatment for this condition. The present study aimed to compare the efficacy of lumbopelvic manipulation alone versus manipulation plus dry needling in physically active patients with PFPS. METHOD Thirty patients (18 women and 12 men) with a diagnosis of PFPS entered this randomized controlled clinical trial and were divided into two groups: lumbopelvic manipulation alone or lumbopelvic manipulation plus dry needling. The interventions were applied for 3 sessions every other day. Dry needling was performed on the quadratus lumborum and gluteus medius muscles. Pain intensity, Kujala score and side-plank time were recorded at baseline, post-intervention and 1 month after the intervention. RESULTS The results of Friedman's test showed statistically significant differences in pain and function in participants during the study period, and post hoc tests revealed differences between the two groups in behavior of the marginal means (p < 0.001). CONCLUSION The use of lumbopelvic manipulation plus dry needling in the quadratus lumborum and gluteus medius muscles may be more effective than manipulation alone in alleviating pain and promoting function in physically active patients with PFPS.
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Affiliation(s)
- Amin Shakouri
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran; Physiotherapy, National University of Medical Science Spain, Spain.
| | - Fahime Kamali
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
| | - Marzieh Mohamadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
| | - Esmat Nouhi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
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Gerbrands TA, Pisters MF, Verschueren S, Vanwanseele B. Determining the optimal gait modification strategy for patients with knee osteoarthritis: Trunk lean or medial thrust? Gait Posture 2023; 102:1-9. [PMID: 36870264 DOI: 10.1016/j.gaitpost.2023.02.017] [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: 10/26/2022] [Revised: 01/25/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The gait modification strategies Trunk Lean and Medial Thrust have been shown to reduce the external knee adduction moment (EKAM) in patients with knee osteoarthritis which could contribute to reduced progression of the disease. Which strategy is most optimal differs between individuals, but the underlying mechanism that causes this remains unknown. RESEARCH QUESTION Which gait parameters determine the optimal gait modification strategy for individual patients with knee osteoarthritis? METHODS Forty-seven participants with symptomatic medial knee osteoarthritis underwent 3-dimensional motion analysis during comfortable gait and with two gait modification strategies: Medial Thrust and Trunk Lean. Kinematic and kinetic variables were calculated. Participants were then categorized into one of the two subgroups, based on the modification strategy that reduced the EKAM the most for them. Multiple logistic regression analysis with backward elimination was used to investigate the predictive nature of dynamic parameters obtained during comfortable walking on the optimal modification gait strategy. RESULTS For 68.1 % of the participants, Trunk Lean was the optimal strategy in reducing the EKAM. Baseline characteristics, kinematics and kinetics did not differ significantly between subgroups during comfortable walking. Changes to frontal trunk and tibia angles correlated significantly with EKAM reduction during the Trunk Lean and Medial Thrust strategies, respectively. Regression analysis showed that MT is likely optimal when the frontal tibia angle range of motion and peak knee flexion angle in early stance during comfortable walking are high (R2Nagelkerke = 0.12). SIGNIFICANCE Our regression model based solely on kinematic parameters from comfortable walking contained characteristics of the frontal tibia angle and knee flexion angle. As the model explains only 12.3 % of variance, clinical application does not seem feasible. Direct assessment of kinetics seems to be the most optimal strategy for selecting the most optimal gait modification strategy for individual patients with knee osteoarthritis.
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Affiliation(s)
- T A Gerbrands
- Fontys Allied Health Professions, Fontys University of Applied Sciences, Eindhoven, the Netherlands; Human Movement Biomechanics Research Group, Department of Kinesiology, KU Leuven, Belgium.
| | - M F Pisters
- Fontys Allied Health Professions, Fontys University of Applied Sciences, Eindhoven, the Netherlands; Physical Therapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands
| | - S Verschueren
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - B Vanwanseele
- Fontys Allied Health Professions, Fontys University of Applied Sciences, Eindhoven, the Netherlands; Human Movement Biomechanics Research Group, Department of Kinesiology, KU Leuven, Belgium
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Concurrent validation of inertial sensors for measurement of knee kinematics in individuals with knee osteoarthritis: A technical report. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00616-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Knee loading in OA subjects is correlated to flexion and adduction moments and to contact point locations. Sci Rep 2021; 11:8594. [PMID: 33883591 PMCID: PMC8060429 DOI: 10.1038/s41598-021-87978-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
This study evaluated the association of contact point locations with the knee medial and lateral contact force (Fmed, Flat) alterations in OA and healthy subjects. A musculoskeletal model of the lower limb with subject-specific tibiofemoral contact point trajectories was used to estimate the Fmed and Flat in ten healthy and twelve OA subjects during treadmill gait. Regression analyses were performed to evaluate the correlation of the contact point locations, knee adduction moment (KAM), knee flexion moment (KFM), frontal plane alignment, and gait speed with the Fmed and Flat. Medial contact point locations in the medial–lateral direction showed a poor correlation with the Fmed in OA (R2 = 0.13, p = 0.01) and healthy (R2 = 0.24, p = 0.001) subjects. Anterior–posterior location of the contact points also showed a poor correlation with the Fmed of OA subjects (R2 = 0.32, p < 0.001). Across all subjects, KAM and KFM remained the best predictors of the Fmed and Flat, respectively (R2 between 0.62 and 0.69). Results suggest different mechanisms of contact force distribution in OA joints. The variations in the location of the contact points participate partially to explains the Fmed variations in OA subjects together with the KFM and KAM.
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Tsurumiya K, Hayasaka W, Komatsu A, Tsukamoto H, Suda T, Iwami T, Shimada Y. Quantitative Evaluation Related to Disease Progression in Knee Osteoarthritis Patients During Gait. ADVANCED BIOMEDICAL ENGINEERING 2021. [DOI: 10.14326/abe.10.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kiyoshi Tsurumiya
- Graduate School of Engineering Science, Akita University, Akita, Japan
| | - Wataru Hayasaka
- Graduate School of Engineering Science, Akita University, Akita, Japan
| | - Akira Komatsu
- National Institute of Technology, Sendai College, Miyagi, Japan
| | | | - Tomohiro Suda
- Department of Rehabilitation Medicine, Akita University Hospital Akita, Japan
| | - Takehiro Iwami
- Graduate School of Engineering Science, Akita University, Akita, Japan
| | - Yoichi Shimada
- Graduate School of Medicine, Akita University, Akita, Japan
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Zerpa C, Sadhu A, Zammali MK, Varga K. Evaluation of spring-loaded cane ground reaction forces during walking using time and frequency domain analysis. J Med Eng Technol 2019; 42:628-638. [PMID: 30932715 DOI: 10.1080/03091902.2019.1595761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study examined the effect of a spring-loaded cane stiffness reduction on upper and lower extremity ground reaction forces in time and frequency domain during cane-aided walking. Twenty-nine participants walked five times over two force plates with a spring-loaded cane set at four different stiffnesses and T-scope knee brace set at 30° of knee flexion to simulate a foot injury. Time-frequency domain analyses revealed an increase in ground reaction forces at the simulated injured foot and a decrease in ground reaction forces at the hand via the shaft of the cane for each spring loaded-cane stiffness reduction during walking. The results build on existing literature and highlight the use of spring-loaded canes, braking and propulsive ground reaction force measures, and frequency domain analysis to more accurately assess and monitor the rehabilitation and prevention of upper and lower extremity injuries during cane-aided walking.
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Affiliation(s)
- Carlos Zerpa
- a School of Kinesiology , Lakehead University , Thunder Bay , ON , Canada
| | - Ayan Sadhu
- b Department of Civil and Environmental Engineering , Western University , London , ON , Canada
| | | | - Katelyn Varga
- d School of Kinesiology , Lakehead University , Thunder Bay , ON , Canada
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Younger Total Knee Replacement Patients Do Not Demonstrate Gait Asymmetry for Heel Strike Transient or Knee Joint Moments That Are Observed in Older Patients. J Appl Biomech 2019; 35:140-148. [PMID: 30526192 DOI: 10.1123/jab.2018-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gait asymmetry is observed after total knee replacement, often leading to excessive forces at the contralateral limb. The number of total knee replacement procedures has increased substantially over the past 2 decades, particularly among younger patients. Relatively little is known regarding these younger patients (<65 y), specifically, with respect to gait asymmetry. The purpose of this study was to investigate if age affects gait asymmetry after unilateral total knee replacement. Three-dimensional analysis of 10 walking trials was collected from the following 4 groups: younger patient (age: 54.3 [7.9] y), younger control (age: 55.2 [4.0] y), older patient (age: 76.9 [4.7] y), and older control (age: 77.7 [4.1] y). The older patients, but not any of the other groups, demonstrated a significantly larger heel strike transient and peak knee adduction moment at the nonsurgical compared with the surgical limb. The observed gait pattern of the younger patients resembled that of the younger controls, rather than the older patients. The greater loading of the nonsurgical limb for the older patients could contribute to the initiation or further progression of osteoarthritic degeneration in the contralateral knee; these asymmetries were not observed for the younger patients.
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Silva FR, Muniz AMDS, Cerqueira LS, Nadal J. Biomechanical alterations of gait on overweight subjects. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/2446-4740.180017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Liu D, Li Y, Cai G, Jia D, Mao J, Meng X, Wang G, He C. [Short-term effectiveness of total knee arthroplasty assisted by three-dimensional printing osteotomy navigation template]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:899-905. [PMID: 30129315 DOI: 10.7507/1002-1892.201802013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the short-term effectiveness of total knee arthroplasty (TKA) assisted by three-dimensional (3D) printing osteotomy navigation template. Methods A retrospective study was performed on 60 patients with osteoarthritis bewteen January 2016 and June 2017. Thirty cases underwent TKA assisted by 3D printing osteotomy navigation template (3D printing group) and 30 cases underwent the conventional TKA (conventional TKA group). There was no significant difference in gender, age, body mass index, surgical side, and disease duration between 2 groups ( P>0.05). The operation time, the pre- and post-operative hemoglobin values, the amount of drainage, the Hospital for Special Surgery (HSS) score and Knee Society Score (KSS) of knee joint before operation and at 3 months after operation were observed. And 6 freedom degrees of knee (the varus and valgus angle, the internal and external rotation angle, the antero-posterior displacement, the proximal-distal displacement, the flexion and extension angle, and the internal and external displacement) before operation and at 3 months after operation were recorded by Opti-Knee (the knee 3D motion analysis system). The values of 2 groups were compared with 30 healthy adults (<60 years). Results The operation time was shorter in 3D printing group than that in conventional TKA group ( t=5.833, P=0.000). The hemoglobin values at 1 and 3 days after operation were higher in 3D printing group than those in conventional TKA group ( P<0.05). The amount of drainage was less in 3D printing group than that in conventional TKA group ( t=5.468, P=0.000). All patients were followed up 6-9 months (mean, 7.3 months). There was no significant difference in pre- and post-operative HSS score and KSS clinical score between 2 groups ( P>0.05). There was no significant difference in preoperative KSS function score between 2 groups ( P>0.05), but the KSS function score of 3D printing group at 3 months after operation was higher than that of conventional TKA group ( P<0.05). Before operation, the varus and valgus angle, the internal and external rotation angle, the antero-posterior displacement, the proximal-distal displacement of 3D printing group and conventional TKA group were larger than that of the healthy adults ( P<0.05); there was no significant difference in the flexion and extension angle and the internal and external displacement between 2 groups and healthy adults ( P>0.05). At 3 months after operation, compared with healthy adults, the varus and valgus angle of conventional TKA group was increased, the flexion and extension angle of conventional TKA group was decreased ( P<0.05); the proximal-distal displacement and the internal and external displacement of 2 groups were decreased ( P<0.05); there was no significant difference in other freedom degrees between groups ( P>0.05). No sign of prosthesis loosening was observed by X-ray examination. Conclusion Compared with the traditional TKA, TKA assisted by the 3D printing osteotomy navigation template had such advantages as shorter operation time, less postoperative blood loss, and well postoperative recovery.
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Affiliation(s)
- Dejian Liu
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Yanlin Li
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032,
| | - Guofeng Cai
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Di Jia
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Jianyu Mao
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Xuhan Meng
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Guoliang Wang
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Chuan He
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
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Jacobs BY, Lakes EH, Reiter AJ, Lake SP, Ham TR, Leipzig ND, Porvasnik SL, Schmidt CE, Wachs RA, Allen KD. The Open Source GAITOR Suite for Rodent Gait Analysis. Sci Rep 2018; 8:9797. [PMID: 29955094 PMCID: PMC6023937 DOI: 10.1038/s41598-018-28134-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/14/2018] [Indexed: 11/24/2022] Open
Abstract
Locomotive changes are often associated with disease or injury, and these changes can be quantified through gait analysis. Gait analysis has been applied to preclinical studies, providing quantitative behavioural assessment with a reasonable clinical analogue. However, available gait analysis technology for small animals is somewhat limited. Furthermore, technological and analytical challenges can limit the effectiveness of preclinical gait analysis. The Gait Analysis Instrumentation and Technology Optimized for Rodents (GAITOR) Suite is designed to increase the accessibility of preclinical gait analysis to researchers, facilitating hardware and software customization for broad applications. Here, the GAITOR Suite’s utility is demonstrated in 4 models: a monoiodoacetate (MIA) injection model of joint pain, a sciatic nerve injury model, an elbow joint contracture model, and a spinal cord injury model. The GAITOR Suite identified unique compensatory gait patterns in each model, demonstrating the software’s utility for detecting gait changes in rodent models of highly disparate injuries and diseases. Robust gait analysis may improve preclinical model selection, disease sequelae assessment, and evaluation of potential therapeutics. Our group has provided the GAITOR Suite as an open resource to the research community at www.GAITOR.org, aiming to promote and improve the implementation of gait analysis in preclinical rodent models.
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Affiliation(s)
- Brittany Y Jacobs
- University of Florida, J. Crayton Pruitt Family Department of Biomedical Engineering, Gainesville, 32611, USA
| | - Emily H Lakes
- University of Florida, J. Crayton Pruitt Family Department of Biomedical Engineering, Gainesville, 32611, USA
| | - Alex J Reiter
- Washington University in St. Louis, School of Engineering and Applied Science, St. Louis, 63130, USA
| | - Spencer P Lake
- Washington University in St. Louis, School of Engineering and Applied Science, St. Louis, 63130, USA
| | - Trevor R Ham
- University of Akron, Chemical and Biomolecular Engineering, Akron, 44325, USA
| | - Nic D Leipzig
- University of Akron, Chemical and Biomolecular Engineering, Akron, 44325, USA
| | - Stacy L Porvasnik
- University of Florida, J. Crayton Pruitt Family Department of Biomedical Engineering, Gainesville, 32611, USA
| | - Christine E Schmidt
- University of Florida, J. Crayton Pruitt Family Department of Biomedical Engineering, Gainesville, 32611, USA
| | - Rebecca A Wachs
- University of Florida, J. Crayton Pruitt Family Department of Biomedical Engineering, Gainesville, 32611, USA.,University of Nebraska-Lincoln, Biological Systems Engineering, Lincoln, 68588, USA
| | - Kyle D Allen
- University of Florida, J. Crayton Pruitt Family Department of Biomedical Engineering, Gainesville, 32611, USA.
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Stickley CD, Presuto MM, Radzak KN, Bourbeau CM, Hetzler RK. Dynamic Varus and the Development of Iliotibial Band Syndrome. J Athl Train 2018; 53:128-134. [PMID: 29373059 DOI: 10.4085/1062-6050-122-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Although the risk of osteoarthritis development after acute knee injury has been widely studied, the long-term consequences of knee overuse injury are not well understood. OBJECTIVE To identify the relationship between gait-related risk factors associated with osteoarthritis and the development of iliotibial band syndrome (ITBS) in members of a single University Army Reserve Officers' Training Corps unit. DESIGN Prospective cohort study. SETTING Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS Sixty-eight cadets undergoing standardized physical fitness training. INTERVENTION(S) Three-dimensional lower extremity kinematics (240 Hz) and kinetics (960 Hz) were collected for 3 bilateral trials during shod running at 4.0 m/s ± 10%. Injury tracking was conducted for 7 months of training. MAIN OUTCOME MEASURE(S) Biomechanical variables, including varus thrust and knee-adduction moment, were compared between the injured and control groups. RESULTS Twenty-six cadets with no history of overuse injury served as the control group, whereas 6 cadets (7 limbs) who developed ITBS that required them to modify their training program or seek medical care (or both) served as the injured group. Maximum varus velocity was higher ( P = .006) and occurred sooner during stance ( P = .04) in the injured group than in the control group, indicating greater varus thrust. Maximum knee-varus angle and maximum knee-adduction moment were higher ( P = .02 and P = .002, respectively) and vertical stiffness was lower ( P = .03) in the injured group. CONCLUSIONS Measures of dynamic varus stability appeared to be altered in individuals who developed ITBS. Biomechanical knee variables previously identified as increasing the risk for knee osteoarthritis were also associated with the development of ITBS in healthy adults.
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Affiliation(s)
- Christopher D Stickley
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu
| | - Melanie M Presuto
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu.,United States Air Force Academy, Colorado Springs, CO
| | - Kara N Radzak
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu.,University of Nevada, Las Vegas
| | - Christina M Bourbeau
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu.,Vail Summit Orthopaedics, CO
| | - Ronald K Hetzler
- Biomechanics & Gait Laboratory, Department of Kinesiology and Rehabilitation Science, University of Hawai'i-Manoa, Honolulu
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Fox AS, Bonacci J, McLean SG, Saunders N. Exploring individual adaptations to an anterior cruciate ligament injury prevention programme. Knee 2018; 25:83-98. [PMID: 29329889 DOI: 10.1016/j.knee.2017.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individual responses to anterior cruciate ligament injury prevention programmes (ACL IPPs) have received little attention. This study examined the effects of an ACL IPP on neuromuscular control and lower limb biomechanics during landing at the group and individual levels. METHODS Sixteen female athletes were randomly allocated to training (n=8) or control (n=8) groups. Electromyography, and three-dimensional kinematic and kinetic data were collected during landing at two testing sessions. Repeated measures ANOVA and effect sizes (Cohen's d) examined the effect of the IPP at the group and individual levels. A sub-group analysis comparing the effect of the IPP on 'high-' (i.e. large peak knee abduction moment at baseline) versus 'low-risk' individuals was also conducted. RESULTS At the group level; the IPP increased activation of the medial hamstrings prior to landing (p<0.001; d=0.264) and the medial gastrocnemius at landing (p<0.001; d=0.426), and increased hip external rotation early after initial contact (p<0.001; d=0.476). Variable adaptations were seen across individuals within the training group for all variables (p<0.001). The IPP had a large effect in reducing frontal plane knee moments for 'high-risk' individuals (d>0.91), however these results did not reach statistical significance (p>0.05). CONCLUSIONS The IPP induced adaptations during landing, however, individual data revealed dissimilar responses to the programme. Individuals displaying a pre-existing high-risk strategy may incur greater benefits from IPPs, yet only if the programme targets the relevant high-risk strategy.
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Affiliation(s)
- Aaron S Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | | | - Natalie Saunders
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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Mahmoudian A, van Dieёn JH, Baert IAC, Bruijn SM, Faber GS, Luyten FP, Verschueren SMP. Changes in gait characteristics of women with early and established medial knee osteoarthritis: Results from a 2-years longitudinal study. Clin Biomech (Bristol, Avon) 2017; 50:32-39. [PMID: 28985489 DOI: 10.1016/j.clinbiomech.2017.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 08/23/2017] [Accepted: 10/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the large number of cross-sectional studies on gait in subjects with knee osteoarthritis, there are scarcely any longitudinal studies on gait changes in knee osteoarthritis. METHODS Gait analysis was performed on 25 women with early and 18 with established medial knee osteoarthritis, as well as a group of 23 healthy controls. Subjects were asked to walk at their comfortable speed. Kinematic and kinetic data were measured at baseline and after 2years follow-up. FINDINGS Results indicated that the early osteoarthritis group, similar to established osteoarthritis group, showed significantly higher maximum knee adduction angles compared to the controls during the early stance phase of gait. None of the kinematic or kinetic measures, changed over two years in the early osteoarthritis group. In the established osteoarthritis group, at the time of entry, an increased first and second peak knee adduction moment, as well as higher mid-stance knee adduction moment and knee adduction moment impulse, were present compared to the control and the early osteoarthritis groups. Mid-stance knee adduction moment and knee adduction moment impulse, further increased over two years only in the established osteoarthritis group. For all three groups, the peak knee flexion angle during the stance phase decreased significantly over time. INTERPRETATION Increased maximum knee adduction angle during stance phase was the only alteration in the gait pattern of subjects with early knee osteoarthritis compared to the controls. This suggests that, unlike in the later stages of the disease, gait is rather stable over two years in early osteoarthritis.
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Affiliation(s)
- Armaghan Mahmoudian
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Jaap H van Dieёn
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands.
| | - Isabel A C Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium.
| | - Sjoerd M Bruijn
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands; Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Gert S Faber
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands
| | - Frank P Luyten
- Department of Development & Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Belgium.
| | - Sabine M P Verschueren
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium.
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14
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Variable compensation during the sit-to-stand task among individuals with severe knee osteoarthritis. Ann Phys Rehabil Med 2017; 60:312-318. [DOI: 10.1016/j.rehab.2017.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/25/2017] [Accepted: 03/27/2017] [Indexed: 11/17/2022]
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Gommans LN, Smid AT, Scheltinga MR, Cancrinus E, Brooijmans FA, Meijer K, Teijink JA. Prolonged stance phase during walking in intermittent claudication. J Vasc Surg 2017; 66:515-522. [DOI: 10.1016/j.jvs.2017.02.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 02/10/2017] [Indexed: 11/24/2022]
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Jacksteit R, Mau-Moeller A, Behrens M, Bader R, Mittelmeier W, Skripitz R, Stöckel T. The mental representation of the human gait in patients with severe knee osteoarthrosis: a clinical study to aid understanding of impairment and disability. Clin Rehabil 2017; 32:103-115. [PMID: 28719981 DOI: 10.1177/0269215517719312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Objectives were (1) to explore differences in gait-specific long-term memory structures and gait performance between knee osteoarthrosis patients and healthy subjects and (2) to identify the extent to which the gait-specific mental representation is associated with gait performance. DESIGN Cross-sectional study. SUBJECTS In total, 18 knee osteoarthrosis patients and 18 control subjects. METHODS Spatio-temporal (gait speed, step length) and temporophasic (stance time, swing time, single support time, total double support time) gait parameters and gait variability were measured with an electronic walkway (OptoGait). The mental representation was assessed using the structural dimensional analysis of mental representations (SDA-M). RESULTS (1) Patients showed significantly longer stance times ( P < 0.002) and total double support times, shorter swing times and single support times, a decreased gait speed ( P-values < 0.001) and structural differences in the gait-specific mental representation as compared with the healthy controls. (2) Correlation analyses revealed the mental representation of the human gait to be associated with actual gait performance in osteoarthrosis patients. Double support times were positively associated with the structural quality of the mental representation and step length variability was positively associated with the number of sequencing errors in the representation. CONCLUSION The gait-specific mental representation and actual gait performance differ between patients with severe knee osteoarthrosis and healthy controls, and both are linked to one another. This finding suggests that musculoskeletal disorders can lead to changes in the mental representation of the gait, and as such the SDA-M could provide useful information to improve the rehabilitation following osteoarthrosis.
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Affiliation(s)
- Robert Jacksteit
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Anett Mau-Moeller
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Martin Behrens
- 2 Institute of Sport Science, University of Rostock, Rostock, Germany
| | - Rainer Bader
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | | | - Ralf Skripitz
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Tino Stöckel
- 2 Institute of Sport Science, University of Rostock, Rostock, Germany
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17
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Kirkwood RN, Gomes HA, Sampaio RF, Furtado SRC, Moreira BS. Spatiotemporal and variability gait data in community-dwelling elderly women from Brazil. Braz J Phys Ther 2017; 20:258-66. [PMID: 27437717 PMCID: PMC4946842 DOI: 10.1590/bjpt-rbf.2014.0157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/26/2015] [Indexed: 12/02/2022] Open
Abstract
Background Gait is an extremely complex motor task; therefore, gait data should encompass as
many gait parameters as possible. Objective To provide reference values for gait measurements obtained from a Brazilian group
of community-dwelling elderly females between the ages of 65 and 89 years and to
apply the PCA-biplot to yield insight into different walking strategies that might
occur during the aging process. Method 305 elderly community-dwelling females living in Brazil were stratified into four
age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80
years (N=30). Age, height, and BMI were assessed to describe the characteristics
of the groups. Gait spatiotemporal and variability data were obtained using the
GAITRite® system. Principal component analysis, followed by MANOVA and the
PCA-biplot approach were used to analyze the data. Results 95% CI showed that only three components – rhythm, variability, and support -
together explained 74.2% of the total variance in gait that were different among
the groups. The older groups (75-79 and ≥80 years) walked with lower than average
velocity, cadence, and step length and were above average for the variables
stance, step, swing, and double support time and the ≥80 year old group presented
the highest gait variability compared to the other groups. Conclusion Aging is associated with decreased gait velocity and cadence and increased stance,
step time, and variability, but not associated with changes in base of support. In
addition, the PCA-biplot indicates a decline towards decreased rhythm and
increased variability with aging.
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Affiliation(s)
- Renata N Kirkwood
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Henrique A Gomes
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Rosana F Sampaio
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Sheyla R C Furtado
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Bruno S Moreira
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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18
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Zago M, Camerota TC, Pisu S, Ciprandi D, Sforza C. Gait analysis of young male patients diagnosed with primary bladder neck obstruction. J Electromyogr Kinesiol 2017; 35:69-75. [PMID: 28601565 DOI: 10.1016/j.jelekin.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/05/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023] Open
Abstract
Primary bladder neck obstruction (PBNO) represents an inappropriate or inadequate relaxation of the bladder neck during micturition. Based on the observation of an increased rate of postural imbalances in male patients with PBNO, we hypothesized a possible role of an unbalanced biomechanics of the pelvis on urethral sphincters activity. Our aim was to identify kinematic imbalances, usually disregarded in PBNO patients, and which could eventually be involved in the etiopathogenesis of the disease. Seven male adult patients (39.6±7.1years) were recruited; in all patients, PBNO was suspected at bladder diary and uroflowmetry, and was endoscopically confirmed with urethroscopy. Participants gait was recorded with a motion capture system (BTS Spa, Italy) to obtain three-dimensional joint angles and gait parameters. Multivariate statistics based on a Principal Component model allowed to assess the similarity of patients' gait patterns with respect to control subjects. The main finding is that patients with PBNO showed significant discordance in the observations at the ankle and pelvis level. Additionally, 6/7 patients demonstrated altered trunk positions compared to normal curves. We suggest that the identified postural imbalances could represent the cause for an anomalous activation of pelvic floor muscles (hypertonia). The consequent urinary sphincters hypercontraction may be responsible for the development of voiding dysfunction in male patients with no significant morphological alterations. Results reinforced the hypothesis of an etiopathogenetic role of postural imbalances on primary bladder neck obstruction in male patients.
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Affiliation(s)
- Matteo Zago
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy; Current address: Dept. of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy.
| | - Tommaso Ciro Camerota
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy.
| | - Stefano Pisu
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy.
| | - Daniela Ciprandi
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy.
| | - Chiarella Sforza
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy.
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Metcalfe AJ, Stewart CJ, Postans NJ, Biggs PR, Whatling GM, Holt CA, Roberts AP. Abnormal loading and functional deficits are present in both limbs before and after unilateral knee arthroplasty. Gait Posture 2017; 55:109-115. [PMID: 28437757 PMCID: PMC5450932 DOI: 10.1016/j.gaitpost.2017.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 01/23/2017] [Accepted: 04/03/2017] [Indexed: 02/02/2023]
Abstract
Unilateral knee replacement is often followed by a contralateral replacement in time and the biomechanics of the other knee before and after knee replacement remains poorly understood. The aim of this paper is to distinguish the features of arthritic gait in the affected and unaffected legs relative to a normal population and to assess the objective recovery of gait function post-operatively, with the aim of defining patients at risk of poor post-operative function. Twenty patients with severe knee OA but no pain or deformity in any other lower limb joint were compared to twenty healthy subjects of the same age. Gait analysis was performed and quadriceps and hamstrings co-contraction was measured. Fifteen subjects returned 1year following knee arthroplasty. Moments and impulses were calculated, principal component analysis was used to analyse the waveforms and a classification technique (the Cardiff Classifier) was used to select the most discriminant data and define functional performance. Comparing pre-operative function to healthy function, classification accuracies for the affected and unaffected knees were 95% and 92.5% respectively. Post-operatively, the affected limb returned to the normal half of the classifier in 8 patients, and 7 of those patients returned to normal function in the unaffected limb. Recovery of normal gait could be correctly predicted 13 out of 15 times at the affected knee, and 12 out of 15 times at the unaffected knee based on pre-operative gait function. Focused rehabilitation prior to surgery may be beneficial to optimise outcomes and protect the other joints following knee arthroplasty.
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Affiliation(s)
- A J Metcalfe
- Warwick Medical School, The University of Warwick, United Kingdom.
| | - C J Stewart
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom; The Institute for Science and Technology in Medicine, Keele University, United Kingdom
| | - N J Postans
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - P R Biggs
- The Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff School of Engineering, Cardiff University, United Kingdom
| | - G M Whatling
- The Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff School of Engineering, Cardiff University, United Kingdom
| | - C A Holt
- The Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff School of Engineering, Cardiff University, United Kingdom
| | - A P Roberts
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
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20
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Chang AH, Chmiel JS, Almagor O, Guermazi A, Prasad PV, Moisio KC, Belisle L, Zhang Y, Hayes K, Sharma L. Association of baseline knee sagittal dynamic joint stiffness during gait and 2-year patellofemoral cartilage damage worsening in knee osteoarthritis. Osteoarthritis Cartilage 2017; 25:242-248. [PMID: 27729289 PMCID: PMC5258842 DOI: 10.1016/j.joca.2016.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/11/2016] [Accepted: 10/05/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee sagittal dynamic joint stiffness (DJS) describes the biomechanical interaction between change in external knee flexion moment and flexion angular excursion during gait. In theory, greater DJS may particularly stress the patellofemoral (PF) compartment and thereby contribute to PF osteoarthritis (OA) worsening. We hypothesized that greater baseline knee sagittal DJS is associated with PF cartilage damage worsening 2 years later. METHODS Participants all had OA in at least one knee. Knee kinematics and kinetics during gait were recorded using motion capture systems and force plates. Knee sagittal DJS was computed as the slope of the linear regression line for knee flexion moments vs angles during the loading response phase. Knee magnetic resonance imaging (MRI) scans were obtained at baseline and 2 years later. We assessed the association between baseline DJS and baseline-to-2-year PF cartilage damage worsening using logistic regression with generalized estimating equations (GEE). RESULTS Our sample had 391 knees (204 persons): mean age 64.2 years (SD 10.0); body mass index (BMI) 28.4 kg/m2 (5.7); 76.5% women. Baseline knee sagittal DJS was associated with baseline-to-2-year cartilage damage worsening in the lateral (OR = 5.35, 95% CI: 2.37-12.05) and any PF (OR = 2.99, 95% CI: 1.27-7.04) compartment. Individual components of baseline DJS (i.e., change in knee moment or angle) were not associated with subsequent PF disease worsening. CONCLUSION Capturing the concomitant effect of knee kinetics and kinematics during gait, knee sagittal DJS is a potentially modifiable risk factor for PF disease worsening.
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Affiliation(s)
- A H Chang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - J S Chmiel
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - O Almagor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - P V Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.
| | - K C Moisio
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - L Belisle
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Y Zhang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - K Hayes
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - L Sharma
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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21
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Komnik I, Peters M, Funken J, David S, Weiss S, Potthast W. Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients. PLoS One 2016; 11:e0168566. [PMID: 28002437 PMCID: PMC5176302 DOI: 10.1371/journal.pone.0168566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/04/2016] [Indexed: 11/19/2022] Open
Abstract
After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.
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Affiliation(s)
- Igor Komnik
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Markus Peters
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Johannes Funken
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Sina David
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stefan Weiss
- ARCUS Clinics Pforzheim, Pforzheim, Baden-Württemberg, Germany
| | - Wolfgang Potthast
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
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22
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Magalhães CMBD, Kirkwood RN. Strategies to reduce joint load in the medial compartment of the knee during gait in individuals with osteoarthritis: a review of the literature. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.004.ao20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Increased joint load on the medial compartment of the knee during gait is a mechanical factor responsible for pain and progression of medial knee osteoarthritis. The knee external adductor moment of force is a kinetic parameter that correlates with the joint load in the medial compartment. Objective: The aim of this study was to conduct a narrative review of the biomechanics strategies during gait of individuals with medial knee osteoarthritis that reduce external adductor moment of force of the knee. Methods: The review of the literature was conducted in the databases MEDLINE, PUBMED and PEDro and included articles published between 2000 and 2011. It was selected transversal, theoretical, correlational and longitudinal studies as well as controlled clinical trials. Results: Decreased gait velocity, increased external rotation of the foot, increased internal abductor moment force of the hip and lateral trunk inclination to the side of the support limb are compensatory strategies used to reduce the external adductor moment of force of the knee during gait of individuals with medial knee osteoarthritis. The lateral trunk inclination may be beneficial in a short term, however it decreases the activity of the abductors muscles of the hip during the support phase of the gait favoring compensation that could result in the progression of medial knee osteoarthritis. Conclusion: Strengthening of the abductors muscles of the hip reduces pain, improves the function and prevents compensations that in a long term could possibly accelerate the progression of the medial knee osteoarthritis.
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23
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Barrois R, Gregory T, Oudre L, Moreau T, Truong C, Aram Pulini A, Vienne A, Labourdette C, Vayatis N, Buffat S, Yelnik A, de Waele C, Laporte S, Vidal PP, Ricard D. An Automated Recording Method in Clinical Consultation to Rate the Limp in Lower Limb Osteoarthritis. PLoS One 2016; 11:e0164975. [PMID: 27776168 PMCID: PMC5077168 DOI: 10.1371/journal.pone.0164975] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/04/2016] [Indexed: 11/19/2022] Open
Abstract
For diagnosis and follow up, it is important to be able to quantify limp in an objective, and precise way adapted to daily clinical consultation. The purpose of this exploratory study was to determine if an inertial sensor-based method could provide simple features that correlate with the severity of lower limb osteoarthritis evaluated by the WOMAC index without the use of step detection in the signal processing. Forty-eight patients with lower limb osteoarthritis formed two severity groups separated by the median of the WOMAC index (G1, G2). Twelve asymptomatic age-matched control subjects formed the control group (G0). Subjects were asked to walk straight 10 meters forward and 10 meters back at self-selected walking speeds with inertial measurement units (IMU) (3-D accelerometers, 3-D gyroscopes and 3-D magnetometers) attached on the head, the lower back (L3-L4) and both feet. Sixty parameters corresponding to the mean and the root mean square (RMS) of the recorded signals on the various sensors (head, lower back and feet), in the various axes, in the various frames were computed. Parameters were defined as discriminating when they showed statistical differences between the three groups. In total, four parameters were found discriminating: mean and RMS of the norm of the acceleration in the horizontal plane for contralateral and ipsilateral foot in the doctor's office frame. No discriminating parameter was found on the head or the lower back. No discriminating parameter was found in the sensor linked frames. This study showed that two IMUs placed on both feet and a step detection free signal processing method could be an objective and quantitative complement to the clinical examination of the physician in everyday practice. Our method provides new automatically computed parameters that could be used for the comprehension of lower limb osteoarthritis. It may not only be used in medical consultation to score patients but also to monitor the evolution of their clinical syndrome during and after rehabilitation. Finally, it paves the way for the quantification of gait in other fields such as neurology and for monitoring the gait at a patient's home.
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Affiliation(s)
- R. Barrois
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
| | - Th. Gregory
- Service de chirurgie orthopédique et traumatologie, HEGP, université Paris Descartes, Paris, France
| | - L. Oudre
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
- Institut Galilée, Université Paris 13, Villetaneuse, France
| | - Th. Moreau
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
| | - Ch. Truong
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
| | - A. Aram Pulini
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
| | - A. Vienne
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
| | - Ch. Labourdette
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
- Centre des Mathématiques et de Leurs Applications, Ecole Normale Supérieure de Cachan, Cachan, France
| | - N. Vayatis
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
- Centre des Mathématiques et de Leurs Applications, Ecole Normale Supérieure de Cachan, Cachan, France
| | - S. Buffat
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | - A. Yelnik
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
- PRM Department, GH St Louis Lariboisière F. Widal, AP-HP, Diderot University, Paris, France
| | - C. de Waele
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
| | - S. Laporte
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, 151 Boulevard de l’Hôpital, 75003, Paris, France
| | - P. P. Vidal
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
| | - D. Ricard
- Cognition and Action Group, Cognac-G, CNRS, Université Paris Descartes, SSA, Paris, France
- Service de Neurologie, Hôpital d’Instruction des Armées de Percy, Service de Santé des Armées, Clamart, France
- * E-mail:
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24
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Determination of patellofemoral pain sub-groups and development of a method for predicting treatment outcome using running gait kinematics. Clin Biomech (Bristol, Avon) 2016; 38:13-21. [PMID: 27522485 DOI: 10.1016/j.clinbiomech.2016.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 07/06/2016] [Accepted: 08/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Not all patients with patellofemoral pain exhibit successful outcomes following exercise therapy. Thus, the ability to identify patellofemoral pain subgroups related to treatment response is important for the development of optimal therapeutic strategies to improve rehabilitation outcomes. The purpose of this study was to use baseline running gait kinematic and clinical outcome variables to classify patellofemoral pain patients on treatment response retrospectively. METHODS Forty-one individuals with patellofemoral pain that underwent a 6-week exercise intervention program were sub-grouped as treatment Responders (n=28) and Non-responders (n=13) based on self-reported measures of pain and function. Baseline three-dimensional running kinematics, and self-reported measures underwent a linear discriminant analysis of the principal components of the variables to retrospectively classify participants based on treatment response. The significance of the discriminant function was verified with a Wilk's lambda test (α=0.05). FINDINGS The model selected 2 gait principal components and had a 78.1% classification accuracy. Overall, Non-responders exhibited greater ankle dorsiflexion, knee abduction and hip flexion during the swing phase and greater ankle inversion during the stance phase, compared to Responders. INTERPRETATION This is the first study to investigate an objective method to use baseline kinematic and self-report outcome variables to classify on patellofemoral pain treatment outcome. This study represents a significant first step towards a method to help clinicians make evidence-informed decisions regarding optimal treatment strategies for patients with patellofemoral pain.
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Walking on a compliant surface does not enhance kinematic gait asymmetries after unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2606-13. [PMID: 26708412 DOI: 10.1007/s00167-015-3931-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate gait asymmetries and the effect of walking on compliant surfaces in individuals with unilateral total knee arthroplasty (TKA), hypothesizing that asymmetries would increase as an effect of the compliant surface. METHODS Individuals with unilateral TKA ~19 months post-operative (n = 23, median age 59 years) recruited from one orthopaedic clinic and age- and gender-matched healthy individuals without knee complaints (n = 23, median age 56 years) walked at comfortable speed on a hard surface and on a compliant surface. 3D kinematic analyses were made for knee and hip angles in sagittal and frontal planes, stance time, step length, and gait velocity. RESULTS Shorter stance time (p < 0.01) and less peak knee flexion (p < 0.001) at weight bearing acceptance was found in the prosthetic side compared with the contralateral side. Larger knee (p < 0.01) and hip (p < 0.001) adduction was found compared with healthy controls. Neither asymmetries between the prosthetic and the contralateral side nor differences compared with healthy controls were enhanced when walking on compliant surfaces compared with hard surfaces. CONCLUSION The TKA group adapted their gait to compliant surfaces similarly to healthy controls. Gait asymmetries in the TKA group observed on hard surface were not enhanced, and adduction in hip and knee joints did not increase further as an effect of walking on compliant surfaces. Thus, unfavourable knee joint loading did not increase when walking on a compliant surface. This implies that recommendations for walking on soft surfaces to reduce knee joint loading are not counteracted by increased gait asymmetries and unfavourable joint loading configurations. LEVEL OF EVIDENCE III.
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26
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Biomechanical and neuromuscular adaptations during the landing phase of a stepping-down task in patients with early or established knee osteoarthritis. Knee 2016; 23:367-75. [PMID: 26922798 DOI: 10.1016/j.knee.2016.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 01/14/2016] [Accepted: 02/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND To compare the knee joint kinematics, kinetics and EMG activity patterns during a stepping-down task in patients with knee osteoarthritis (OA) with control subjects. METHODS 33 women with knee OA (early OA, n=14; established OA n=19) and 14 female control subjects performed a stepping-down task from a 20cm step. Knee joint kinematics, kinetics and EMG activity were recorded on the stepping-down leg during the loading phase. RESULTS During the stepping-down task patients with established knee OA showed greater normalized medial hamstrings activity (p=0.034) and greater vastus lateralis-medial hamstrings co-contraction (p=0.012) than controls. Greater vastus medialis-medial hamstrings co-contraction was found in patients with established OA compared to control subjects (p=0.040) and to patients with early OA (p=0.023). Self-reported knee instability was reported in 7% and 32% of the patients with early and established OA, respectively. CONCLUSIONS The greater EMG co-activity found in established OA might suggest a less efficient use of knee muscles or an attempt to compensate for greater knee laxity usually present in patients with established OA. In the early stage of the disease, the biomechanical and neuromuscular control of stepping-down is not altered compared to healthy controls.
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Pamukoff DN, Lewek MD, Blackburn JT. Greater vertical loading rate in obese compared to normal weight young adults. Clin Biomech (Bristol, Avon) 2016; 33:61-65. [PMID: 26952204 DOI: 10.1016/j.clinbiomech.2016.02.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/07/2016] [Accepted: 02/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is a risk factor for knee osteoarthritis. Altered gait biomechanics are common in obese individuals, and may contribute to the development of knee osteoarthritis. Research has focused on older obese adults with knee osteoarthritis, and it is unclear if young obese individuals display similar aberrant biomechanics. The purpose of this study was to compare gait biomechanics between normal-weight and obese young adults. METHODS 15 normal-weight (body mass index=21.5 (1.1)) and 15 obese (body mass index=33.5 (3.7)) young adults were recruited and categorized by body mass index. Lower extremity kinematics and kinetics were collected while participants walked at standardized (1m/s) and self-selected speeds. Analysis of variance (group by condition) was used to compare peak vertical ground reaction force, vertical loading rate, peak internal knee extension moment, peak internal knee abduction moment, peak knee flexion angle, and knee flexion excursion between groups. FINDINGS Gait biomechanics did not differ between groups during walking at a self-selected speed. When walking at a standardized speed, obese subjects displayed greater instantaneous vertical loading rates (46.2 vs. 35.0 N/s, P<0.001), and lesser knee flexion excursion (5.5° vs. 7.7°, P=0.04). Instantaneous vertical loading rate was greater during walking at a self-selected speed compared to a standardized speed in the obese (P=0.007) and normal weight groups (P=0.001). INTERPRETATION As greater loading rates are related to cartilage degeneration, these results suggest that obesity may contribute to knee osteoarthritis. Prospective studies are needed to identify the influence of higher loading rates on knee osteoarthritis.
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Affiliation(s)
- Derek N Pamukoff
- Department of Kinesiology, California State University, Fullerton, 800 N State College, Fullerton, CA 92831, USA; Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 209 Fetzer Hall, Chapel Hill, NC 27599-8700, USA; Curriculum in Human Movement Science, The University of North Carolina at Chapel Hill, Bondurant Hall, Suite 3000, Chapel Hill, NC 27599-7135, USA.
| | - Michael D Lewek
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 209 Fetzer Hall, Chapel Hill, NC 27599-8700, USA; Curriculum in Human Movement Science, The University of North Carolina at Chapel Hill, Bondurant Hall, Suite 3000, Chapel Hill, NC 27599-7135, USA; Division of Physical Therapy, The University of North Carolina at Chapel Hill, Bondurant Hall, Suite 3000, Chapel Hill, NC 27599-7135, USA.
| | - J Troy Blackburn
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 209 Fetzer Hall, Chapel Hill, NC 27599-8700, USA; Curriculum in Human Movement Science, The University of North Carolina at Chapel Hill, Bondurant Hall, Suite 3000, Chapel Hill, NC 27599-7135, USA; Department of Orthopedics, The University of North Carolina at Chapel Hill, 209 Fetzer Hall, Chapel Hill, NC 27599-8700, USA.
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LEPORACE GUSTAVO, METSAVAHT LEONARDO, ZEITOUNE GABRIEL, MARINHO THIAGO, OLIVEIRA TAINÁ, PEREIRA GLAUBERRIBEIRO, OLIVEIRA LISZTPALMEIRADE, BATISTA LUIZALBERTO. USE OF SPATIOTEMPORAL GAIT PARAMETERS TO DETERMINE RETURN TO SPORTS AFTER ACL RECONSTRUCTION. ACTA ORTOPEDICA BRASILEIRA 2016; 24:73-6. [PMID: 26981039 PMCID: PMC4775493 DOI: 10.1590/1413-785220162402147450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE : To compare gait spatiotemporal parameters of healthy and ACL reconstructed subjects in order to classify the status of gait normality. METHODS : Fourteen healthy subjects and eight patients submitted to ACL reconstruction walked along a walkway while the lower limbs movement was captured by an infrared camera system. The frames where the initial contact and toe-off took place were determined and the following dependent variables, which were compared between groups through the Mann-Whitney test (a=0.05) were calculated: percentage of time in initial double stance, percentage of time in single stance, percentage of time in terminal double stance, stride length and gait velocity. Initially, all variables were compared between groups using a Mann-Whitney test. A logistic regression was applied, including all dependent variables, to create a model that could differentiate healthy and ACL reconstructed subjects. RESULTS : ACL reconstructed group showed no differences in any spatiotemporal parameter of gait (p > 0.05) in relation to the control group, although the angular kinematic differences of the knee remained altered, as evidenced in a study with a similar sample. CONCLUSION : The regression classified all subjects as healthy, including the ACL reconstructed group, suggesting the spatiotemporal variables should not be used as the sole criterion of return to sports activities at the same level as prior to injury. Level of Evidence III, Case Control Study.
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Affiliation(s)
- GUSTAVO LEPORACE
- Universidade Federal do Rio de Janeiro, Brazil; Instituto Brasil de Tecnologia da Saúde, Brazil
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Farrokhi S, Voycheck CA, Gustafson JA, Fitzgerald GK, Tashman S. Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis. Knee 2016; 23:49-56. [PMID: 27030846 PMCID: PMC4817272 DOI: 10.1016/j.knee.2015.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). METHODS Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. RESULTS Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p < 0.02) and greater heel-strike joint contact point velocities (p < 0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p = 0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p < 0.01) and greater quadriceps and hip abductor muscle weakness (p = 0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p < 0.04) but not with quadriceps or hip abductor strength. CONCLUSION Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.
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Affiliation(s)
- Shawn Farrokhi
- Assistant Professor & Co-director of the Human Movement Research Laboratory, Department of Physical Therapy, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carrie A. Voycheck
- Posdoctoral Fellow, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan A. Gustafson
- Doctoral Student, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - G. Kelley Fitzgerald
- Professor & Director of the Physical Therapy Clinical and Translational Research Center, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Associate Professor & Director of Biodynamics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, PA, USA
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Osteoarthritis year in review 2015: mechanics. Osteoarthritis Cartilage 2016; 24:27-35. [PMID: 26707990 PMCID: PMC4693146 DOI: 10.1016/j.joca.2015.08.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/13/2015] [Accepted: 08/29/2015] [Indexed: 02/02/2023]
Abstract
Motivated by the conceptual framework of multi-scale biomechanics, this narrative review highlights recent major advances with a focus on gait and joint kinematics, then tissue-level mechanics, cell mechanics and mechanotransduction, matrix mechanics, and finally the nanoscale mechanics of matrix macromolecules. A literature review was conducted from January 2014 to April 2015 using PubMed to identify major developments in mechanics related to osteoarthritis (OA). Studies of knee adduction, flexion, rotation, and contact mechanics have extended our understanding of medial compartment loading. In turn, advances in measurement methodologies have shown how injuries to both the meniscus and ligaments, together, can alter joint kinematics. At the tissue scale, novel findings have emerged regarding the mechanics of the meniscus as well as cartilage superficial zone. Moving to the cell level, poroelastic and poro-viscoelastic mechanisms underlying chondrocyte deformation have been reported, along with the response to osmotic stress. Further developments have emerged on the role of calcium signaling in chondrocyte mechanobiology, including exciting findings on the function of mechanically activated cation channels newly found to be expressed in chondrocytes. Finally, AFM-based nano-rheology systems have enabled studies of thin murine tissues and brush layers of matrix molecules over a wide range of loading rates including high rates corresponding to impact injury. With OA acknowledged to be a disease of the joint as an organ, understanding mechanical behavior at each length scale helps to elucidate the connections between cell biology, matrix biochemistry and tissue structure/function that may play a role in the pathomechanics of OA.
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Hatfield GL, Stanish WD, Hubley-Kozey CL. Relationship between knee adduction moment patterns extracted using principal component analysis and discrete measures with different amplitude normalizations: Implications for knee osteoarthritis progression studies. Clin Biomech (Bristol, Avon) 2015; 30:1146-52. [PMID: 26363732 DOI: 10.1016/j.clinbiomech.2015.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee adduction moment discrete features (peaks and impulses) are commonly reported in knee osteoarthritis gait studies, but they do not necessarily capture loading patterns. Principal component analysis extracts dynamic patterns, but can be difficult to interpret. This methodological study determined relationships between external knee adduction moment discrete measures and principal component analysis features, and examined whether amplitude-normalization methods influenced differences in those with knee osteoarthritis who progressed to surgery versus those that did not. METHODS 54 knee osteoarthritis patients had three-dimensional biomechanical measures assessed during walking. Knee adduction moments were calculated and non-normalized and amplitude-normalized waveforms using two common methods were calculated. Patterns were extracted using principal component analysis. Knee adduction moment peak and impulse were calculated. Correlation coefficients were determined between two knee adduction moment patterns extracted and peak and impulse. T-tests evaluated between-group differences. FINDINGS An overall magnitude pattern was correlated with peak (r=0.88-0.90, p<0.05) and impulse (r=0.93, p<0.05). A pattern capturing a difference between early and mid/late -stance knee adduction moment was significantly correlated with peak (r=0.27-0.40, p<0.05), but explained minimal variance. Between-group peak differences were only affected by amplitude-normalization method. INTERPRETATION Findings suggest that the overall magnitude knee adduction moment principal pattern does not provide unique information from peak and impulse measures. However, low correlations and minimal variance explained between the pattern capturing ability to unload the joint during mid-stance and the two discrete measures, suggests that this pattern captured a unique waveform feature.
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Affiliation(s)
- Gillian L Hatfield
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - William D Stanish
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
| | - Cheryl L Hubley-Kozey
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada; School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
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Qingguang Z, Min F, Li G, Shuyun J, Wuquan S, Jianhua L, Yong L. Gait analysis of patients with knee osteoarthritis before and after Chinese massage treatment. J TRADIT CHIN MED 2015; 35:411-6. [PMID: 26427110 DOI: 10.1016/s0254-6272(15)30117-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this study was to evaluate the effectiveness of Chinese massage therapy in patients with knee osteoarthritis (OA) by measuring lower-limb gait parameters. We recruited 20 women with knee OA, who then underwent Chinese massage therapy three times per week for 2 weeks. The patients underwent gait evaluation using a six-camera infrared motion analysis system. They completed Western Ontario and McMaster Universities Osteoarthritis Index questionnaires before and after treatment. We calculated the forward speed, step width, step length, total support time percentage, initial double support time percentage, and single support time percentage. We also measured the angles at the knee, hip, and ankle during the stance phase of walking. The results showed statistically significant mean differences in knee pain relief, alleviation of stiffness, and physical function enhancement after therapy (P < 0.05). The patients gained significantly faster gait speed, greater step width, and increased total support time percentage after the Chinese massage therapy (P < 0.05). There were no significant differences in the range of motion or initial contact angles of the knee, hip, or ankle during the stance phase of walking. We concluded that Chinese massage is a beneficial complementary treatment and an alternative therapy choice for patients with knee OA for short-term pain relief. Chinese massage may improve walking ability for these patients.
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Abstract
This study tested the hypothesis that the presence of isolated ankle (A-OA; N=30), knee (K-OA; N=20), or hip (H-OA; N=30) osteoarthritis (OA) compared to asymptomatic controls (N=15) would lead to mechanical changes in the affected joint but also in all other lower limb joints and gait overall. Stride length, stance and swing times, as well as joint angles and moments at the hip, knee, and ankle were derived from 3-D kinematic and kinetic data collected from seven self-selected speed walking trial. Values were compared across groups using a 1×4 ANCOVA, covarying for walking speed. With walking speed controlled, the results indicated a reduction in hip and knee extension and ankle plantar flexion in accordance with the joint affected. In addition, OA in one joint had strong effects on other joints. In both H-OA and K-OA groups the hip never passed into extension, and A-OA subjects significantly changed hip kinematics to compensate for lack of plantar flexion. Finally, OA in any joint led to lower peak vertical forces as well as extension and plantar flexion moments compared to controls. The presence of end-stage OA at various lower extremity joints results in compensatory gait mechanics that cause movement alterations throughout the lower extremity. This work reinforces our understanding of the complex interaction of joints of the lower limb and the importance of focusing on the mechanics of the entire lower limb when considering gait disability and potential interventions in patients with isolated OA.
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Affiliation(s)
- Daniel Schmitt
- Department of Evolutionary Anthropology, Duke University, DUMC 2914, Durham, NC 27710, USA
| | - Alexander Vap
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Robin M Queen
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Michael W. Krzyzewski Human Performance Lab, Duke University Medical Center DUMC 102916, Durham, NC 27710, USA
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Hebenstreit F, Leibold A, Krinner S, Welsch G, Lochmann M, Eskofier BM. Effect of walking speed on gait sub phase durations. Hum Mov Sci 2015; 43:118-24. [PMID: 26256534 DOI: 10.1016/j.humov.2015.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
Abstract
Gait phase durations are important spatiotemporal parameters in different contexts such as discrimination between healthy and pathological gait and monitoring of treatment outcomes after interventions. Although gait phases strongly depend on walking speed, the influence of different speeds has rarely been investigated in literature. In this work, we examined the durations of the stance sub phases and the swing phase for 12 different walking speeds ranging from 0.6 to 1.7 m/s in 21 healthy subjects using infrared cinematography and an instrumented treadmill. We separated the stance phase into loading response, mid stance, terminal stance and pre-swing phase and we performed regression modeling of all phase durations with speed to determine general trends. With an increasing speed of 0.1m/s, stance duration decreased while swing duration increased by 0.3%. All distinct stance sub phases changed significantly with speed. These findings suggest the importance of including all distinct gait sub phases in spatiotemporal analyses, especially when different walking speeds are involved.
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Affiliation(s)
- Felix Hebenstreit
- Digital Sports Group, Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Haberstrasse 2, 91058 Erlangen, Germany; Department of Trauma Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Gebbertstrasse 123b, 91058 Erlangen, Germany.
| | - Andreas Leibold
- Digital Sports Group, Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Haberstrasse 2, 91058 Erlangen, Germany.
| | - Sebastian Krinner
- Department of Trauma Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany.
| | - Götz Welsch
- Department of Trauma Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany.
| | - Matthias Lochmann
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Gebbertstrasse 123b, 91058 Erlangen, Germany.
| | - Bjoern M Eskofier
- Digital Sports Group, Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Haberstrasse 2, 91058 Erlangen, Germany.
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Gustafson JA, Robinson ME, Fitzgerald GK, Tashman S, Farrokhi S. Knee motion variability in patients with knee osteoarthritis: The effect of self-reported instability. Clin Biomech (Bristol, Avon) 2015; 30:475-80. [PMID: 25796536 PMCID: PMC4428966 DOI: 10.1016/j.clinbiomech.2015.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee osteoarthritis has been previously associated with a stereotypical knee-stiffening gait pattern and reduced knee joint motion variability due to increased antagonist muscle co-contractions and smaller utilized arc of motion during gait. However, episodic self-reported instability may be a sign of excessive motion variability for a large subgroup of patients with knee osteoarthritis. The objective of this work was to evaluate the differences in knee joint motion variability during gait in patients with knee osteoarthritis with and without self-reported instability compared to a control group of older adults with asymptomatic knees. METHODS Forty-three subjects, 8 with knee osteoarthritis but no reports of instability (stable), 11 with knee osteoarthritis and self-reported instability (unstable), and 24 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a decline gait task on a treadmill. Knee motion variability was assessed using parametric phase plots during the loading response phase of decline gait. FINDINGS The stable group demonstrated decreased sagittal-plane motion variability compared to the control group (p=0.04), while the unstable group demonstrated increased sagittal-plane motion variability compared to the control (p=0.003) and stable groups (p<0.001). The unstable group also demonstrated increased anterior-posterior joint contact point motion variability for the medial tibiofemoral compartment compared to the control (p=0.03) and stable groups (p=0.03). INTERPRETATION The finding of decreased knee motion variability in patients with knee osteoarthritis without self-reported instability supports previous research. However, presence of self-reported instability is associated with increased knee motion variability in patients with knee osteoarthritis and warrants further investigation.
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Affiliation(s)
- Jonathan A. Gustafson
- Doctoral Student, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Megan E. Robinson
- Research Assistant, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - G. Kelley Fitzgerald
- Professor, Department of Physical Therapy, Director, Physical Therapy Clinical and Translational Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Associate Professor Department of Orthopaedic Surgery, Department of Bioengineering, Director, Biodynamics Laboratory, University of Pittsburgh, PA, USA
| | - Shawn Farrokhi
- Assistant Professor, Departments of Physical Therapy & Bioengineering, Co-director, Human Movement Research Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
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Altered frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during downhill gait in patients with mixed knee osteoarthritis. J Biomech 2015; 48:1707-12. [PMID: 26087880 DOI: 10.1016/j.jbiomech.2015.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 11/23/2022]
Abstract
Patients with knee osteoarthritis often present with signs of mixed tibiofemoral and patellofemoral joint disease. It has been suggested that altered frontal and transverse plane knee joint mechanics play a key role in compartment-specific patterns of knee osteoarthritis, but in-vivo evidence in support of this premise remains limited. Using Dynamic Stereo X-ray techniques, the aim of this study was to compare the frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during the loading response phase of downhill gait in three groups of older adults: patients with medial tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=11); patients with lateral tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=10); and an osteoarthritis-free control group (n=22). Patients with lateral compartment osteoarthritis walked with greater and increasing degrees of tibiofemoral abduction compared to the medial compartment osteoarthritis and the control groups who walked with increasing degrees of tibiofemoral adduction. Additionally, the medial and lateral compartment osteoarthritis groups demonstrated reduced degrees of tibiofemoral internal rotation compared to the control group. Both medial and lateral compartment osteoarthritis groups also walked with increasing degrees of lateral patella tilt and medial patella translation during the loading response phase of downhill gait. Our findings suggest that despite the differences in frontal and transverse plane tibiofemoral kinematics between patients with medial and lateral compartment osteoarthritis, the malalignments of their arthritic patellofemoral joint appears to be similar. Further research is needed to determine if these kinematic variations are relevant targets for interventions to reduce pain and disease progression in patients with mixed disease.
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Bischoff JE, Dai Y, Goodlett C, Davis B, Bandi M. Incorporating population-level variability in orthopedic biomechanical analysis: a review. J Biomech Eng 2014; 136:021004. [PMID: 24337168 DOI: 10.1115/1.4026258] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/16/2013] [Indexed: 11/08/2022]
Abstract
Effectively addressing population-level variability within orthopedic analyses requires robust data sets that span the target population and can be greatly facilitated by statistical methods for incorporating such data into functional biomechanical models. Data sets continue to be disseminated that include not just anatomical information but also key mechanical data including tissue or joint stiffness, gait patterns, and other inputs relevant to analysis of joint function across a range of anatomies and physiologies. Statistical modeling can be used to establish correlations between a variety of structural and functional biometrics rooted in these data and to quantify how these correlations change from health to disease and, finally, to joint reconstruction or other clinical intervention. Principal component analysis provides a basis for effectively and efficiently integrating variability in anatomy, tissue properties, joint kinetics, and kinematics into mechanistic models of joint function. With such models, bioengineers are able to study the effects of variability on biomechanical performance, not just on a patient-specific basis but in a way that may be predictive of a larger patient population. The goal of this paper is to demonstrate the broad use of statistical modeling within orthopedics and to discuss ways to continue to leverage these techniques to improve biomechanical understanding of orthopedic systems across populations.
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Moreira BS, Sampaio RF, Kirkwood RN. Spatiotemporal gait parameters and recurrent falls in community-dwelling elderly women: a prospective study. Braz J Phys Ther 2014; 19:61-9. [PMID: 25714603 PMCID: PMC4351609 DOI: 10.1590/bjpt-rbf.2014.0067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 08/01/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND: Falling is a common but devastating and costly problem of aging. There is no
consensus in the literature on whether the spatial and temporal gait parameters
could identify elderly people at risk of recurrent falls. OBJECTIVE: To determine whether spatiotemporal gait parameters could predict recurrent falls
in elderly women. METHOD: One hundred and forty-eight elderly women (65-85 years) participated in this
study. Seven spatiotemporal gait parameters were collected with the GAITRite(r)
system. Falls were recorded prospectively during 12 months through biweekly phone
contacts. Elderly women who reported two or more falls throughout the follow-up
period were considered as recurrent fallers. Principal component analysis (PCA)
and discriminant analysis followed by biplot graph interpretation were applied to
the gait parameters. RESULTS: After 12 months, 23 elderly women fell twice or more and comprised the recurrent
fallers group and 110 with one or no falls comprised the non-recurrent fallers
group. PCA resulted in three components that explained 88.3% of data variance.
Discriminant analysis showed that none of the components could significantly
discriminate the groups. However, visual inspection of the biplot showed a trend
towards group separation in relation to gait velocity and stance time. PC1
represented gait rhythm and showed that recurrent fallers tend to walk with lower
velocity and cadence and increased stance time in relation to non-recurrent
fallers. CONCLUSIONS: The analyzed spatiotemporal gait parameters failed to predict recurrent falls in
this sample. The PCA-biplot technique highlighted important trends or red flags
that should be considered when evaluating recurrent falls in elderly females.
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Affiliation(s)
- Bruno S Moreira
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rosana F Sampaio
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Renata N Kirkwood
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Chehab EF, Favre J, Erhart-Hledik JC, Andriacchi TP. Baseline knee adduction and flexion moments during walking are both associated with 5 year cartilage changes in patients with medial knee osteoarthritis. Osteoarthritis Cartilage 2014; 22:1833-9. [PMID: 25211281 PMCID: PMC4369510 DOI: 10.1016/j.joca.2014.08.009] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 07/04/2014] [Accepted: 08/16/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test the hypothesis that knee cartilage changes over 5 years are associated with baseline peak knee adduction moment (KAM) and peak knee flexion moment (KFM) during early stance. DESIGN Baseline KAM and KFM were measured in sixteen subjects with medial knee osteoarthritis (OA). Regional changes in cartilage thickness and changes in medial-to-lateral thickness ratio were quantified using magnetic resonance imaging (MRI) at baseline and again after 5 years. Multiple regression was used to determine whether baseline measures of KAM and KFM were associated with cartilage changes over 5 years. Associations with baseline pain score, Kellgren-Lawrence (KL) grade, walking speed, age, gender, and body mass index (BMI) were tested one-by-one in the presence of KAM and KFM. RESULTS Changes over 5 years in femoral medial-to-lateral thickness ratio were associated with baseline KAM, KFM, and pain score (R(2) = 0.60, P = 0.010), and most significantly with KAM (R(2) = 0.33, P = 0.019). Changes in tibial medial-to-lateral thickness ratio were associated with baseline KAM, KFM, and walking speed (R(2) = 0.49, P = 0.039), with KFM driving this association (R(2) = 0.40, P = 0.009). Changes in medial tibial thickness were associated with baseline KAM, KFM, and walking speed (R(2) = 0.49, P = 0.041); KFM also drove this association (R(2) = 0.42, P = 0.006). CONCLUSIONS The findings that the KAM has a greater influence on femoral cartilage change and the KFM has a greater influence on tibial cartilage change provide new insight into the tibiofemoral variations in cartilage changes associated with walking kinetics. These results suggest that both KAM and KFM should be considered when designing disease interventions as well as when assessing the risk for OA progression.
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Affiliation(s)
- Eric F. Chehab
- Department of Mechanical Engineering, Stanford, CA, United States,Department of Bioengineering, Stanford University, Stanford, CA, United States,Corresponding author: Eric F Chehab, 496 Lomita Mall, Durand Building, Room 061, Stanford, CA 94305-4038, United States, Phone: (650) 723-5793,
| | - Julien Favre
- Department of Mechanical Engineering, Stanford, CA, United States
| | - Jennifer C. Erhart-Hledik
- Department of Mechanical Engineering, Stanford, CA, United States,Palo Alto Veterans Affairs, Palo Alto, CA, United States
| | - Thomas P. Andriacchi
- Department of Mechanical Engineering, Stanford, CA, United States,Palo Alto Veterans Affairs, Palo Alto, CA, United States,Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, United States
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Wang H, Fleischli JE, Hutchinson ID, Zheng NN. Knee moment and shear force are correlated with femoral tunnel orientation after single-bundle anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42:2377-85. [PMID: 25062662 DOI: 10.1177/0363546514541232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increasing evidence has shown that anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) better restores normal knee kinematics and functionality than nonanatomic ACLR. Whether anatomic reconstruction results in better knee kinetics during daily activities has not been fully investigated. PURPOSE To assess the relationship between femoral tunnel angle and kinetic parameters of the knee joint during walking after single-bundle ACLR and to compare the radiographic and kinetic results of patients who underwent anatomic ACLR with those of patients who underwent nonanatomic ACLR. STUDY DESIGN Controlled laboratory study. METHODS Twenty-one patients who underwent unilateral ACLR were recruited, and 20 healthy subjects from a previous study were used as a control group. All surgical procedures were performed by a single surgeon, 11 using the transtibial (TT) technique and 10 using the anteromedial portal (AMP) technique. Femoral tunnel orientation was measured from posterior-to-anterior radiographs. Dynamic knee joint moments and shear forces during gait were evaluated using 3-dimensional motion analysis and inverse dynamics. Relationships between femoral tunnel angles and kinetic results were evaluated via linear regression. Results were compared between 2 ACLR groups and controls using 1-way analysis of variance. RESULTS Femoral tunnel angle had significant correlations with peak external knee flexion moment and posterior shear force during early stance. The TT group had a significantly smaller (more vertical) mean femoral tunnel angle (19.4° ± 4.1°) than the AMP group (36.4° ± 5.8°). Significant reductions were found in the normalized peak external knee flexion moment (TT, 0.15 ± 0.12 Nm/kg·m; AMP, 0.25 ± 0.12 Nm/kg·m; control, 0.25 ± 0.16 Nm/kg·m) (P = .032) and posterior shear force (TT, 0.64 ± 0.55 N/kg; AMP, 1.10 ± 0.58 N/kg; control, 1.35 ± 0.55 N/kg) (P = .024) in the TT group compared with controls, but not in the AMP group. Moreover, a significantly greater medial shear force was found in the TT group during the late stance phase (TT, 1.08 ± 0.32 N/kg; AMP, 0.89 ± 0.26 N/kg; control, 0.83 ± 0.22 N/kg) (P = .038). A greater peak external knee adduction moment was found in both ACL groups during the early stance phase (TT, 0.25 ± 0.07 Nm/kg·m; AMP, 0.25 ± 0.07 Nm/kg·m; control, 0.19 ± 0.05 Nm/kg·m) (P < .01). CONCLUSION Knee joint kinetic changes are seen within months (~10 months) after ACLR. This study revealed significant relationships between femoral tunnel orientation and postoperative knee joint flexion moment and posterior shear force during walking. The AMP technique provides better restoration of these knee kinetic parameters compared with the TT technique at this postoperative time point. CLINICAL RELEVANCE The femoral tunnel angle measured from plain radiographs can be used as an important metric of postoperative knee joint kinetics. This information provides a better understanding of the knee joint's biomechanical environment after ACLR using commonly used single-bundle techniques.
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Affiliation(s)
- Hongsheng Wang
- Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - James E Fleischli
- Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina, USA
| | - Ian D Hutchinson
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Naiquan Nigel Zheng
- Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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Phinyomark A, Hettinga BA, Osis ST, Ferber R. Gender and age-related differences in bilateral lower extremity mechanics during treadmill running. PLoS One 2014; 9:e105246. [PMID: 25137240 PMCID: PMC4138160 DOI: 10.1371/journal.pone.0105246] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/23/2014] [Indexed: 11/19/2022] Open
Abstract
Female runners have a two-fold risk of sustaining certain running-related injuries as compared to their male counterparts. Thus, a comprehensive understanding of the sex-related differences in running kinematics is necessary. However, previous studies have either used discrete time point variables and inferential statistics and/or relatively small subject numbers. Therefore, the first purpose of this study was to use a principal component analysis (PCA) method along with a support vector machine (SVM) classifier to examine the differences in running gait kinematics between female and male runners across a large sample of the running population as well as between two age-specific sub-groups. Bilateral 3-dimensional lower extremity gait kinematic data were collected during treadmill running. Data were analysed on the complete sample (n = 483: female 263, male 220), a younger subject group (n = 56), and an older subject group (n = 51). The PC scores were first sorted by the percentage of variance explained and we also employed a novel approach wherein PCs were sorted based on between-gender statistical effect sizes. An SVM was used to determine if the sex and age conditions were separable and classifiable based on the PCA. Forty PCs explained 84.74% of the variance in the data and an SVM classification accuracy of 86.34% was found between female and male runners. Classification accuracies between genders for younger subjects were higher than a subgroup of older runners. The observed interactions between age and gender suggest these factors must be considered together when trying to create homogenous sub-groups for research purposes.
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Affiliation(s)
| | - Blayne A. Hettinga
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, Calgary, Alberta, Canada
| | - Sean T. Osis
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, Calgary, Alberta, Canada
| | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, Calgary, Alberta, Canada
- * E-mail:
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Russell DF, Deakin AH, Fogg QA, Picard F. Repeatability and accuracy of a non-invasive method of measuring internal and external rotation of the tibia. Knee Surg Sports Traumatol Arthrosc 2014; 22:1771-7. [PMID: 24370989 DOI: 10.1007/s00167-013-2812-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/02/2013] [Indexed: 01/16/2023]
Abstract
PURPOSE The ability to quantify rotational laxity of the knee would increase understanding of functional rotatory instability, identify the best treatment methods for soft tissue injury, and have a role in diagnosis of soft tissue injury. This study aimed to report the reliability, repeatability and precision of a non-invasive adaptation of image-free navigation technology by comparing with a validated invasive system used for computer-assisted surgery. METHODS Twelve cadaveric lower limbs were tested with a commercial image-free navigation system using passive trackers secured by bone screws. They were then tested a non-invasive fabric-strap system. Manual application of torque was used consistent with clinical examination to rotate the tibia to the end of internal rotation and external rotation range. Measurements were taken at 10° intervals from full extension to 90° flexion, and protocol was repeated twice using each system. Intraclass correlation coefficient (ICC) was used to reflect reliability of measurements. At each flexion interval, coefficient of repeatability (CR) was calculated for each system, and limits of agreement (LOA) were used to reflect agreement between the systems. RESULTS The results for internal and external rotation were combined throughout flexion: ICC invasive; 0.94 (0.86-0.99), non-invasive; 0.92 (0.7-0.99), CR invasive; 2.4° (1.3-4.8°), non-invasive; 3.5° (1.8-6.6), LOA; 8.2° (4.3-13.5). CONCLUSION Non-invasive optical tracker fixation gives improved agreement with a validated method of measurement compared with devices measuring tibial rotation by foot position. This system gives the added possibility of dynamic, weight-bearing testing in the clinically important range of 0°-30° knee flexion without the need for any limb restraint.
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Affiliation(s)
- David F Russell
- Faculty of Biomedical and Life Sciences, Thomson Building, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK,
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Towards understanding knee joint laxity: Errors in non-invasive assessment of joint rotation can be corrected. Med Eng Phys 2014; 36:889-95. [DOI: 10.1016/j.medengphy.2014.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 03/06/2014] [Accepted: 03/24/2014] [Indexed: 12/20/2022]
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Farrokhi S, Voycheck CA, Klatt BA, Gustafson JA, Tashman S, Fitzgerald GK. Altered tibiofemoral joint contact mechanics and kinematics in patients with knee osteoarthritis and episodic complaints of joint instability. Clin Biomech (Bristol, Avon) 2014; 29:629-35. [PMID: 24856791 PMCID: PMC4111962 DOI: 10.1016/j.clinbiomech.2014.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/15/2014] [Accepted: 04/22/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND To evaluate knee joint contact mechanics and kinematics during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability. METHODS Forty-three subjects, 11 with medial compartment knee osteoarthritis and self-reported instability (unstable), 7 with medial compartment knee osteoarthritis but no reports of instability (stable), and 25 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a downhill gait task on a treadmill. FINDINGS The medial compartment contact point excursions were longer in the unstable group compared to the stable (P=0.046) and the control groups (P=0.016). The peak medial compartment contact point velocity was also greater for the unstable group compared to the stable (P=0.047) and control groups (P=0.022). Additionally, the unstable group demonstrated a coupled movement pattern of knee extension and external rotation after heel contact which was different than the coupled motion of knee flexion and internal rotation demonstrated by stable and control groups. INTERPRETATION Our findings suggest that knee joint contact mechanics and kinematics are altered during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability. The observed longer medial compartment contact point excursions and higher velocities represent objective signs of mechanical instability that may place the arthritic knee joint at increased risk for disease progression. Further research is indicated to explore the clinical relevance of altered contact mechanics and kinematics during other common daily activities and to assess the efficacy of rehabilitation programs to improve altered joint biomechanics in knee osteoarthritis patients with self-reported instability.
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Affiliation(s)
- Shawn Farrokhi
- Assistant Professor & Co-director of Human Movement Research Laboratory, Departments of Physical Therapy & Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carrie A. Voycheck
- Posdoctoral Fellow, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian A. Klatt
- Assistant Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA
| | - Jonathan A. Gustafson
- Doctoral Student, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Associate Professor & Director of Biodynamics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, PA, USA
| | - G. Kelley Fitzgerald
- Professor, Department of Physical Therapy, Director, Physical Therapy Clinical and Translational Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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Hooper L, Bowen CJ, Gates L, Culliford D, Arden NK, Edwards CJ. Comparative Distribution of Ultrasound-Detectable Forefoot Bursae in Patients With Osteoarthritis and Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2014. [DOI: 10.1002/acr.22217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Lindsey Hooper
- University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, and University of Oxford, NIHR Musculoskeletal Biomedical Research Unit; Oxford UK
| | - Catherine J. Bowen
- University Hospital Southampton NHS Foundation Trust, Southampton, and University of Oxford, NIHR Musculoskeletal Biomedical Research Unit; Oxford UK
| | - Lucy Gates
- University Hospital Southampton NHS Foundation Trust and University of Southampton; Southampton UK
| | - David Culliford
- University of Southampton, Southampton, and University of Oxford, NIHR Musculoskeletal Biomedical Research Unit; Oxford UK
| | - Nigel K. Arden
- University of Southampton, Southampton, and University of Oxford, NIHR Musculoskeletal Biomedical Research Unit; Oxford UK
| | - Christopher J. Edwards
- University Hospital Southampton NHS Foundation Trust and University of Southampton; Southampton UK
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Teoh JC, Low JH, Lim YB, Shim VPW, Park J, Park SB, Park SJ, Lee T. Investigation of the biomechanical effect of variable stiffness shoe on external knee adduction moment in various dynamic exercises. J Foot Ankle Res 2013; 6:39. [PMID: 24044429 PMCID: PMC3848782 DOI: 10.1186/1757-1146-6-39] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 08/22/2013] [Indexed: 12/05/2022] Open
Abstract
Background The growing ageing population and high prevalence of knee osteoarthritis (OA) in athletes across nations have created a strong demand for improved non-invasive therapeutic alternatives for knee OA. The aim of this study is to investigate the effect of the variable stiffness shoe (VSS), a new non-invasive therapeutic approach, on external knee adduction moment (EKAM) in various dynamic exercises. EKAM is believed to have positive correlation with the progression and development of knee OA. Methods Thirty young participants (16 male and 14 female; age 22.6 ± 1.9 years) from National University of Singapore were enrolled in this study. The tested activities were walking, running, drop-landing, and lateral hopping. All the dynamic exercises were recorded simultaneously by the 8-camera VICON Motion Systems (Oxford Metric, UK) with a sampling rate of 100 Hz. Results The results showed that the EKAM was reduced in all the dynamic exercises with the use of VSS. The VSS produced significant reductions in the peak EKAM during walking (4.97%, p = 0.039), running (11.15%, p = 0.011), drop-landing (11.18%, p = 0.038) and lateral hopping (17.34%, p = 0.023) as compared to the control shoe. Conclusions The reduction of EKAM with the use of VSS in various dynamic exercises demonstrates its potential in delaying the onset and the progression of knee OA in early stage of knee OA patients.
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Affiliation(s)
- Jee Chin Teoh
- Department of Bioengineering, Faculty of Engineering, National University of Singapore, Block E3A #07-15, 7 Engineering Drive 1, Singapore 117574, Singapore.
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Leporace G, Batista LA, Muniz AM, Zeitoune G, Luciano T, Metsavaht L, Nadal J. Classification of gait kinematics of anterior cruciate ligament reconstructed subjects using principal component analysis and regressions modelling. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:6514-7. [PMID: 23367421 DOI: 10.1109/embc.2012.6347486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to compare the knee kinematics of anterior cruciate ligament reconstructed (ACL-R) and healthy subjects (CG) during gait and classify the status of normality. Ten healthy and six ACL-R subjects had their gait analyzed at 60 fps. 3D knee angles were calculated and inserted into three separate matrices used to perform the principal component (PC) analysis. The scores of PCs retained in each analysis were used to calculate the standard distances (SD) of each participant in relation to the center of the CG. The PC scores of the three planes were used in a logistic regression to define normality. In the sagittal plane there was no difference between groups. In the frontal and transverse planes ACL-R subjects showed higher SD values than CG. PCs identified that ACL-R subjects showed increased adduction, internal and external rotation. All these subjects had their gait classified as abnormal by logistic regression. Therefore, in the studied ACL-R subjects the gait pattern did not return to normal levels after surgery. This may lead to degenerative injuries, as osteoarthritis, in the future.
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Affiliation(s)
- Gustavo Leporace
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, PO Box 68.510, 21941-972 Rio de Janeiro RJ, Brasil.
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Federolf PA, Boyer KA, Andriacchi TP. Application of principal component analysis in clinical gait research: identification of systematic differences between healthy and medial knee-osteoarthritic gait. J Biomech 2013; 46:2173-8. [PMID: 23910389 DOI: 10.1016/j.jbiomech.2013.06.032] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 06/28/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
Abstract
For a successful completion of a movement task the motor control system has to observe a multitude of internal constraints that govern the coordination of its segments. The purpose of this study was to apply principal component (PC) analysis to detect differences in the segmental coordination between healthy subjects and patients with medial knee osteoarthritis (OA). It was hypothesized that (1) systematic differences in patterns of whole body movement would be identifiable with this method even in small sample sized groups and that (2) these differences will include compensatory movements in the OA patients in both the lower and upper body segments. Marker positions and ground reaction forces of three gait trials of 5 healthy and 5 OA participants with full body marker sets were analyzed using a principal component analysis. Group differences in the PC-scores were determined for the first 10 PC-vectors and a linear combination of those PC-vectors where differences were found defined a discriminant vector. Projecting the original trials onto this discriminant vector yielded significant group differences (t(d=8)=3.011; p=0.017) with greater upper body movement in patients with knee OA that was correlated with the medial-lateral ground reaction force. These results help to characterize the adaptation of whole-body gait patterns to knee OA in a relatively small population and may provide an improved basis for the development of interventions to modify knee load. The PC-based motion analysis offered a highly sensitive approach to identify characteristic whole body patterns of movement associated with pathological gait.
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Affiliation(s)
- P A Federolf
- Mechanical Engineering, Stanford University, Stanford, CA, USA.
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Freedman Silvernail J, Milner CE, Thompson D, Zhang S, Zhao X. The influence of body mass index and velocity on knee biomechanics during walking. Gait Posture 2013; 37:575-9. [PMID: 23103243 DOI: 10.1016/j.gaitpost.2012.09.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 05/22/2012] [Accepted: 09/20/2012] [Indexed: 02/02/2023]
Abstract
Obesity has been associated with both the development and progression of knee osteoarthritis. Being overweight or obese from a young age is likely to decrease the age of onset for co-morbidities of obesity such as osteoarthritis. However, research on osteoarthritis has thus far focused on older adults. Therefore, the purpose of this study was to determine whether young adults who are overweight or obese exhibit biomechanical risk factors for knee osteoarthritis at either their preferred walking velocity or at 1m/s, which was slower than the preferred velocity. Thirty healthy young adults formed three equal groups according to body mass index. Three dimensional kinetics and kinematics were collected while participants walked overground at both velocities. Joint moments were normalized to fat free weight and height. The preferred walking velocity of obese participants was slower than that of normal weight individuals. There were no differences in knee flexion excursion, peak knee flexion angle, normalized peak knee flexion moment or normalized peak knee adduction moment among groups. Obese participants walked with lower peak knee adduction angle than both overweight and normal body mass index participants and several shifted towards knee abduction. All groups had smaller knee flexion excursion, peak knee flexion angle, peak knee flexion moment and peak knee adduction moment at 1m/s compared to preferred walking velocity. Overall, young and otherwise healthy overweight and obese participants have knee biomechanics during gait at preferred and slow walking velocities that are comparable to normal weight adults.
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Sagawa Y, Armand S, Lubbeke A, Hoffmeyer P, Fritschy D, Suva D, Turcot K. Associations between gait and clinical parameters in patients with severe knee osteoarthritis: a multiple correspondence analysis. Clin Biomech (Bristol, Avon) 2013; 28:299-305. [PMID: 23410553 DOI: 10.1016/j.clinbiomech.2013.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Given the complexity of the gait of patients with knee osteoarthritis, a multiple correspondence analysis may be helpful to optimise the extraction of relevant gait and clinical information. Therefore, the aims of this study are to identify the main associations with clinical and gait biomechanical parameters and to evaluate whether there are more specific knee osteoarthritis groups with different gait profiles. METHODS Ninety patients with severe knee osteoarthritis and twenty-six healthy individuals participated in this study. Pain and function were assessed with the WOMAC Index; knee joint deformity was assessed by the hip-knee-ankle angle on full-limb radiography; and full body gait analysis was performed with a motion analysis system and force plates. FINDINGS Using multiple correspondence analysis, two categories of gait parameters that best explain the gait variance of patients with knee osteoarthritis were highlighted. The forward displacement category is composed of the parameters speed, stride length, hip flexion and knee flexion. The frontal category is composed of the parameters thorax obliquity and knee adductor moments. Moreover, based on these parameters, four distinct gait profiles were identified: two gait profiles were associated with knee varus deformities, increased thorax obliquity and different forward displacements, while two gait profiles were associated with valgus deformities and different forward displacements. INTERPRETATION These gait parameters can be used to simplify the characterisation of the gait of the knee osteoarthritis population. Patients in varus profiles increase thorax obliquity on the stance limb and may reduce forward displacement. Patients in valgus profiles, however, only reduce forward displacement.
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Affiliation(s)
- Y Sagawa
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland.
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