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Markström JL, Grinberg Y, Sole G, Häger CK. Strategies for knee stabilising and pivot-shift avoidance in a step-down and cross-over task observed sub-acutely after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 115:106255. [PMID: 38669919 DOI: 10.1016/j.clinbiomech.2024.106255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Individuals with a recent anterior cruciate ligament reconstruction may demonstrate an altered movement strategy for protecting the knee and maintaining stability. Altered knee movement might lead to abnormal intra-articular load, potentially contributing to early knee osteoarthritis onset. A protective strategy may be particularly evident during active tasks that induce a pivot-shift manoeuvre, such as a step-down and cross-over task. In this study, we investigated whether knee joint mechanics and muscle activity differed between participants early (∼3 months) following reconstruction (n = 35) to uninjured controls (n = 35) during a step-down and cross-over task with a 45° change-of-direction. METHODS We used motion capture, force plates and surface electromyography to compare time-normalised curves of sagittal and transverse-plane knee mechanics and muscle activity during the cross-over phase between groups using functional t-tests. We also compared knee mechanics between sides within the injured group and compared discrete outcomes describing the cross-over phase between groups. FINDINGS Compared to controls, the injured participants had greater knee flexion angle and moment, lower internal rotation moment, more preparatory foot rotation of the pivoting leg, a smaller cross-over angle, and a longer cross-over phase for both the injured and uninjured sides. The injured leg also had greater biceps femoris and vastus medialis muscle activity compared to controls and different knee mechanics than the uninjured leg. INTERPRETATION Individuals with anterior cruciate ligament reconstruction showed a knee-stabilising and pivot-shift avoidance strategy for both legs early in rehabilitation. These results may reflect an altered motor representation and motivate considerations early in rehabilitation.
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Affiliation(s)
- Jonas L Markström
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Sweden; Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Sweden.
| | - Yevgenia Grinberg
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Sweden
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Sweden
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Starbuck C, Walters V, Herrington L, Barkatali B, Jones R. Knee Offloading by Patients During Walking and Running After Meniscectomy. Orthop J Sports Med 2024; 12:23259671231214766. [PMID: 38524891 PMCID: PMC10958822 DOI: 10.1177/23259671231214766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 03/26/2024] Open
Abstract
Background Changes in knee loading have been reported after meniscectomy. Knee loading has previously been assessed during jogging and treadmill running rather than overground running, which could give altered results. Purpose/Hypothesis The purpose of this study was to evaluate knee function during overground running and walking after meniscectomy. It was hypothesized that the affected limb would demonstrate higher external knee adduction moment, lower knee flexion moment (KFM), and lower knee rotation moment (KRM) compared with the contralateral limb and with healthy individuals. Study Design Controlled laboratory study. Methods Kinematic and kinetic data were collected during running and walking in individuals after a meniscectomy and healthy individuals. Total knee joint moments (TKJM) were calculated from the sagittal, frontal, and transverse knee moments. Isometric quadriceps strength, perceived knee function, and kinesiophobia were also assessed. A mixed linear model compared differences between the affected leg, the contralateral leg, and the healthy leg. Results Data were collected on 20 healthy individuals and 30 individuals after a meniscectomy (mean ± SD, 5.7 ± 2.9 months postsurgery), with 12, 16, and 2 individuals who had medial, lateral, and both medial and lateral meniscectomy, respectively. The affected limb demonstrated lower TKJM (P < .001), KFM (P = .004), and KRM (P < .001) during late stance of walking compared with the healthy group. Lower TKJM and KFM were observed during running in the affected limb compared with the contralateral limb and healthy group. No significant differences were observed between contralateral and healthy limbs except for KRM during late stance of walking. Lower quadriceps strength was observed in the affected (P < .001) and contralateral limbs (P = .001) compared with the healthy group. Individuals after a meniscectomy also reported greater kinesiophobia (P = .006) and lower perceived knee function (31.1%; P < .001) compared with the healthy group. Conclusion After meniscectomy, individuals who sustained a traumatic meniscal injury showed lower TKJM in the affected limb compared with the contralateral limb and healthy individuals. This decrease in TKJM can be attributed to altered knee-loading strategies in the sagittal and transverse planes. Clinical Relevance Improving movement strategies, quadriceps strength, and kinesiophobia through rehabilitation approaches will allow individuals to load their knee appropriately when returning to sport. Registration NCT03379415 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Chelsea Starbuck
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, UK
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- Manchester Institute of Health and Performance, Manchester, UK
| | - Vanessa Walters
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- Manchester Institute of Health and Performance, Manchester, UK
| | - Lee Herrington
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | | | - Richard Jones
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- Manchester Institute of Health and Performance, Manchester, UK
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Pereira CS, Klauznicer J, Maree D, McAuliffe S, Farooq A, Whiteley R, Finni T. Quadriceps strength, patellar tendon quality, relative load exposure, and knee symptoms in male athletes before the anterior cruciate ligament reconstruction. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1283635. [PMID: 37928751 PMCID: PMC10624220 DOI: 10.3389/fresc.2023.1283635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Introduction Anterior cruciate ligament (ACL) injuries cause knee instability, knee pain, weight-bearing adjustments, and functional deficits but their association to patellar tendon quality is unknown. Our purpose was to investigate quadriceps strength, patellar tendon quality, relative load exposure, perceived knee stability, knee pain, extension angle, and time from ACL injury; in addition to examining their relative associations. Methods Injured and uninjured legs of 81 male athletes of different sports with a unilateral ACL injury (18-45 years) were examined. Participants reported location and intensity of knee pain and their perceived stability using a numerical rating scale (NRS 0-10). Strength was tested with an isokinetic device. Tendon quality was measured using ultrasound tissue characterization. Means ± standard deviation (SD) of perceived knee stability, knee extension angle, knee pain, isokinetic quadriceps strength in relation to body mass, proportion of echo-types (I-IV), tendon volume, and number of days from ACL injury to assessment are reported. Values of effect sizes (ES) and correlations (rs) were calculated. Results ACL injured leg demonstrated reduced reported knee stability (6.3 ± 2.5), decreased knee extension angle (-0.7 ± 3.1° vs. -2.7 ± 2.2°; ES = 0.7; P < 0.001), greater knee pain (NRS 3.1 ± 2.2 vs. 0.0 ± 0.1; ES = 2.0; P < 0.001), and 22% lower quadriceps strength (228.0 ± 65.0 vs. 291.2 ± 52.9 Nm/kg: ES = 1.2; P < 0.001) as compared to the uninjured leg. However, patellar tendons in both legs displayed similar quality. Quadriceps strength was associated with stability (rs = -0.54; P < 0.001), pain (rs = -0.47; P < 0.001), extension angle (rs = -0.39; P < 0.001), and relative load exposure (rs = -0.34; P < 0.004). Echo-types distribution was beneficially associated with time from ACL injury (rs range: -0.20/ -0.32; P < 0.05). Discussion ACL injured athletes displayed knee pain, extension deficit, and weaker quadriceps in the injured leg. While there were no differences in patellar tendon quality between legs, longer time from ACL injury showed better tendon quality.
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Affiliation(s)
- Carla S. Pereira
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
- Neuromuscular Research Center, Biology of PhysicalActivity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jasenko Klauznicer
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Dustin Maree
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Sean McAuliffe
- Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Abdulaziz Farooq
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Rod Whiteley
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Taija Finni
- Neuromuscular Research Center, Biology of PhysicalActivity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Kong L, Yang T, Wang Q, Ou Y, Huang H, Huang W, Zhang T, Zhang Y, Zeng X. ACLD patients exhibit additional knee kinematic asymmetries at the speed level of healthy subjects. Front Bioeng Biotechnol 2022; 10:930722. [PMID: 36082158 PMCID: PMC9445214 DOI: 10.3389/fbioe.2022.930722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Anterior cruciate ligament deficiency (ACLD) patients tend to walk slowly but try to catch up with the speed level of healthy subjects daily. Exploring the effects of the walking speed level of healthy subjects on the ACLD patients’ knee kinematics is important to improving non-operative treatments and delaying the progression of posttraumatic knee osteoarthritis. This study aimed to explore whether healthy controls’ walking speed level leads to additional knee kinematic asymmetries in patients with ACLD. 27 ACLD patients and 29 healthy controls were recruited for the study. The ACLD patients walked at two levels of walking speed, including self-selected and healthy controls’ walking speed levels. A three-dimensional gait analysis system was used to collect their knee kinematic data. ACLD patients exhibited more kinematic asymmetries when walking at healthy controls’ walking speed level than at their self-selected speeds. The kinematic asymmetries included increased posterior tibial translation (4.6 mm) and anteroposterior tibial ROM (3.9 mm), abduction angle (1.5°), and distal tibial translation (3.2 mm) asymmetries (p < 0.05). Our findings are meaningful for developing non-operative treatment strategies for patients with ACLD. To get fewer knee kinematic asymmetries, self-selected walking speed could be suggested for patients with ACLD daily rather than the speed levels of healthy subjects.
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Affiliation(s)
- Lingchuang Kong
- Department of Orthopaedics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Wang
- Department of Orthopaedics, General Hospital of Southern Theater Command, Guangzhou, China
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yongliang Ou
- Department of Orthopaedics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Huayang Huang
- Department of Orthopaedics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Zhang
- Department of Orthopaedics, General Hospital of Southern Theater Command, Guangzhou, China
- *Correspondence: Tao Zhang, ; Yu Zhang, ; Xiaolong Zeng,
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Tao Zhang, ; Yu Zhang, ; Xiaolong Zeng,
| | - Xiaolong Zeng
- Department of Orthopaedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Tao Zhang, ; Yu Zhang, ; Xiaolong Zeng,
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Li C, Lin Y, Kernkamp WA, Xia H, Lin Z. Effect of Time After Injury on Tibiofemoral Joint Kinematics in Anterior Cruciate Ligament-Deficient Knees During Gait. Orthop J Sports Med 2022; 10:23259671221110160. [PMID: 35898201 PMCID: PMC9310238 DOI: 10.1177/23259671221110160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) injury can lead to changes in tibiofemoral kinematics during gait, but the detailed short-term kinematic changes after ACL injury are still unknown. Purpose: To measure tibiofemoral kinematics during gait in ACL-deficient (ACLD) knees over time after ACL injury. Study Design: Controlled laboratory study. Methods: The authors categorized 76 patients with unilateral ACLD knees into 4 groups based on the time from injury: <3 months (group 1), 3 to 6 months (group 2), >6 to 12 months (group 3), and >12 months (group 4). The controls were 20 participants with ACL-intact knees. Changes in the knee kinematics and range of motion during gait were compared among ACLD groups and those with ACL-intact knees. Results: Compared with controls, the range of motion of flexion in group 1 was significantly lower (6°; P = .033), and the mean knee flexion was significantly increased (0.7°-3.4°) in groups 1 to 4 (all P ≤ .004). There was more internal tibial rotation (2.9°-4.3°) in group 1 and 2, and more anterior tibial translation (4.3 mm) in group 1 during the stance or swing phases than in controls (P ≤ .049 for all). The mean internal tibial rotation and anterior tibial translation significantly decreased from group 1 to group 4 (P < .001 for both). Compared with controls, the mean medial tibial translation was significantly greater (1.2-2.5 mm) in all groups, and more medial tibial translations (2.4-3.7 mm) were observed during the stance phase in groups 1, 3, and 4 (P ≤ .047 for all). Conclusion: ACLD knees displayed a motion impairment walking strategy within 3 months, and a higher-flexion walking strategy increased with time after injury. Excessive anterior translation and internal rotation of the tibia tended to return to normal, while excessive medial translation of the tibia increased in ACLD knees after 6 months postinjury. These results may provide new insight into the compensatory mechanisms and risk factors for premature osteoarthritis in ACLD knees.
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Affiliation(s)
- Changzhao Li
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area, Department of Orthopedics, General Hospital of Southern Theater Command, Guangzhou, China.,Southern Medical University, Guangzhou, China
| | - Yulin Lin
- Department of Orthopedics, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Willem A Kernkamp
- Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hong Xia
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area, Department of Orthopedics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Zefeng Lin
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area, Department of Orthopedics, General Hospital of Southern Theater Command, Guangzhou, China
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Zeng X, Xie Z, Zhong G, Chen Y, Wen B, Li Y, Ma L, Huang W, Yang T, Zhang Y. The 6DOF knee kinematics of healthy subjects during sloped walking compared to level walking. Gait Posture 2022; 95:198-203. [PMID: 35526472 DOI: 10.1016/j.gaitpost.2022.05.004] [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: 03/04/2022] [Revised: 04/23/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Level Walking is a frequent functional movement during daily life. However, sloped walking is also common. Exploring 6DOF knee kinematics during sloped walking is important. It provides a reference for the rehabilitation, safety, and knee health of patients with knee diseases walking on sloped surfaces. RESEARCH QUESTION The study aimed to explore 6DOF knee kinematics characteristics during sloped walking compared to level walking. We hypothesized that tibial anteroposterior translation and flexion angle (the sagittal plane) were significantly different from those of level walking. METHODS One hundred young, healthy adults (50 males and 50 females) were recruited for this study. A three-dimensional gait analysis system was used to collect 6DOF knee kinematics during level and sloped walking. The slope was set to ± 15% when the sloped walking was performed. RESULTS Sloped walking mainly increased knee flexion angle (upslope, 2.5-26.2°, 1-100% gait cycle (GC), p < 0.05; downslope, 1.7-11.9°, 15-95% GC, p < 0.05) and anterior tibial translation (upslope, 0.7-4.1 mm, 3-54% GC & 0.6-2.1 mm, 80-94% GC; downslope, 1.0-2.2 mm, 21-69% GC) in the participants' knees. However, participants' other 4DOF knee kinematics during sloped walking were significantly different from those during level walking (p < 0.05). Participants had 'drastically changeable' knee kinematic alterations in the transverse and coronal plane (the other 4DOF knee kinematics) during sloped walking compared to level walking. SIGNIFICANCE Our results confirmed the hypothesis. Sloped walking significantly increased anterior tibial translation (in most GC) and flexion angle. These kinematic changes in healthy subjects should be evaluated and further explored for patients with knee diseases, such as anterior cruciate ligament deficiency. Our findings are meaningful for their rehabilitation or safety or knee health while walking on sloped surfaces. Our study may provide a pilot reference for the 6DOF knee kinematic exploration of sloped walking.
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Affiliation(s)
- Xiaolong Zeng
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Zhenyan Xie
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; Shantou Central Hospital, Shantou 515000, Guangdong, China
| | - Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; Shantou Central Hospital, Shantou 515000, Guangdong, China
| | - Ying Chen
- Shantou Central Hospital, Shantou 515000, Guangdong, China
| | - Baohong Wen
- Shantou Central Hospital, Shantou 515000, Guangdong, China
| | - Yixi Li
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510000, Guangdong, China
| | - Limin Ma
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Tao Yang
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Yu Zhang
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
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7
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Stress on the posteromedial region of the proximal tibia increased over time after anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2022; 30:1744-1751. [PMID: 34505928 DOI: 10.1007/s00167-021-06731-4] [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: 05/25/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injury induces anterior and rotatory instability of the knee. However, the effect of this instability on the stress distribution in the knee joint in living participants is not clear. The aim of this study was to compare the distribution pattern of subchondral bone density across the proximal tibia in the knees with and without ACL injury, and to investigate the correlation between the distribution patterns of the subchondral bone density and the duration of ACL-deficiency. METHODS Radiographic and computed tomography (CT) data pertaining to 20 patients with unilateral ACL injury without combined injury (ACL-deficient group) and 19 nontraumatic subjects (control group) were collected retrospectively. Subchondral bone density of the proximal tibia was assessed using CT-osteoabsorptiometry. Both the medial and lateral compartments of the proximal tibia were divided into three subregions of equal width in the sagittal direction. The percentage of high subchondral bone density areas (HDA%) in each subregion was quantitatively analyzed. RESULTS HDA% of the posteromedial region was significantly higher in the ACL-deficient group (mean: 21.6%) than in the control group (14.7%) (p = 0.002). In contrast, HDA% of the anteromedial region was significantly lower in the ACL-deficient group (9.4%) than in the control group (15.3%) (p = 0.048). The logarithm of the time elapsed from ACL injury to CT examination showed a significant correlation with HDA% in the posteromedial region (p = 0.032). CONCLUSIONS Subchondral bone density in the posteromedial region significantly increased after ACL injury and correlated with the duration of ACL-deficiency in semi-log manner in meniscus intact knees. The increase in stress on the posteromedial region after ACL injury, which induces a change in the subchondral bone density, justifies early ACL reconstruction after ACL injury.
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Schrijvers JC, van den Noort JC, van der Esch M, Harlaar J. Neuromechanical assessment of knee joint instability during perturbed gait in patients with knee osteoarthritis. J Biomech 2021; 118:110325. [PMID: 33601186 DOI: 10.1016/j.jbiomech.2021.110325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/20/2020] [Accepted: 01/31/2021] [Indexed: 01/02/2023]
Abstract
Knee joint instability is frequently reported by patients with knee osteoarthritis (KOA). Objective metrics to assess knee joint instability are lacking, making it difficult to target therapies aiming to improve stability. Therefore, the aim of this study was to compare responses in neuromechanics to perturbations during gait in patients with self-reported knee joint instability (KOA-I) versus patients reporting stable knees (KOA-S) and healthy control subjects. Forty patients (20 KOA-I and 20 KOA-S) and 20 healthy controls were measured during perturbed treadmill walking. Knee joint angles and muscle activation patterns were compared using statistical parametric mapping and discrete gait parameters. Furthermore, subgroups (moderate versus severe KOA) based on Kellgren and Lawrence classification were evaluated. Patients with KOA-I generally had greater knee flexion angles compared to controls during terminal stance and during swing of perturbed gait. In response to deceleration perturbations the patients with moderate KOA-I increased their knee flexion angles during terminal stance and pre-swing. Knee muscle activation patterns were overall similar between the groups. In response to sway medial perturbations the patients with severe KOA-I increased the co-contraction of the quadriceps versus hamstrings muscles during terminal stance. Patients with KOA-I respond to different gait perturbations by increasing knee flexion angles, co-contraction of muscles or both during terminal stance. These alterations in neuromechanics could assist in the assessment of knee joint instability in patients, to provide treatment options accordingly. Furthermore, longitudinal studies are needed to investigate the consequences of altered neuromechanics due to knee joint instability on the development of KOA.
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Affiliation(s)
- Jim C Schrijvers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Medical Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands; Delft University of Technology, Department of Biomechanical Engineering, Delft, The Netherlands; Erasmus Medical Center, Department of Orthopedics, Rotterdam, The Netherlands
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9
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Sharifi M, Shirazi-Adl A. Knee flexion angle and muscle activations control the stability of an anterior cruciate ligament deficient joint in gait. J Biomech 2021; 117:110258. [PMID: 33493713 DOI: 10.1016/j.jbiomech.2021.110258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/03/2021] [Accepted: 01/10/2021] [Indexed: 01/14/2023]
Abstract
Anterior cruciate ligament (ACL) is a primary structure and a commonly injured ligament of the knee joint. Some patients with ACL deficiency (ACLD) experience joint instability and require a reconstructive surgery to return to daily routines, some can adapt by limiting their activities while others, called copers, can return to high-level activities with no instability. We investigated the effects of alterations in the knee flexion angle (KFA) and muscle force activations on the stability and biomechanics of ACLD joints at 25, 50, and 75% periods of gait stance. ACLD joint stability is controlled by variations in both KFA and knee muscle forces. For the latter, a parameter called activity index is defined as the ratio of forces in ACL antagonists (quadriceps and gastrocnemii) to those in ACL agonists (hamstrings). Under a greater KFA (2-6° beyond the mean of reported values in healthy subjects), an ACLD joint regains its pre-injury stability levels. The ACLD joint stability also markedly improves at smaller quadriceps and larger hamstrings forces (activity indices of 2.0-3.6 at 25%) at the first half of stance and smaller gastrocnemii and larger hamstrings forces (activity indices of 0.1-1.1 at 50% and 0.1-1.2 at 75%) at the second half of stance. Activity index and KFA are both crucial when assessing the dynamic stability of an ACLD joint. These results are helpful in our understanding of the biomechanics and stability of ACLD joints towards improved prevention and treatment strategies.
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Affiliation(s)
- M Sharifi
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Québec, Canada
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Québec, Canada.
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Takasago T, Hamada D, Wada K, Nitta A, Tamaki Y, Goto T, Tsuruo Y, Sairyo K. Insufficient lateral joint laxity after bicruciate-retaining total knee arthroplasty potentially influences kinematics during flexion: A biomechanical cadaveric study. Knee 2021; 28:311-318. [PMID: 33477002 DOI: 10.1016/j.knee.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Soft tissue balancing in bicruciate-retaining (BCR) total knee arthroplasty (TKA) is a challenge that must be overcome to achieve excellent clinical outcomes. However, the optimal degree of joint laxity has yet to be clarified. This cadaveric study sought to examine joint laxity after BCR TKA using a navigation system. METHODS Knee joint laxity was quantified using an image-free navigation system in 8 intact fresh frozen cadavers under three conditions: the native knee, BCR TKA knee, and BCR TKA knee after anterior cruciate ligament resection. Rotational kinematics in the BCR TKA knee during flexion were compared according to whether joint laxity was increased or decreased. RESULTS Knee joint laxity after BCR TKA under varus-valgus movement, anterior translation, and internal-external rotation loadings was similar to that of the native knee. However, lateral joint laxity was decreased during flexion in some cases. BCR TKA-treated knees with decreased lateral joint laxity at 90° of flexion demonstrated more limited tibial internal rotation in deep flexion than the native knee (p < 0.05). The loss of internal rotation in deep flexion was partly recovered by using a lateral insert with a posterior slope of +3°. CONCLUSIONS Restoring optimal joint laxity was not always straightforward in BCR TKA if the 4 ligaments were preserved. Lateral joint laxity was potentially decreased in BCR TKA and may result in kinematic conflict during flexion. Surgeons should be aware of the need to achieve sufficient lateral joint laxity in this type of BCR TKA.
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Affiliation(s)
- Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Akihiro Nitta
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Yoshihiro Tsuruo
- Department of Anatomy, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
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11
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Nishizawa K, Harato K, Morishige Y, Kobayashi S, Niki Y, Nagura T. A comparison of gait characteristics between posterior stabilized total knee and fixed bearing unicompartmental knee arthroplasties. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 22:62-66. [PMID: 32983900 PMCID: PMC7479273 DOI: 10.1016/j.asmart.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/04/2020] [Accepted: 07/27/2020] [Indexed: 11/02/2022]
Abstract
Background/Objective According to previous studies, physiological gait pattern was found in unicompartmental knee arthroplasty (UKA) as compared to total knee arthroplasty (TKA) concerning the gait parameters including gait speed, cadence, and step length. However, little attention had been paid to the detailed kinematic and kinetic differences during gait between TKAs and UKAs. The aim of the present study was to investigate and to clarify the biomechanical differences between posterior stabilized TKAs and fixed bearing UKAs during walking. Methods A total of 28 patients participated in the present study. Fifteen patients who underwent TKA and thirteen patients who underwent UKA were enrolled. Gait analysis was done at an average of 12.9 months after surgery. The subjects performed level walking at a preferred speed. For each subject, three-dimensional kinematic, kinetic and ground reaction force data were recorded as well as clinical data including range of motion at the knee joint and plain radiographs. Differences of knee kinematics or kinetics were compared between TKAs and UKAs using two-tailed Mann Whitney U-test. Results On physical examination, passive range motion was significantly smaller in TKAs than in UKAs, while femorotibial angle on plain radiographs was not significantly different on plain radiographs. In terms of kinematics, TKAs were more flexed at heel contact and less extended in mid-stance phase compared to UKAs in the sagittal plane, and total excursion of TKAs were also smaller than UKAs. Regarding knee kinetics, TKA patients had significantly less peak tibial internal rotation moment in terminal stance phase. In addition, peak knee adduction moment was significantly larger in UKAs than in TKAs, while peak knee flexion moment was not significantly different. Conclusion Posterior stabilized TKAs exhibited less peak tibial internal rotation moment, which is known as pivot shift avoidance gait, in the present study, compared to fixed bearing UKAs. TKAs had similar gait pattern to anterior cruciate ligament deficient knees, compared to UKAs even if patients with TKAs had no subjective pain during walking.
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Affiliation(s)
- Kohei Nishizawa
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yutaro Morishige
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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12
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Miura K, Ohkoshi Y, Ino T, Ukishiro K, Kawakami K, Suzuki S, Suzuki K, Maeda T. Kinematics and center of axial rotation during walking after medial pivot type total knee arthroplasty. J Exp Orthop 2020; 7:72. [PMID: 32986185 PMCID: PMC7522154 DOI: 10.1186/s40634-020-00286-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE In recent years, the medial pivot (MP) type total knee arthroplasty (TKA) implant has been developed and marketed for achieving more natural kinematics with MP. However, little is known about the pivot pattern during walking after MP type TKA. This study aimed to determine the kinematics and center of axial rotation during walking after MP type TKA. METHODS This randomized prospective study enrolled 40 patients with MP type TKA, 20 with cruciate-substituting TKA (MP-CS group), 20 with posterior-stabilized TKA (MP-PS group), and 10 healthy volunteers (control group). The kinematics and center of axial rotation during overground walking were measured by a three-dimensional motion analysis system. The six-degrees-of-freedom kinematics of the knee were calculated by the point cluster method. RESULTS The amount of change in knee flexion in early stance phase was significantly lower in the MP-CS and MP-PS groups than in the control group. The femur showed anterior translation during early stance phase in all three groups. The median center of axial rotation in the transverse plane was predominantly on the lateral side of the knee during stance in all groups. CONCLUSIONS Kinematics during gait are thought to be determined by physical posture, the kinetic chain during weight-bearing, and the kinematic features of adjacent structures, such as the behavior of the biarticular muscles. MP-CS and MP-PS did not necessarily induce rotational motion centered on the medial ball-in-socket component during walking; translational and lateral pivoting movements were also observed. Long-term follow-up is needed to monitor for polyethylene wear and implant loosening.
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Affiliation(s)
- Kota Miura
- Department of Rehabilitation, Hakodate Orthopedics Clinic, 2-115, Ishikawa-cho, Hakodate-shi, Hokkaido, 041-0802, Japan.
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Takumi Ino
- Department of Rehabilitation, Hakodate Orthopedics Clinic, 2-115, Ishikawa-cho, Hakodate-shi, Hokkaido, 041-0802, Japan.,Department of Physical Therapy, Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan
| | - Kengo Ukishiro
- Department of Rehabilitation, Hakodate Orthopedics Clinic, 2-115, Ishikawa-cho, Hakodate-shi, Hokkaido, 041-0802, Japan
| | - Kensaku Kawakami
- Department of Production Systems Eng., National Institute of Technology, Hakodate College, Hakodate, Japan
| | - Sho'ji Suzuki
- Department of Complex and Intelligent Systems, Future University Hakodate, Hakodate, Japan
| | - Ko Suzuki
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
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13
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Liu X, Huang H, Ren S, Rong Q, Ao Y. Use of the normalcy index for the assessment of abnormal gait in the anterior cruciate ligament deficiency combined with meniscus injury. Comput Methods Biomech Biomed Engin 2020; 23:1102-1108. [PMID: 32648770 DOI: 10.1080/10255842.2020.1789119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The normalcy index (NI) has been implemented by several studies as a simple index for quantitatively analyzing diffident gait abnormalities, such as children with cerebral palsy and idiopathic toe-walkers. However, whether the NI can be used in anterior cruciate ligament (ACL) deficiency with different types of meniscus injuries or not, has not been reported yet. In this study, 25 patients who combined different types of ACL and meniscus injuries were evaluated by the NI analysis. 12 healthy subjects were used to define the normal range of NI. The result showed that NI values of patients were significantly larger than the control group (P < 0.05). Meanwhile, the tendency of increasing NI values associated with increasing pathology were significant with only 5 subjects in the smallest group (Jonkheere-Terpsta test: P < 0.001). These results indicated that the NI was a concise yet effective tool to evaluate combined ACL and meniscus injury patients. Increasing severity degree of meniscus tears in ACL rupture patients is corresponded to increasing NI values. It also demonstrates that the proposed NI can be applied as a robustness factor to detect the discrepancy between healthy and patient subjects clinically, and has the potential in the quantitative evaluation of pre- or post-surgery and rehabilitation.
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Affiliation(s)
- Xiaode Liu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Hongshi Huang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Shuang Ren
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Yingfang Ao
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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Sánchez-Alepuz E, Miranda I, Miranda FJ. Functional evaluation of patients with anterior cruciate ligament injury. A transversal analytical study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Liu X, Huang H, Yin W, Ren S, Rong Q, Ao Y. Anterior cruciate ligament deficiency combined with lateral and/or medial meniscal injury results in abnormal kinematics and kinetics during level walking. Proc Inst Mech Eng H 2020; 234:91-99. [PMID: 31714178 DOI: 10.1177/0954411919886763] [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: 11/16/2022]
Abstract
Anterior cruciate ligament injuries are commonly combined with meniscal tears. This study was performed to analyze the kinematics and kinetics of knees with anterior cruciate ligament deficiency with or without a combined medial or/and lateral meniscal injury during level walking. In all, 29 patients with unilateral anterior cruciate ligament deficiency and 15 healthy male volunteers were recruited. Among these patients, 12 had isolated unilateral anterior cruciate ligament injuries (ACLD group), 5 had combined anterior cruciate ligament and lateral meniscal injuries (ACLDL group), 5 had combined anterior cruciate ligament and medial meniscal injuries (ACLDM group), and 7 had combined anterior cruciate ligament and medial/lateral meniscal injuries (ACLDML group). A subject-specific musculoskeletal multibody dynamics model was utilized to estimate the tibiofemoral joint kinematic and kinetic behaviors based on the experimental data measured by using an optical tracking system. Regardless of the presence or absence of meniscal injury, the knees with anterior cruciate ligament deficiency exhibited significantly less extension than the control knees at the terminal stance (range of extension: ACLD, 4.84° ± 4.31°; ACLDL, 6.65° ± 5.73°; ACLDM, 5.21° ± 4.77°; ACLDML, 6.91° ± 4.30°; control, 12.35° ± 5.52°; P < 0.05). A lower extension moment and adduction moment in all anterior cruciate ligament deficiency affected knees were detected during the terminal stance when compared with control knees (P < 0.05). The ACLDML group showed significantly lower proximal-distal compressive forces and anterior-posterior shear forces (approximately 0.5-1.5 body weight; P < 0.05) compared to the other 4 groups, while the anterior-posterior and medial-lateral shear forces tended to increase in the ACLD, ACLDL, and ACLDM groups at the mid to terminal stance. Significant lower adduction-abduction and internal-external moment peaks were observed in ACLDML groups, but not in the ACLD, ACLDL and ACLDM groups. These results indicate that the combination of an anterior cruciate ligament injury and meniscal injury could alter the kinematics and kinetics of anterior cruciate ligament deficiency affected knees depending on the presence and type of the meniscal tear.
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Affiliation(s)
- Xiaode Liu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Hongshi Huang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Wei Yin
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Shuang Ren
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Yingfang Ao
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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16
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Sharifi M, Shirazi-Adl A, Marouane H. Sensitivity of the knee joint response, muscle forces and stability to variations in gait kinematics-kinetics. J Biomech 2020; 99:109472. [DOI: 10.1016/j.jbiomech.2019.109472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
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17
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Sánchez-Alepuz E, Miranda I, Miranda FJ. Functional evaluation of patients with anterior cruciate ligament injury. A transversal analytical study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:99-107. [PMID: 31780400 DOI: 10.1016/j.recot.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 05/29/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate, by means of biomechanical analysis, functional alterations of gait and balance of patients with anterior cruciate ligament (ACL) injury. MATERIAL AND METHODS Transversal analytical study on 64 people, 27 health subjects and 37 patients with ACL injury. Biomechanical analysis of gait in all individuals was performed by means of four tests: 1) kinematic test, to characterize gait pattern; 2) kinetic test, to characterize forces against the floor, duration of treads, symmetry of both legs, and the reproducibility of the gait; 3) pivot-shift test, to analyze the rotational stability of the knee on the sagittal axis; and 4) equilibrium test. RESULTS alterations in kinematic and kinetic analysis were found in both the injured knee and the healthy knee compared to the control group. In the pivot-shift gait test there is a tendency to increase the forces on the three axes, both in the support leg and in the exit leg in patients with ACL injury, in comparison with healthy subjects. CONCLUSION ACL injury-induced changes in gait pattern, changes in forces against the floor, duration of treads, symmetry of both legs, and the reproducibility of gait and changes in rotational stability of the knee on the sagittal axis.
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Affiliation(s)
- E Sánchez-Alepuz
- Servicio de Cirugía Ortopédica y Traumatología de Unión de Mutuas, Valencia, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital IMED Valencia, Burjassot, Valencia, España
| | - I Miranda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - F J Miranda
- Departamento de Fisiología, Universitat de València, Valencia, España
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18
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Sakurai A, Harato K, Morishige Y, Kobayashi S, Niki Y, Nagura T. The effects of toe direction on three-dimensional knee kinematics during closed kinetic chain exercise in patients with anterior cruciate ligament deficient knee. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2019; 18:1-5. [PMID: 31516838 PMCID: PMC6728610 DOI: 10.1016/j.asmart.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 01/14/2023]
Abstract
Background/Objective Closed Kinetic Chain Exercise (CKC Ex) is a safe rehabilitation method for anterior cruciate ligament deficient (ACLD) and reconstructed knees. However, CKC Ex can be risky based on abnormal toe directions. The purpose was to investigate knee kinematics during CKC Ex under three toe directions in ACLD. Methods Twenty patients with unilateral ACL injury participated. The subjects performed five weight-bearing-static lunge tests on each limb under three toe directions, including 0 degrees (TN), 20 degrees (TI), and -20 degrees (TO). Three-dimensional knee kinematics were calculated using three-dimensional motion analysis system and were compared among three different toe directions. Results Among three different toe directions, peak values of knee valgus and external rotation on ACLD side were significantly larger in TO than in TN and TI. In addition, the total excursion in the coronal plane on ACLD side was significantly larger in TO than in TN and TI. Regarding the differences between ACLD and ACLI, peak values of internal rotation angle was significantly smaller in ACLD than in ACLI. Conclusion From the present results, tibial rotation and knee abduction were strongly affected by toe direction. When considering a safe rehabilitation, it would be better to avoid TI and TO in CKC Ex in patients with unilateral ACL injury.
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Affiliation(s)
- Aiko Sakurai
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yutaro Morishige
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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19
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Muscular Force Patterns during Level Walking in ACL-Deficient Patients with a Concomitant Medial Meniscus Tear. Appl Bionics Biomech 2019; 2019:7921785. [PMID: 31191712 PMCID: PMC6525939 DOI: 10.1155/2019/7921785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/25/2019] [Accepted: 04/14/2019] [Indexed: 11/17/2022] Open
Abstract
Background The abnormal knee joint motion patterns caused by anterior cruciate ligament (ACL) deficiency are thought to be associated with articular cartilage degeneration. High rates of meniscus tear combined with ACL rupture are observed, and these knees suffer a higher risk of early cartilage degeneration. Research Question This study investigated lower limb muscular force patterns of ACL-deficient knees with a concomitant medial meniscus tear. Methods 12 volunteers and 22 patients were recruited, including 12 patients with isolated ACL deficiency (ACLD) and 10 ACL-deficient patients with a concomitant medial meniscus tear (ACLDM). Level walking data at a self-selected speed were collected before surgery. Then, a musculoskeletal dynamic analysis system, AnyBody, was applied to simulate tibiofemoral flexion moments and muscle forces. Results Our results indicate that the tibiofemoral peak flexion and extension moments in ACLDM patients are significantly lower than in controls. The rectus femoris force in ACLDM patients was significantly lower than in isolated ACL-deficient patients and the controls during mid and terminal stance phase, while no significant difference was found in hamstring and vastus force. Additionally, the gastrocnemius force in ACL-deficient patients both with and without a medial meniscus tear was lower than in controls during mid-stance phase. Significance The ACLDM patients had lower peak tibiofemoral flexion moment, lower gastrocnemius force in mid-stance phase, and lower rectus femoris force during the mid and terminal stance phase. These results may help clinicians to better understand the muscle function and gait pattern in ACL-deficient patients with a concomitant medial meniscus tear.
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Schrijvers JC, van den Noort JC, van der Esch M, Dekker J, Harlaar J. Objective parameters to measure (in)stability of the knee joint during gait: A review of literature. Gait Posture 2019; 70:235-253. [PMID: 30909003 DOI: 10.1016/j.gaitpost.2019.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Instability of the knee joint during gait is frequently reported by patients with knee osteoarthritis or an anterior cruciate ligament rupture. The assessment of instability in clinical practice and clinical research studies mainly relies on self-reporting. Alternatively, parameters measured with gait analysis have been explored as suitable objective indicators of dynamic knee (in)stability. RESEARCH QUESTION This literature review aimed to establish an inventory of objective parameters of knee stability during gait. METHODS Five electronic databases (Pubmed, Embase, Cochrane, Cinahl and SPORTDiscuss) were systematically searched, with keywords concerning knee, stability and gait. Eligible studies used an objective parameter(s) to assess knee (in)stability during gait, being stated in the introduction or methods section. Out of 10717 studies, 89 studies were considered eligible. RESULTS Fourteen different patient populations were investigated with kinematic, kinetic and/or electromyography measurements during (challenged) gait. Thirty-three possible objective parameters were identified for knee stability, of which the majority was based on kinematic (14 parameters) or electromyography (12 parameters) measurements. Thirty-nine studies used challenged gait (i.e. external perturbations, downhill walking) to provoke knee joint instability. Limited or conflicting results were reported on the validity of the 33 parameters. SIGNIFICANCE In conclusion, a large number of different candidates for an objective knee stability gait parameter were found in literature, all without compelling evidence. A clear conceptual definition for dynamic knee joint stability is lacking, for which we suggest : "The capacity to respond to a challenge during gait within the natural boundaries of the knee". Furthermore biomechanical gait laboratory protocols should be harmonized, to enable future developments on clinically relevant measure(s) of knee stability during gait.
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Affiliation(s)
- Jim C Schrijvers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Musculoskeletal Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands; Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Joost Dekker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Delft University of Technology, Department of Biomechanical Engineering, Delft, the Netherlands
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21
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Classification of gait patterns in patients with unilateral anterior cruciate ligament deficiency based on phase space reconstruction, Euclidean distance and neural networks. Soft comput 2019. [DOI: 10.1007/s00500-019-04017-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Wu W, Zeng W, Ma L, Yuan C, Zhang Y. Modeling and classification of gait patterns between anterior cruciate ligament deficient and intact knees based on phase space reconstruction, Euclidean distance and neural networks. Biomed Eng Online 2018; 17:165. [PMID: 30382920 PMCID: PMC6211421 DOI: 10.1186/s12938-018-0594-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/24/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The anterior cruciate ligament (ACL) plays an important role in stabilizing translation and rotation of the tibia relative to the femur. ACL injury alters knee kinematics and usually links to the alternation of gait patterns. The aim of this study is to develop a new method to distinguish between gait patterns of patients with anterior cruciate ligament deficient (ACL-D) knees and healthy controls with ACL-intact (ACL-I) knees based on nonlinear features and neural networks. Therefore ACL injury will be automatically and objectively detected. METHODS First knee rotation and translation parameters are extracted and phase space reconstruction (PSR) is employed. The properties associated with the gait system dynamics are preserved in the reconstructed phase space. For the purpose of classification of ACL-D and ACL-I knee gait patterns, three-dimensional (3D) PSR together with Euclidean distance computation has been used. These measured parameters show significant difference in gait dynamics between the two groups and have been utilized to form a feature set. Neural networks are then constructed to identify gait dynamics and are utilized as the classifier to distinguish between ACL-D and ACL-I knee gait patterns based on the difference of gait dynamics between the two groups. RESULTS Experiments are carried out on a database containing 18 patients with ACL injury and 28 healthy controls to assess the effectiveness of the proposed method. By using the twofold and leave-one-subject-out cross-validation styles, the correct classification rates for ACL-D and ACL-I knees are reported to be 91.3[Formula: see text] and 95.65[Formula: see text], respectively. CONCLUSION Compared with other state-of-the-art methods, the results demonstrate that gait alterations in the presence of ACL deficiency can be detected with superior performance. The proposed method is a potential candidate for the automatic and non-invasive classification between patients with ACL deficiency and healthy subjects.
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Affiliation(s)
- Wenbao Wu
- Department of Acupuncture, Longyan First Hospital, Longyan, 364000, China
| | - Wei Zeng
- School of Physics and Mechanical & Electrical Engineering, Longyan University, Longyan, 364012, China.
| | - Limin Ma
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China
| | - Chengzhi Yuan
- Department of Mechanical, Industrial and Systems Engineering, University of Rhode Island, Kingston, RI, 02881, USA
| | - Yu Zhang
- Department of Orthopedics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
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Ren S, Yu Y, Shi H, Miao X, Jiang Y, Liang Z, Hu X, Huang H, Ao Y. Three dimensional knee kinematics and kinetics in ACL-deficient patients with and without medial meniscus posterior horn tear during level walking. Gait Posture 2018; 66:26-31. [PMID: 30142451 DOI: 10.1016/j.gaitpost.2018.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/18/2018] [Accepted: 08/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The location of the meniscus tear has been reported to influence kinematics in anterior cruciate ligament deficient (ACLD) knees. Medial meniscus posterior horn tear (MMPHT) often occurred after ACL rupture. Whether MMPHT influences the kinematics and kinetics in ACLD knees has not been reported yet. RESEARCH QUESTION The purpose of this study was to investigate three-dimensional (3D) kinematics and kinetics in ACLD knees with and without MMPHT (ACLD + MMPHT, ACLDs) during level walking. METHODS Fifteen patients with isolated unilateral ACLD, ten with unilateral ACLD + MMPHT, and twenty-two healthy controls underwent gait testing between January 2014 and December 2016. Participant characteristics, as well as gait parameters, were compared among control, ACLDs and ACLD + MMPHT knees. RESULTS Compared to the healthy controls, the ACLD knees with and without MMPHT showed significant extension deficiency at maximum extension (flexion: ACLDs: 7.83 ± 4.3°, ACLD + MMPHT: 11.09 ± 7.8°, control: 3.12 ± 4.6°, p = 0.005) and lower extension moments during terminal stance phase of gait. Compared with the healthy controls, significantly increased external tibial rotation during pre-swing phase and lower rotation moments at terminal stance phase were observed in the ACLD + MMPHT knees, but not in the ACLDs knees. No significant differences in gait parameters were observed between ACLDs and ACLD + MMPHT knees during stance phase of walking. SIGNIFICANCE The ACLD knees with medial meniscus posterior horn tear exhibited extension deficiency, increased external tibial rotation, lower extension and internal rotation moments during the terminal stance phase compared to healthy control knees, presenting a combination of "stiffening gait" and "pivot shift gait" pattern. The ACLDs knees only presented extension deficiency and lower extension moments compared with healthy control knees, presenting a "stiffening gait". Medial meniscus posterior horn tear did not significantly affect gait patterns during stance of walking in ACLD knees.
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Affiliation(s)
- Shuang Ren
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Yuanyuan Yu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Huijuan Shi
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Xin Miao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Yanfang Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Zixuan Liang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Hongshi Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China.
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Computation of the role of kinetics, kinematics, posterior tibial slope and muscle cocontraction on the stability of ACL-deficient knee joint at heel strike – Towards identification of copers from non-copers. J Biomech 2018; 77:171-182. [DOI: 10.1016/j.jbiomech.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/21/2018] [Accepted: 07/04/2018] [Indexed: 02/06/2023]
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Clément J, Toliopoulos P, Hagemeister N, Desmeules F, Fuentes A, Vendittoli PA. Healthy 3D knee kinematics during gait: Differences between women and men, and correlation with x-ray alignment. Gait Posture 2018; 64:198-204. [PMID: 29933182 DOI: 10.1016/j.gaitpost.2018.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 02/13/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Normal 3D knee kinematics during gait is still not well understood, especially regarding differences between women and men. RESEARCH QUESTION The objective of the present study was to characterize 3D knee kinematics during gait in healthy women and men with a validated tool. METHODS Knee kinematics was analysed with the KneeKG™ system in 90 healthy subjects (49 females and 41 males). 3D knee rotations were compared between women and men, and between right and left knees. Each subject underwent full-length weight-bearing x-rays. Correlations between abduction-adduction angles and lower-limb alignment measures on x-rays were assessed. RESULTS In the frontal plane, 2.0-5.0° more abduction occurred in women compared to men (0.000 ≤ p ≤ 0.015) throughout the entire gait cycle. In the transverse plane, 2.4-3.7° more external tibial rotation was seen in women than in men (0.002 ≤ p ≤ 0.041) during the initial and mid-swing phases. No difference was found between the right and left knees. Low correlations (-0.52 ≤ r≤-0.41, p < 0.001) were observed between radiographic hip-knee-ankle angle (HKA) and abduction-adduction angles throughout the stance phase. SIGNIFICANCE Kinematic differences between women and men in the frontal plane can be partly explained by their anatomical differences: women were less in varus than men (HKA of -0.8° vs. -2.6°, p < 0.001). Our study contributes to a better understanding of healthy 3D knee kinematics during gait and highlights the need for accounting of gender differences in future investigations. Better knowledge of natural knee kinematics will be helpful in assessing pathological gait patterns or determining the efficiency of conservative and surgical treatments to restore normal kinematics.
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Affiliation(s)
- Julien Clément
- Hôpital Maisonneuve-Rosemont, Université de Montréal 5415 Boulevard de l'Assomption Montreal, Quebec, H1T 2M4, Canada; Laboratoire de recherche en imagerie orthopédique, École de technologie supérieure, Centre de recherche du CHUM, Tour Viger 900, rue St-Denis, local R11.322 Montreal, Quebec, H2X 0A9, Canada
| | - Panagiota Toliopoulos
- Hôpital Maisonneuve-Rosemont, Université de Montréal 5415 Boulevard de l'Assomption Montreal, Quebec, H1T 2M4, Canada
| | - Nicola Hagemeister
- Laboratoire de recherche en imagerie orthopédique, École de technologie supérieure, Centre de recherche du CHUM, Tour Viger 900, rue St-Denis, local R11.322 Montreal, Quebec, H2X 0A9, Canada
| | - François Desmeules
- Hôpital Maisonneuve-Rosemont, Université de Montréal 5415 Boulevard de l'Assomption Montreal, Quebec, H1T 2M4, Canada
| | | | - Pascal-André Vendittoli
- Hôpital Maisonneuve-Rosemont, Université de Montréal 5415 Boulevard de l'Assomption Montreal, Quebec, H1T 2M4, Canada.
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Kinematics and arthrokinematics in the chronic ACL-deficient knee are altered even in the absence of instability symptoms. Knee Surg Sports Traumatol Arthrosc 2018; 26:1406-1413. [PMID: 29124285 PMCID: PMC5910211 DOI: 10.1007/s00167-017-4780-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the in vivo kinematics and arthrokinematics of chronic ACL-deficient (ACL-D) and unaffected contralateral knees during level walking and downhill running using dynamic biplane radiography. It was hypothesized that ACL-D knees would demonstrate increased anterior translation and internal rotation, and that ACL-deficiency would alter the tibiofemoral contact paths in comparison to the unaffected contralateral side. METHODS Eight participants with unilateral chronic ACL-D without instability symptoms were recruited. The contralateral unaffected knee was considered as control. Kellgren-Lawrence (K-L) grades were determined from ACL-D and unaffected knees. Dynamic knee motion was determined from footstrike through the early-stance phase (20-25% of gait cycle) using a validated volumetric model-based tracking process that matched subject-specific CT bone models to dynamic biplane radiographs. Participants performed level walking at 1.2 m/s and downhill running at 2.5 m/s while biplane radiographs were collected at 100 and 150 images per second, respectively. Tibiofemoral kinematics and arthrokinematics (the path of the closest contact point between articulating subchondral bone surfaces) were determined and compared between ACL-D and unaffected knees. A two-way repeated measures analysis of variance was used to identify differences between ACL-D and unaffected knees at 5% increments of the gait cycle. RESULTS Anterior-posterior translations were significantly larger in ACL-D than unaffected knees during level walking (all p < 0.001) and downhill running (all p ≤ 0.022). Internal rotation showed no significant difference between ACL-D and unaffected knees during level walking and downhill running. Closest contact points on the femur in ACL-D knees were consistently more anterior in the lateral compartment during downhill running (significant from 10 to 20% of the gait cycle, all p ≤ 0.044), but not during level walking. No differences in medial compartment contact paths were identified. Half of the participants had asymmetric K-L grades, with all having worse knee OA in the involved knee. Only 2 relatively young individuals had not progressed beyond stage 1 in either knee. CONCLUSION The results suggest that anterior translation and knee joint contact paths are altered in ACL-D knees even in the absence of instability symptoms. The clinical relevance is that ACL-D patients who do not report symptoms of instability likely still demonstrate altered knee kinematics and arthrokinematics compared to their uninvolved limb. LEVEL OF EVIDENCE Case-control study, Level III.
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Nazary-Moghadam S, Salavati M, Esteki A, Akhbari B, Keyhani S, Zeinalzadeh A. Reliability of kinematic measures in subjects with anterior cruciate ligament deficiency during dual-task walking. J Bodyw Mov Ther 2017; 21:852-859. [DOI: 10.1016/j.jbmt.2017.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 02/14/2017] [Accepted: 02/23/2017] [Indexed: 11/25/2022]
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Mannering N, Young T, Spelman T, Choong PF. Three-dimensional knee kinematic analysis during treadmill gait: Slow imposed speed versus normal self-selected speed. Bone Joint Res 2017; 6:514-521. [PMID: 28855191 PMCID: PMC5579312 DOI: 10.1302/2046-3758.68.bjr-2016-0296.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/16/2017] [Indexed: 11/22/2022] Open
Abstract
Objectives Whilst gait speed is variable between healthy and injured adults, the extent to which speed alone alters the 3D in vivo knee kinematics has not been fully described. The purpose of this prospective study was to understand better the spatiotemporal and 3D knee kinematic changes induced by slow compared with normal self-selected walking speeds within young healthy adults. Methods A total of 26 men and 25 women (18 to 35 years old) participated in this study. Participants walked on a treadmill with the KneeKG system at a slow imposed speed (2 km/hr) for three trials, then at a self-selected comfortable walking speed for another three trials. Paired t-tests, Wilcoxon signed-rank tests, Mann-Whitney U tests and Spearman’s rank correlation coefficients were conducted using Stata/IC 14 to compare kinematics of slow versus self-selected walking speed. Results Both cadence and step length were reduced during slow gait compared with normal gait. Slow walking reduced flexion during standing (10.6° compared with 13.7°; p < 0.0001), and flexion range of movement (ROM) (53.1° compared with 57.3°; p < 0.0001). Slow walking also induced less adduction ROM (8.3° compared with 10.0°; p < 0.0001), rotation ROM (11.4° compared with 13.6°; p < 0.0001), and anteroposterior translation ROM (8.5 mm compared with 10.1 mm; p < 0.0001). Conclusion The reduced spatiotemporal measures, reduced flexion during stance, and knee ROM in all planes induced by slow walking demonstrate a stiff knee gait, similar to that previously demonstrated in osteoarthritis. Further research is required to determine if these characteristics induced in healthy knees by slow walking provide a valid model of osteoarthritic gait. Cite this article: N. Mannering, T. Young, T. Spelman, P. F. Choong. Three-dimensional knee kinematic analysis during treadmill gait: Slow imposed speed versus normal self-selected speed. Bone Joint Res 2017;6:514–521. DOI: 10.1302/2046-3758.68.BJR-2016-0296.R1.
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Affiliation(s)
- N Mannering
- The University of Melbourne, Melbourne Medical School, Melbourne, 3010 Victoria, Australia
| | - T Young
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Level 3 Daly Wing, 35 Victoria Parade, Fitzroy, 3065 Victoria, Australia
| | - T Spelman
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital, Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, 3065 Victoria, Australia
| | - P F Choong
- University of Melbourne Department of Surgery, Director of Orthopaedics, Department of Orthropaedics, The University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia
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Iliopoulos E, Galanis N, Iosifidis M, Zafeiridis A, Papadopoulos P, Potoupnis M, Geladas N, Vrabas IS, Kirkos J. Anterior cruciate ligament deficiency reduces walking economy in "copers" and "non-copers". Knee Surg Sports Traumatol Arthrosc 2017; 25:1403-1411. [PMID: 26231149 DOI: 10.1007/s00167-015-3709-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 07/13/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Patients with ACL injury requiring surgical treatment (non-copers) demonstrate altered neuromuscular control and gait pattern compared with those returning to their pre-injury activities without surgery (copers). Pathological gait pattern may increase the energy cost of walking. We compared the energy cost of flat, uphill, and downhill walking between ACL-deficient and healthy individuals and between "copers" and "non-copers". METHODS Nineteen young males with unilateral ACL injury were allocated into "copers" and "non-copers" according to their ability to return to pre-injury activity without ACL reconstruction. Lysholm and IKDC scales were recorded, and a control group (n = 10) matched for physical characteristics and activity levels was included. All participants performed 8-min walking tasks at 0, +10, and -10 % gradients. Energy cost was assessed by measurement of oxygen consumption (VO2). HR and ventilation (VE), respiratory exchange ratio (RER), and VE/VO2 were also measured. RESULTS VO2 and HR were higher in ACL-deficient patients than in controls during walking at 0, +10, and -10 % gradients (p < 0.01-0.05). There were no differences between "copers" and "non-copers" in VO2 and HR for any gradient. No differences were observed in VE, RER, and VE/VO2 among the three groups. CONCLUSIONS The walking economy of level, uphill, and downhill walking is reduced in ACL-deficient patients. Despite the improved functional and clinical outcome of "copers", their walking economy appears similar to that of "non-copers" but impaired compared with healthy individuals. The higher energy demand and effort during locomotion in "copers" and "non-copers" has clinical implications for designing safer rehabilitation programmes. The increased energy cost in "copers" may be another parameter to consider when deciding on the most appropriate therapeutic intervention (operative and non-operative), particularly for athletes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Efthymios Iliopoulos
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece
| | - Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece.
| | - Michael Iosifidis
- Sports Medicine Unit, 2nd Orthopaedic Department, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Pericles Papadopoulos
- 1st Department of Orthopaedics, Papanikolaou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Potoupnis
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece
| | - Nikolaos Geladas
- Department of Sport Medicine and Biology of Exercise, School of Physical Education and Sport Science, University of Athens, Athens, Greece
| | - Ioannis S Vrabas
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - John Kirkos
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece
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Yao ZL, Wang SB, Zhang Y, Huang WH, Shen HY, Ma LM, Huang HY, Xia H. Clinical Significance of a Novel Knee Joint Stability Assessment System for Evaluating Anterior Cruciate Ligament Deficient Knees. Orthop Surg 2017; 8:75-80. [PMID: 27028384 DOI: 10.1111/os.12225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 12/08/2015] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To investigate the six degrees of freedom (6DOF) kinematics of anterior cruciate ligament (ACL) deficient knees during gait and to explore the clinical significance of a novel knee joint stability assessment system (Opti_Knee, Innomotion, Shanghai, China) in comparison with imaging and arthroscopic examination. METHODS Three subjects diagnosed with ACL deficient knees on the basis of preoperative MRI and CT findings were subjected to treadmill gait analysis. Motion of both knees in 6DOF was measured and analyzed with an optical joint kinematics measurement system. Arthroscopic examination, the gold standard, was performed to confirm the final diagnosis and the clinical diagnosis of ACL deficiency by imaging and motion marker techniques compared with this gold standard. RESULTS Only two of the three subjects diagnosed with ACL deficiency by imaging techniques were later confirmed to have this condition by arthroscopic examination; the third was found to have an intact ACL. When the kinematics of their injured and contralateral knees were compared, abnormalities were found in the two subjects confirmed by arthroscopy to be ACL deficient However, no kinematic difference between the two knees was found in the ACL intact subject. CONCLUSIONS Opti_Knee (Innomotion) can detect abnormal kinematics in ACL deficient knees and thus provides an effective way of assisting the diagnosis of this condition and has potential for clinical application.
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Affiliation(s)
- Zi-long Yao
- Southern Medical University, Guangzhou, Guangdong, China.,Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China.,Department of Orthopedics, Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China
| | - Shao-bai Wang
- Key Laboratory of Exercise and Health Science, Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Yu Zhang
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China.,Department of Orthopedics, Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China
| | - Wen-han Huang
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China.,Department of Orthopedics, Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China
| | - Hong-yuan Shen
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China.,Department of Orthopedics, Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China
| | - Li-min Ma
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China.,Department of Orthopedics, Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China
| | - Hua-yang Huang
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China.,Department of Orthopedics, Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China
| | - Hong Xia
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China.,Department of Orthopedics, Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China
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Bohn MB, Petersen AK, Nielsen DB, Sørensen H, Lind M. Three-dimensional kinematic and kinetic analysis of knee rotational stability in ACL-deficient patients during walking, running and pivoting. J Exp Orthop 2016; 3:27. [PMID: 27730595 PMCID: PMC5059229 DOI: 10.1186/s40634-016-0062-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/30/2016] [Indexed: 12/01/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) deficiency leads to altered stability of the knee. The purpose of this study was to compare the dynamic, rotational stability of the knee, expressed as rotational stiffness, between anterior cruciate ligament-deficient (ACLD) knees, their contralateral intact knees (ACLI) and a knee healthy control group during walking, running and 90° pivoting. We hypothesized a larger tibial internal rotation, a smaller knee joint external moment and a lower rotational stiffness in the ACLD group compared to the ACLI and the control group. Methods Kinematic and kinetic data were collected from both legs of 44 ACLD patients and 16 healthy controls during walking, running and a pivoting maneuver (descending a staircase and immediately pivoting 90° on the landing leg). Motion data were captured using 8 high-speed cameras and a force-plate. Reflective markers were attached to bony landmarks of the lower limb and rigid clusters on the shank and thigh (CASH model). Maximum internal tibial rotation and the corresponding rotational moment were identified for all tasks and groups and used to calculate rotational stiffness (= Δmoment /Δrotation) of the knee. Results The tibial internal rotation of the ACLD knee was not significantly different from the ACLI knee during all three tasks. During walking and running, the tibial rotation of the control group was significantly different from both legs of the ACL-injured patient. For pivoting, no difference in tibial rotation between knees of the ACLD, ACLI and the control group was found. Knee joint external moments were not significantly different between the three groups during walking and pivoting. During running, the moments of the ACLI group were significantly higher than both the knees of the ACLD and the control group. Rotational stiffness did not differ significantly between groups in any of the three tasks. Conclusion A high-intensity activity combining stair descent and pivoting produces similar angular rotations, knee joint external moments and rotational stiffness in ACLD knees compared to ACLI knees and the control group. During running, the ACLI knee displayed a higher external moment than the ACLD and the healthy control group. This could indicate some type of protective strategy or muscular adaptation in the ACL-injured patients.
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Affiliation(s)
- Marie Bagger Bohn
- Division of Sportstrauma, Department of Orthopedics, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Dennis Brandborg Nielsen
- Department of Public Health - Sport, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark
| | - Henrik Sørensen
- Department of Public Health - Sport, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark
| | - Martin Lind
- Division of Sportstrauma, Department of Orthopedics, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark
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Harato K, Sakurai A, Kudo Y, Nagura T, Masumoto K, Otani T, Niki Y. Three-dimensional knee kinematics in patients with a discoid lateral meniscus during gait. Knee 2016; 23:622-6. [PMID: 26979382 DOI: 10.1016/j.knee.2015.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 09/26/2015] [Accepted: 10/14/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND To date, the knee kinematics of a discoid lateral meniscus (DLM) has not been elucidated. The aim was to investigate the three-dimensional knee kinematics in knees with a DLM using gait analysis. METHODS Ten patients (mean: 14years) diagnosed with bilateral DLM and unilaterally symptomatic snapping as well as 10 healthy controls (mean: 23years) participated in the study. Each patient with a DLM had unilaterally snapping knee in full extension and deep flexion. The three-dimensional gait analysis was performed with the point cluster technique. All subjects were asked to walk on a level floor at the speed of their choice. In the sagittal plane, knee excursion was separately evaluated during the weight acceptance phase and the mid-stance phase. In the axial plane, knee excursion during the stance phase was assessed. Finally, knee excursion during the whole gait cycle was evaluated in the frontal plane. Statistical comparison was conducted between groups, and between both sides in the DLM group. RESULTS In the sagittal plane, knee excursions during the weight acceptance phase and the mid-stance phase were significantly smaller in the DLM group than in the control group; in addition, these were smaller on the symptomatic side than on the asymptomatic side in the DLM group. In the axial plane, knee excursion was also significantly smaller on the symptomatic side than on the asymptomatic side in the DLM group, whereas the frontal knee motion did not differ significantly. CONCLUSION Less knee motion in the sagittal plane may prevent snapping during extension and flexion in patients with a DLM. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Aiko Sakurai
- Department of Physical Therapy, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Yutaka Kudo
- Department of Physical Therapy, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, Tokyo, Japan
| | | | - Toshiro Otani
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Ismail SA, Button K, Simic M, Van Deursen R, Pappas E. Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knee: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2016; 35:68-80. [PMID: 27132248 DOI: 10.1016/j.clinbiomech.2016.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/23/2016] [Accepted: 04/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered joint motion that occurs in people with an anterior cruciate ligament deficient knee is proposed to play a role in the initiation of knee osteoarthritis, however, the exact mechanism is poorly understood. Although several studies have investigated gait deviations in individuals with chronic anterior cruciate ligament deficient knee in the frontal and transverse planes, no systematic review has summarized the kinematic and kinetic deviations in these two planes. METHODS We searched five electronic databases from inception to 14th October 2013, with key words related to anterior cruciate ligament, biomechanics and gait, and limited to human studies only. Two independent reviewers assessed eligibility based on predetermined inclusion/exclusion criteria and methodological quality was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology statement checklist. FINDINGS We identified 16 studies, totaling 183 subjects with anterior cruciate ligament deficient knee and 211 healthy subjects. Due to the variability in reported outcomes, we could only perform meta-analysis for 13 sagittal plane outcomes. The only significant finding from our meta-analysis showed that individuals with anterior cruciate ligament deficient knee demonstrated a significantly greater external hip flexor angular impulse compared to control (P=0.03). INTERPRETATION No consensus about what constitutes a typical walking pattern in individuals with anterior cruciate ligament deficient knee can be made, nor can conclusions be derived to explain if gait deviations in the frontal and transverse plane contributed to the development of the knee osteoarthritis among this population.
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Affiliation(s)
- Shiek Abdullah Ismail
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Milena Simic
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Robert Van Deursen
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Gait changes of the ACL-deficient knee 3D kinematic assessment. Knee Surg Sports Traumatol Arthrosc 2015; 23:3259-65. [PMID: 25026934 DOI: 10.1007/s00167-014-3169-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/02/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE Static, one-dimensional testing cannot predict the behaviour of the anterior cruciate ligament (ACL)-deficient knee under realistic loading conditions. Currently, the most widely accepted method for assessing joint movement patterns is gait analysis. The purpose of the study was in vivo evaluation of the behaviour of the anterior cruciate ligament-deficient (ACLD) knees during walking, using 3D, real-time assessment tool. METHODS Biomechanical data were collected prospectively on 30 patients with ACL rupture and 15 healthy subjects as a control group, with KneeKg™ System. Kinematic data were recorded in vivo during treadmill walking at self-selected speed. Flexion/extension, abduction/adduction, anterior/posterior tibial translation and external/internal tibial rotation were compared between groups. RESULTS The ACLD patients showed a significant lower extension of the knee joint during stance phase (p < 0.05; 13.2° ± 2.1° and 7.3° ± 2.7°, for ACLD and control group, respectively). A significant difference in tibial rotation angle was found in ACLD knees compared to control knees (p < 0.05). The patients with ACLD rotated the tibia more internally (-1.4° ± 0.2°) during the mid-stance phase, than control group (0.2° ± 0.3°). There was no significant difference in anteroposterior translation and adduction-abduction angles. CONCLUSION Significant alterations of joint kinematics in the ACLD knee were revealed in this study by manifesting a higher flexion gait strategy and excessive internal tibial rotation during walking that could result in a more rapid cartilage thinning throughout the knee. The preoperative data obtained in this study will be useful to understand the post-ACL reconstruction kinematic behaviour of the knee. CLINICAL RELEVANCE The findings in this study indicate that ACLD knee may adapt functionally to prevent excessive anterior-posterior translation but they fail to avoid rotational instability.
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Harato K, Niki Y, Kudo Y, Sakurai A, Nagura T, Hasegawa T, Masumoto K, Otani T. Effect of unstable meniscal injury on three-dimensional knee kinematics during gait in anterior cruciate ligament-deficient patients. Knee 2015; 22:395-9. [PMID: 26006771 DOI: 10.1016/j.knee.2015.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/13/2015] [Accepted: 03/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our purpose was to clarify the differences of three-dimensional knee kinematics in anterior cruciate ligament (ACL)-deficient patients between with and without meniscal injury using gait analysis. METHODS A total of 72 knees in 36 young athletes with primary and unilateral ACL injury, with a mean age of 22 years, participated. Gait analysis was done before surgery. According to the arthroscopic findings, patients were divided into two groups. The patients with an unstable meniscal tear were allocated to the meniscal injury group (ACL+M group), and the patients without a meniscal tear were allocated to the no meniscal injury group (ACL group). In the gait analysis, three-dimensional knee kinematics was evaluated and compared. RESULTS The patients in both groups exhibited lower sagittal plane knee excursions and peak knee extension angles on the affected limb than on the unaffected limb during the mid-stance. In terms of the axial plane, a rotation angle was significantly smaller in the affected knees than in the unaffected knees in the ACL group. On the other hand, an opposite phenomenon was observed in the ACL+M group. Moreover, a significantly larger rotation angle in the affected knees during the stance phase and the whole gait cycle was observed in the ACL+M group than in the ACL group. CONCLUSION Increased rotational motion during the gait was observed in the ACL-deficient knees combined with unstable meniscal injuries. Meniscal condition may be a key factor for compensatory gait mechanics to prevent rotatory instability in ACL-deficient patients patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kudo
- Department of Physical Therapy, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Aiko Sakurai
- Department of Physical Therapy, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Hasegawa
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Toshiro Otani
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
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de Guise J. KneeKG: A Canadian example of participative innovation in orthopaedic functional evaluation. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Colle F, Lopomo N, Visani A, Zaffagnini S, Marcacci M. Comparison of three formal methods used to estimate the functional axis of rotation: an extensive in-vivo analysis performed on the knee joint. Comput Methods Biomech Biomed Engin 2015. [PMID: 26207419 DOI: 10.1080/10255842.2015.1042464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Estimating the main axis of rotation (AoR) of a human joint represents an important issue in biomechanics. This study compared three formal methods used to estimate functional AoR, namely a cylindrical fitting method, a mean helical axis transformation, and a symmetrical axis approach. These methods were tested on 106 subjects undergoing navigated total knee arthroplasty. AoR orientation in 3D and in the frontal and coronal planes provided by each method was compared to the transepicondylar axis direction. Although all the methods resulted effective, significant differences were identified among them, relatively to the orientation in 3D and in the frontal plane projection. This was probably due to the presence of secondary rotations during the first degrees of knee flexion.
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Affiliation(s)
- Francesca Colle
- a Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli , Via di Barbiano 1/10, 40136 Bologna , Italy.,b Laboratorio di NanoBiotecnologie - NaBi, Istituto Ortopedico Rizzoli , Via di Barbiano 1/10, 40136 Bologna , Italy.,c The BioRobotics Institute, Scuola Superiore Sant'Anna , Pisa , Italy
| | - Nicola Lopomo
- a Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli , Via di Barbiano 1/10, 40136 Bologna , Italy.,b Laboratorio di NanoBiotecnologie - NaBi, Istituto Ortopedico Rizzoli , Via di Barbiano 1/10, 40136 Bologna , Italy.,d Dipartimento di Ingegneria dell'Informazione , Università degli Studi di Brescia , Via Branze 38, 25123 Brescia , Italy
| | - Andrea Visani
- a Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli , Via di Barbiano 1/10, 40136 Bologna , Italy
| | - Stefano Zaffagnini
- a Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli , Via di Barbiano 1/10, 40136 Bologna , Italy
| | - Maurilio Marcacci
- a Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli , Via di Barbiano 1/10, 40136 Bologna , Italy
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Riss des vorderen Kreuzbandes. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-014-0833-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yim JH, Seon JK, Kim YK, Jung ST, Shin CS, Yang DH, Rhym IS, Song EK. Anterior translation and rotational stability of anterior cruciate ligament-deficient knees during walking: speed and turning direction. J Orthop Sci 2015; 20:155-62. [PMID: 25395272 DOI: 10.1007/s00776-014-0672-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/22/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is one of the most common injuries associated with the knee. After ACL injury, knee joint stability can be altered, resulting in abnormal loading during functional activities. Since ACL-deficient (ACLD) knees are also vulnerable to translational and rotational instability, patients need to be wary of certain motions encountered in daily life. The present study investigated the effect of walking speed and pivoting directional change during gait on knee joint kinematics of ACLD knees. We hypothesized that faster walking and crossover turning would induce severe kinematic changes. METHODS Thirty-five patients (22 males and 13 females) having a unilateral isolated subacute ACLD knee (from 1 to 3 months after injury) and contralateral intact (CLI) knee participated in this study. Spatiotemporal parameters, three-dimensional (3D) knee joint angles, and anterior-posterior (AP) translation were obtained by a 3D high-speed motion-capturing system. The CLI knee of each patient served as the control. The calculated AP stability and knee joint angles were used to test the research hypothesis. Mixed two-way repeated measures analysis of variance was performed to clarify the effects of walking speed and pivoting direction with a significance of 0.05. When a significance of mean comparison was detected, a post hoc test was performed. RESULTS Significant and consistent increased AP translation of the tibia relative to the femur at the whole stance phase of the gait cycle was evident in ACLD knees compared to CLI knees for normal and faster (20 % greater than normal) walking speeds. Faster walking speed did not induce significantly more anterior location of the tibia. In addition, ACLD knees were significantly less extended than CLI knees during a large portion of midstance. Although there was a consistent varus offset between the curves of ACLD and CLI knees, the difference did not reach statistical significance during the stance phase. Also, ACLD knees did not show any significant difference in tibial rotation compared to CLI knees during the entire stance phase of the gait cycle. For pivoting turns, ACLD knees showed significantly less extended and varus offset than CLI knees only during the cutting turn. ACLD knees exhibited less tibial internal rotation during the crossover turn and less tibial external rotation during the cutting turn than CLI knees. CONCLUSIONS In ACLD knees, the tibia tended to shift more anteriorly and changed with less extension at walking. However, faster walking speed did not induce any significant difference compared with normal-speed walking. In addition, ACLD knees displayed kinematic changes during pivoting, but not the crossover turn.
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Affiliation(s)
- Ji Hyeon Yim
- Department of Orthopaedic Surgery, Gwangju Hyundae Hospital, Gwangju, Republic of Korea
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Sebastian D, Chovvath R, Malladi R. The sitting active and prone passive lag test: An inter-rater reliability study. J Bodyw Mov Ther 2014; 18:204-9. [DOI: 10.1016/j.jbmt.2013.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/12/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
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Takeda K, Hasegawa T, Kiriyama Y, Matsumoto H, Otani T, Toyama Y, Nagura T. Kinematic motion of the anterior cruciate ligament deficient knee during functionally high and low demanding tasks. J Biomech 2014; 47:2526-30. [PMID: 24837218 DOI: 10.1016/j.jbiomech.2014.03.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 03/14/2014] [Accepted: 03/18/2014] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to determine whether mechanical adaptations were present in patients with anterior cruciate ligament (ACL)-deficient knees during high-demand activities. Twenty-two subjects with unilateral ACL deficiency (11 males and 11 females, 19.6 months after injury) performed five different activities at a comfortable speed (level walking, ascending and descending steps, jogging, jogging to a 90-degree side cutting toward the opposite direction of the tested side). Three-dimensional knee kinematics for the ACL-deficient knees and uninjured contralateral knees were evaluated using the Point Cluster Technique. There was no significant difference in knee flexion angle, but an offset toward the knee in less valgus and more external tibial rotation was observed in the ACL-deficient knee. The tendency was more obvious in high demand motions, and a significant difference was clearly observed in the side cutting motions. These motion patterns, with the knee in less valgus and more external tibial rotation, are proposed to be an adaptive movement to avoid pivot shift dynamically, and reveal evidence in support of a dynamic adaptive motion occurring in ACL-deficient knees.
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Affiliation(s)
- Kentaro Takeda
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Takayuki Hasegawa
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | | | - Hideo Matsumoto
- Institute for Integrated Sports Medicine, Keio University, Tokyo, Japan
| | - Toshiro Otani
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Department of Clinical Biomechanics, Keio University, Tokyo, Japan
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The KneeKG system: a review of the literature. Knee Surg Sports Traumatol Arthrosc 2012; 20:633-8. [PMID: 22215077 DOI: 10.1007/s00167-011-1867-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 12/23/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Accurately quantifying knee joint motion is not simple. Skin movement over the medial and lateral femoral condyles is the greatest obstacle to obtaining accurate movement data non-invasively. The KneeKG™ system was developed with the objective of providing high reliability movement analysis. The goal of this manuscript is to review the technical details, clinical evidence, and potential applications of this system for evaluation of rotational knee laxity. METHODS A comprehensive review of the MEDLINE database was carried out to identify all clinical and biomechanical studies related to KneeKG™ system. RESULTS The KneeKG™ system non-invasively quantifies knee abduction/adduction, axial rotation, and relative translation of the tibia and femur. The accuracy and reproducibility of the system have been assessed. The average accuracy of the acquisition is 0.4° for abduction/adduction, 2.3° for axial rotation, 2.4 mm for anteroposterior translation, and 1.1 mm for axial translation. This clinical tool enables an accurate and objective assessment of the tri-planar function of the knee joint. The measured biomechanical parameters are sensitive to changes in gait due to knee osteoarthritis and ACL deficiency. CONCLUSION The KneeKG™ system provides reliable movement analysis. This system has the potential to improve understanding the biomechanical consequences of trauma or degenerative changes of the knee as well as more accurately quantify rotational laxity as detected by a positive pivot-shift test.
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Chen CH, Li JS, Hosseini A, Gadikota HR, Gill TJ, Li G. Anteroposterior stability of the knee during the stance phase of gait after anterior cruciate ligament deficiency. Gait Posture 2012; 35:467-71. [PMID: 22169387 PMCID: PMC3299839 DOI: 10.1016/j.gaitpost.2011.11.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 11/01/2011] [Accepted: 11/03/2011] [Indexed: 02/02/2023]
Abstract
Quadriceps avoidance and higher flexion strategies have been assumed as effects of ACL deficiency on knee joint function during gait. However, the effect of ACL deficiency on anteroposterior stability of the knee during gait is not well defined. In this study, 10 patients with unilateral acute ACL ruptures and the contralateral side intact performed gait on a treadmill. Flexion angles and anteroposterior translation of the ACL injured and the intact controlateral knees were measured at every 10% of the stance phase of the gait (from heel strike to toe-off) using a combined MRI and dual fluoroscopic imaging system (DFIS). The data indicated that during the stance phase of the gait, the ACL-deficient knees showed higher flexion angles compared to the intact contralateral side, consistent with the assumption of a higher flexion gait strategy. However, the data also revealed that the ACL-deficient knees had higher anterior tibial translation compared to the intact contralateral side during the stance phase of the gait. The higher flexion gait strategy was not shown to correlate to a reduction of the anterior tibial translation in ACL deficient knees. These data may provide indications for conservative treatment or surgical reconstruction of the ACL injured knees in restoration of the knee kinematics during daily walking activities.
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Affiliation(s)
- CH Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - JS Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A Hosseini
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - HR Gadikota
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - TJ Gill
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - G Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Correspondence to: Guoan Li, PhD, Orthopaedic Bioengineering Laboratory, Harvard Medical School/Massachusetts General Hospital, 55 Fruit Street - GRJ 1215, Boston, MA 02114, USA, (), Tel: +1-617-726-6472, Fax: +1-617-724-4392
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