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Hart HF, Birmingham TB, Sritharan P, Primeau C, King MG, Fischer LK. Sex-related differences in gait characteristics and their associations with symptoms in individuals with patellofemoral osteoarthritis. Gait Posture 2024; 107:35-41. [PMID: 37734189 DOI: 10.1016/j.gaitpost.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Patellofemoral osteoarthritis (OA) is an important subgroup of knee OA. However, the influence of sex on gait characteristics in patients with patellofemoral OA is unknown. RESEARCH QUESTION Compare gait characteristics in females and males with patellofemoral OA and investigate their associations with patellofemoral joint-related symptoms and limitations. METHODS Mixed effects polynomial regression models compared knee flexion-extension and adduction moments, knee flexion angles, and vertical ground reaction forces over 100% of stance between 26 females and 22 males with patellofemoral OA, with and without adjustment for walking speed and body mass. Multivariable linear regression models were then used to investigate the associations of gait characteristics with symptoms and limitations measured with the Knee injury and Osteoarthritis Outcome Score Patellofemoral Pain and Osteoarthritis (KOOS-PF) Subscale. Models included a sex-by-gait interaction term, and if significant, separate models were built for females and males. RESULTS While controlling for walking speed and body mass, females had lower knee flexion moment (6-19% and 97-100% of stance), knee extension moment (45-86% of stance), knee adduction moment (3-37% and 69-99% of stance), vertical ground reaction force (1-97% of stance) and knee flexion angle (90-100% of stance) compared with males, when fitted over 100% of stance. Lower cadence, lower knee flexion angular impulse, and higher peak knee flexion angle were associated with worse KOOS-PF scores. Associations were not modified by sex. SIGNIFICANCE There are distinct sex-based differences in gait characteristics throughout stance with patellofemoral OA when adjusting for body mass and walking speed. Lower cadence and knee flexion angular impulse, and higher peak knee flexion angle were associated with more extreme patellofemoral joint-related symptoms and limitations.
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Affiliation(s)
- Harvi F Hart
- School of Physical Therapy, Faculty of Health Sciences, Western University, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, Ontario, Canada
| | - Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Victoria, Australia
| | - Codie Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, Ontario, Canada
| | - Matthew G King
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Victoria, Australia
| | - Lisa K Fischer
- Fowler Kennedy Sport Medicine Clinic, Western University, Ontario, Canada
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Hart HF, Birmingham TB, Sritharan P, Fischer LK. Walk Smarter, Not Harder: Effects of Cadence Manipulation on Gait Biomechanics in Patients with Patellofemoral Osteoarthritis. Med Sci Sports Exerc 2023; 55:633-641. [PMID: 36345138 DOI: 10.1249/mss.0000000000003081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE This study aimed to investigate the effect of walking cadence on knee flexion angular impulse and peak external flexion moment in patients with patellofemoral osteoarthritis (OA). METHODS Forty-eight patients with patellofemoral OA underwent repeated quantitative gait analyses on an instrumented treadmill using a randomized crossover design. Walking trials were conducted at a fixed gait speed, under three cadence conditions: (i) preferred cadence, (ii) +10% increased cadence, and (iii) -10% decreased cadence, completed in random order. Using a linear mixed model, we tested the association of cadence conditions with surrogate measures of patellofemoral load (primary outcome measure: knee flexion angular impulse) while controlling for body mass. We then repeated the analyses while sequentially replacing the dependent variable with secondary outcome measures. RESULTS Walking with increased cadence decreased (adjusted mean difference [95% confidence interval]) the knee flexion angular impulse (-0.85 N·m·s -1 [-1.52 to -0.18], d = 0.20) and peak knee flexion moment (-4.11 N·m [-7.35 to -0.86], d = 0.24), whereas walking with decreased cadence increased the knee flexion angular impulse (1.83 N·m·s -1 [1.15 to 2.49], d = 0.42) and peak knee flexion moment (3.55 N·m [0.30 to 6.78], d = 0.21). Similar decreases and increases were observed for secondary outcome measures. CONCLUSIONS Walking with increased cadence, while maintaining a fixed gait speed, reduces knee flexion angular impulse as well as other surrogate measures of knee loading in patients with patellofemoral OA.
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Affiliation(s)
- Harvi F Hart
- School of Physical Therapy, Faculty of Health Sciences, Western University, Ontario, CANADA
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, Ontario, CANADA
| | - Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Victoria, AUSTRALIA
| | - Lisa K Fischer
- Fowler Kennedy Sports Medicine Clinic, Western University, Ontario, CANADA
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Kayll SA, Hinman RS, Bryant AL, Bennell KL, Rowe PL, Paterson KL. Do biomechanical foot-based interventions reduce patellofemoral joint loads in adults with and without patellofemoral pain or osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2023:bjsports-2022-106542. [PMID: 36898768 DOI: 10.1136/bjsports-2022-106542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To evaluate the effects of biomechanical foot-based interventions (eg, footwear, insoles, taping and bracing on the foot) on patellofemoral loads during walking, running or walking and running combined in adults with and without patellofemoral pain or osteoarthritis. DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, CINAHL, SPORTdiscus, Embase and CENTRAL. ELIGIBILITY CRITERIA FOR SELECTING STUDIES English-language studies that assessed effects of biomechanical foot-based interventions on peak patellofemoral joint loads, quantified by patellofemoral joint pressure, reaction force or knee flexion moment during gait, in people with or without patellofemoral pain or osteoarthritis. RESULTS We identified 22 footwear and 11 insole studies (participant n=578). Pooled analyses indicated low-certainty evidence that minimalist footwear leads to a small reduction in peak patellofemoral joint loads compared with conventional footwear during running only (standardised mean difference (SMD) (95% CI) = -0.40 (-0.68 to -0.11)). Low-certainty evidence indicated that medial support insoles do not alter patellofemoral joint loads during walking (SMD (95% CI) = -0.08 (-0.42 to 0.27)) or running (SMD (95% CI) = 0.11 (-0.17 to 0.39)). Very low-certainty evidence indicated rocker-soled shoes have no effect on patellofemoral joint loads during walking and running combined (SMD (95% CI) = 0.37) (-0.06 to 0.79)). CONCLUSION Minimalist footwear may reduce peak patellofemoral joint loads slightly compared with conventional footwear during running only. Medial support insoles may not alter patellofemoral joint loads during walking or running and the evidence is very uncertain about the effect of rocker-soled shoes during walking and running combined. Clinicians aiming to reduce patellofemoral joint loads during running in people with patellofemoral pain or osteoarthritis may consider minimalist footwear.
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Affiliation(s)
- Samual A Kayll
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adam L Bryant
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick L Rowe
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kade L Paterson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Carvalho C, de Oliveira MPB, Pisani GK, Marolde IB, Serrão PRMDS. Biomechanical characteristics and muscle function in individuals with patellofemoral osteoarthritis: A systematic review of cross-sectional studies. Clin Biomech (Bristol, Avon) 2022; 98:105721. [PMID: 35868250 DOI: 10.1016/j.clinbiomech.2022.105721] [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: 09/15/2021] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our objective was to investigate kinematic and kinetic characteristics and changes in muscle function in individuals with patellofemoral osteoarthritis compared to healthy individuals. METHODS Searches were performed of the Medline, Embase, Web of Science, The Cochrane Library, LILACS, and SciELO databases until May of 2022 for observational studies comparing individuals with patellofemoral osteoarthritis to a control group. The PRISMA guidelines and recommendations of the Cochrane Collaboration were followed. The GRADE approach was used to analyze and synthesize the level of evidence. FINDINGS Fourteen studies were included, involving a total of 594 participants (360 with patellofemoral osteoarthritis and 234 controls). The level of evidence for pelvis, hip adduction and knee abduction angles at 45° of knee flexion during the single-leg squat, and knee flexion angle during the task of walking was very low. Regarding muscle strength, the level of evidence for isometric strength of the hip abductors, extensors and external rotators, and concentric strength of the knee extensors and flexors was very low. It was not possible to synthesize any type of evidence for kinetic, electromyography, or muscle volume variables. INTERPRETATION The level of evidence was very low for all synthesized evidence for kinematic and muscle strength variables. However, individuals with patellofemoral osteoarthritis have lower isometric strength of the hip abductor muscles. Further studies with adequate adjustment for confounding factors, such as the non-inclusion of individuals with osteoarthritis in the tibiofemoral compartment concomitant to patellofemoral osteoarthritis, are needed to gain a better understanding of the clinical characteristics of patellofemoral osteoarthritis.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Marcos Paulo Braz de Oliveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Isabela Bianchini Marolde
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
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MERINO MATHEUSGARCIALOPES, MORALE VICTOR, OCAMPOS GUILHERMEPEREIRA, LUZO MARIACÂNDIDAMIRANDA, CAMARGO OLAVOPIRESDE, REZENDE MÁRCIAUCHOADE. ONE-YEAR RESULTS OF BRACING FOR PATELLO-FEMORAL OSTEOARTHRITIS. PROSPECTIVE RANDOMIZED STUDY. ACTA ORTOPEDICA BRASILEIRA 2021; 29:127-131. [PMID: 34290558 PMCID: PMC8266283 DOI: 10.1590/1413-785220212903243598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/09/2020] [Indexed: 11/21/2022]
Abstract
Objective To compare the long-term effects of a brace designed to stabilize the patellofemoral (PF) joint in comparison to a standard neoprene sleeve for the knee with patellar hole in patients with patellofemoral osteoarthritis (PFOA). Methods 38 patients with PFOA and comorbidities received either a functional PF brace (Study Group, SG) or a neoprene sleeve for the knee (Control Group, CG). Both groups received clinical treatment to OA and comorbidities according to a program from the institution. Patients were evaluated with Western Ontario and MacMaster (WOMAC) and Lequesne questionnaires, 30-second chair stand test (30CST), Timed Up and Go (TUG), anthropometric measures and self-reported physical activity in minutes/week at inclusion, one, three and twelve months after placing the brace. X-Rays were taken to measure the angles. Results At one year there was more abandonment in the CG without differences in weight and body mass index between groups during the study. The SG maintained improvements in Lequesne and WOMAC total and subsets during the year, whereas the CG returned to baseline values for pain, function and total (p < 0.01). TUG and 30CST results were always better in the study group without any clinically important improvement in both groups. Conclusion Long-term use of functional brace added to self-management program improves pain and function in patients with PFOA. Level of Evidence II, Lesser quality RCT (eg, < 80% followup, no blinding, or improper randomization).
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Wheatley MGA, Clouthier AL, Thelen DG, Rainbow MJ. Patella Apex Influences Patellar Ligament Forces and Ratio. J Biomech Eng 2021; 143:1109464. [PMID: 34008841 DOI: 10.1115/1.4051213] [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: 07/28/2020] [Indexed: 11/08/2022]
Abstract
The relationship between three-dimensional shape and patellofemoral mechanics is complicated. The Wiberg patella classification is a method of distinguishing shape differences in the axial plane of the patella that can be used to connect shape differences to observed mechanics. This study uses the Wiberg patella classification to differentiate variance in a statistical shape model describing changes in patella morphology and height. We investigate how patella morphology influences force distribution within the patellofemoral joint. The Wiberg type I patella has a more symmetrical medial and lateral facet while the type III patella has a larger lateral facet compared to medial. The second principal component of the statistical shape model described shape variation that qualitatively resembled the different Wiberg patellas. We generated patellofemoral morphologies from the statistical shape model and integrated them into a musculoskeletal model with a twelve degrees-of-freedom knee. We simulated an overground walking trial with these morphologies and recorded patellofemoral mechanics and ligament forces. An increase in patellar ligament force corresponded with an increase in patella height. Wiberg type III patellas had a sharper patella apex which related to lower ratios of quadriceps tendon forces to patellar ligament forces. The change in pivot point of the patella affects the ratio of forces as well as the patellofemoral reaction force. This study provides a better understanding of how patella morphology affects fundamental patella mechanics which may help identify at-risk populations for pathology development.
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Affiliation(s)
- Mitchell G A Wheatley
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart Street, Kingston, ON K7 L 3N6, Canada
| | - Allison L Clouthier
- School of Human Kinetics, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON K1N 6N5, Canada
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart Street, Kingston, ON K7 L 3N6, Canada
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Influence of the initial foot contact strategy on knee joint moments during stair and ramp descent. Sci Rep 2020; 10:13922. [PMID: 32811865 PMCID: PMC7435172 DOI: 10.1038/s41598-020-70933-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022] Open
Abstract
Gait modification strategies are effective in reducing knee joint loads, which are associated with the development and progression of knee osteoarthritis (OA). However, the effect of modification of the initial foot contact method in high-loading descending task was not investigated. Here, we show that the initial foot contact strategy significantly alters knee joint moments during descending tasks. We found that the second peak flexion moment was lower for the forefoot strike (FFS) than for the rearfoot strike (RFS) in both stair and ramp descent. As for the peak adduction moment, the second peak was lower for the FFS in stair descent, but two peaks were inconsistent in ramp descent. Our results demonstrate that the knee joint loads can be reduced by simple modification of the initial foot contact strategy. In both descending modalities, the FFS may benefit people with early OA in the patellofemoral joint, whose progression is associated with the peak flexion moment. Likewise, the FFS during stair descent may benefit people with early OA in the medial knee, whose progression is associated with the peak adduction moment. The results would be helpful for prevention and rehabilitation programmes of knee OA.
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Teng HL, Dilauro A, Weeks C, Odell C, Kincaid H, VanDine B, Wu WFW. Short-term effects of a trunk modification program on patellofemoral joint stress in asymptomatic runners. Phys Ther Sport 2020; 44:107-113. [PMID: 32504959 DOI: 10.1016/j.ptsp.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate short-term effects of a four-week gait retraining program using visual feedback on trunk flexion angle, patellofemoral joint (PFJ) stress, lower extremity biomechanics and motor skill automaticity. DESIGN Longitudinal interventional study. SETTINGS University research laboratory. PARTICIPANTS Twelve asymptomatic recreational runners (seven male and five female). MAIN OUTCOME MEASURES Trunk kinematics as well as lower extremity kinematics and kinetics were assessed prior to training at week 1 (baseline) and week 2, 3, 4 and 8 (retention). PFJ stress was computed using a sagittal plane model. A dual-task procedure was performed to examine automaticity. RESULTS At week 8, runners demonstrated 10.1° increase in trunk flexion angle (p < .001) and 17.8% reduction in peak PFJ stress (p < .001) compared to baseline. This is associated with a 16.8% decrease in knee extensor moment and less than 2.5° change in knee flexion angle. Participants also showed 33.3% increase in peak hip extensor moment and small reduction in peak ankle plantar flexor moment. Lastly, runners demonstrated automaticity of the modified skill with a dual-task cost of less than 3%. CONCLUSION The gait retraining program is effective to elicit short term changes in trunk position, PFJ stress, and automaticity of the new motor skill.
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Affiliation(s)
- Hsiang-Ling Teng
- Department of Physical Therapy, California State University, Long Beach, United States.
| | - Alyssa Dilauro
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Courtney Weeks
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Christopher Odell
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Heather Kincaid
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Brittany VanDine
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Will F W Wu
- Department of Kinesiology, California State University, Long Beach, United States
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Samaan MA, Grace T, Zhang AL, Majumdar S, Souza RB. Short term outcomes of hip arthroscopy on hip joint mechanics and cartilage health in patients with femoroacetabular impingement syndrome. Clin Biomech (Bristol, Avon) 2020; 71:214-220. [PMID: 31794897 PMCID: PMC7039761 DOI: 10.1016/j.clinbiomech.2019.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/02/2019] [Accepted: 11/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femoroacetabular acetabular impingement syndrome consists of abnormal hip joint morphology resulting in painful hip joint impingement. Hip arthroscopy corrects the abnormal morphology and reduces clinical symptoms associated with femoroacetabular impingement syndrome yet the effects of hip arthroscopy on gait mechanics and cartilage health are not well understood. METHODS Ten femoroacetabular impingement syndrome patients and 10 matched asymptomatic controls underwent gait analysis consisting of three-dimensional hip joint kinematics and kinetics. Femoroacetabular impingement syndrome patients underwent gait analysis and quantitative magnetic resonance imaging of the surgical hip joint before and seven months post-surgery. Patient reported outcomes were obtained from all study participants and were used to quantify hip joint pain, function and quality of life. FINDINGS Prior to surgery, femoroacetabular impingement syndrome patients demonstrated hip joint kinematics or kinetics as the control group. After surgery, femoroacetabular impingement syndrome patients exhibited improved patient reported outcomes, similar hip joint kinematic patterns, increased hip flexion and decreased hip extension moment impulses within the surgical limb. The femoroacetabular impingement syndrome patients that ambulated with increased HFMI post-surgery demonstrated a decrease in femoral cartilage T1ρ and T2 values. INTERPRETATION Femoroacetabular impingement syndrome patients exhibited improved clinical symptoms yet ambulated with altered sagittal plane hip joint loading after hip arthroscopy. Increased hip flexion moment impulse post-surgery was associated with improved cartilage health within the surgical limb. These study findings suggest that sagittal plane hip joint loading at short-term follow-up after hip arthroscopy is associated with cartilage health and may be an important biomechanical parameter in post-operative rehabilitation programs.
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Affiliation(s)
- Michael A Samaan
- Department of Kinesiology and Health Promotion, University of Kentucky, 1200 University Drive, Lexington, KY, 40506, USA
| | - Trevor Grace
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry Street, San Francisco, CA, 94107, USA
| | - Richard B Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry Street, San Francisco, CA, 94107, USA,Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
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Liao TC, Teng HL, Link TM, Majumdar S, Souza RB. Association Between Gait Kinetics and Symptomatic Progression in Persons With Patellofemoral With/Without Concurrent Tibiofemoral Osteoarthritis. J Orthop Res 2019; 37:2593-2600. [PMID: 31378998 DOI: 10.1002/jor.24433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/24/2019] [Indexed: 02/04/2023]
Abstract
To identify the biomechanical risk factors associated with symptomatic progression at 1-year follow-up in persons with patellofemoral joint (PFJ) osteoarthritis (OA). Patients' self-reported Knee Injury and Osteoarthritis Outcome Score questionnaires, magnetic resonance (MR) imaging, and three-dimensional gait analysis were obtained in 53 subjects with PFJ OA at baseline and after 1 year. Joint OA was diagnosed on knee MR images if cartilage lesions existed. Progression was defined by worsening of patients' self-reported symptoms from baseline to 1 year exceeding the minimal detectable change score. Analysis of covariance was used to compare peak knee flexion moment, knee flexion moment impulse, and vertical ground reaction force loading rate between progressors and non-progressors. Seven (13.2%) subjects exhibited progression in self-reported symptoms at 1-year follow-up. When comparing to non-progressors, significantly higher peak knee flexion moment during first half of stance (p = 0.017) and higher moment impulse during the both halves of stance were observed among progressors (p = 0.020-0.040). Persons with symptomatic PFJ OA progression with or without concurrent tibiofemoral OA exhibited abnormal joint loading mechanics when compared with individuals who did not progress. Further work is needed to determine if modification to these loading variables results in a change in the symptomatic progression in these individuals. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2593-2600, 2019.
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Affiliation(s)
- Tzu-Chieh Liao
- Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, California, CA94107
| | - Hsiang-Ling Teng
- Department of Physical Therapy, California State University, Long Beach, California
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, California, CA94107
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, California, CA94107
| | - Richard B Souza
- Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, California, CA94107.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California
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Atkins LT, Smithson C, Grimes D, Heuer N. The influence of sagittal trunk posture on the magnitude and rate of patellofemoral joint stress during stair ascent in asymptomatic females. Gait Posture 2019; 74:121-127. [PMID: 31499406 DOI: 10.1016/j.gaitpost.2019.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Excessive patellofemoral joint stress (PFJS) is thought to be a contributory factor to patellofemoral pain (PFP). Thus, treatment strategies that minimize PFJS rate and magnitude during painful activities like stair ascent may be useful for optimizing outcomes for PFP patients. Sagittal plane trunk posture has been shown to influence PFJS during running although it is unknown if a similar relationship exists during stair ascent. RESEARCH QUESTION Does altering sagittal plane trunk posture affect PFJS rate and/or magnitude during stair ascent? METHODS Twenty asymptomatic females (23.4±2.5 yr; height: 164.4±7.9 cm; mass: 63.0±12.2 kg) performed 5 stair ascent trials (96 steps/min) during 3 conditions: self-selected trunk (SS), flexed trunk (FLX), and extended trunk (EXT). Three-dimensional kinematics (200 Hz) and ground reaction forces (2000 Hz) were collected during each trial. A previously described mathematical model was used to calculate PFJS that included subject-specific and non-subject-specific model inputs. Dependent variables included sagittal plane trunk angle, and the rates and magnitudes of PFJS, patellofemoral joint reaction force (PFJRF), and PFJ contact area during the stance phase of stair ascent. RESULTS Compared to SS, peak PFJS decreased during FLX (mean difference (MD)=2.6 MPa; p<0.001; 95%CI=2.2 to 2.9; effect size (ES)=5.2) and increased during EXT (MD=-3.3 MPa; p<0.001; 95%CI=-3.9 to -2.6; ES=-3.4). Similarly, PFJS rate decreased during FLX (MD=17.8 MPa/sec; p<0.001; 95%CI=13.6 to 21.9; ES=3.6) and increased during EXT (MD=-14 MPa/sec; 95%CI=-19.4 to -8.7; p<0.001; ES=-2.2). SIGNIFICANCE Sagittal plane trunk posture influences PFJS rate and magnitude during stair ascent in asymptomatic females. Increasing and decreasing forward trunk flexion resulted in decreased and increased PFJS respectively. Future studies should examine the effects of these movement strategy modifications on pain and function in patients with PFP.
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Affiliation(s)
- Lee T Atkins
- Angelo State University, Physical Therapy Department, ASU Station #10923, San Angelo, Texas 76909, USA.
| | - Cevan Smithson
- West Texas Rehabilitation Center, 3001 S Jackson Street, San Angelo, Texas, 76904, USA.
| | | | - Nancy Heuer
- Allied Therapy & Consulting Services, Little Rock, Arkansas, USA.
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Liao TC, Powers CM. Tibiofemoral kinematics in the transverse and frontal planes influence the location and magnitude of peak patella cartilage stress: An investigation of runners with and without patellofemoral pain. Clin Biomech (Bristol, Avon) 2019; 62:72-78. [PMID: 30703692 DOI: 10.1016/j.clinbiomech.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/27/2018] [Accepted: 01/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND To determine whether the location and magnitude of peak patella cartilage stress varies among runners with and without patellofemoral pain. To determine whether tibiofemoral kinematics in the frontal and transverse planes predict peak lateral and medial patella cartilage stress. METHODS Twelve recreational runners with patellofemoral pain and 10 pain-free controls participated. Peak patella cartilage stress was quantified using finite element models that incorporated subject-specific kinematic and kinetic data obtained during running. Chi-square analysis was used to determine whether the location of peak patella cartilage stress (medial or lateral) varied between groups. Student's t-tests were used to determine whether the magnitude of peak medial and lateral patella cartilage stress varied between groups. In addition, stepwise regression analysis was performed to determine if tibiofemoral kinematics were predictive of peak medial and lateral cartilage stress. FINDINGS Among all subjects, 64% exhibited peak cartilage stress on the lateral patella facet. No group differences were found for the location and magnitude of peak cartilage stress on the medial or lateral facets. Tibiofemoral rotation in the transverse plane was the best predictor of peak lateral stress (45% of the variance, r = 0.67). Tibiofemoral rotation in the transverse plane was the best predictor of peak medial stress (44% of the variance, r = -0.67), followed by tibiofemoral rotation in the frontal plane (26% of the variance, r = 0.57). INTERPRETATIONS The location and magnitude of peak patella cartilage stress was similar among runners with and without patellofemoral pain. Tibiofemoral kinematics in the frontal and transverse planes are predictive of cartilage stress on the medial and lateral patella facets.
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Affiliation(s)
- Tzu-Chieh Liao
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Christopher M Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
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13
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Foot and ankle characteristics and dynamic knee valgus in individuals with patellofemoral osteoarthritis. J Foot Ankle Res 2018; 11:65. [PMID: 30559838 PMCID: PMC6290542 DOI: 10.1186/s13047-018-0310-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
Study design Controlled laboratory study; cross-sectional design. Background Foot and ankle characteristics and dynamic knee valgus differ in people with and without patellofemoral (PF) pain. However, it is unknown if these characteristics are evident in people with PF osteoarthritis (OA), compared to pain-free older adults. Objectives To compare foot and ankle mobility, foot posture and dynamic knee valgus, measured as the frontal plane projection angle (FPPA) during single-leg squatting, between individuals with and without PFOA. Methods Fifty-one participants with PFOA (66% women, mean ± SD age 57 ± 10 years, body mass index (BMI) 27 ± 6 kg/m2), and 23 controls (56% women, age 56 ± 9 years, BMI 24 ± 4 kg/m2) had ankle dorsiflexion measured using the knee-to-wall test, foot mobility calculated as the difference in midfoot height or width between non-weightbearing and weightbearing, and static foot posture characterized utilizing the Foot Posture Index. Peak FPPA was determined from video recordings while participants performed 5 single-leg squats. Linear regressions examined between-groups relationships for foot and ankle characteristics and the FPPA. Results The PFOA group had less ankle dorsiflexion (odds ratio 6.7, 95% confidence interval 2.46-18.2), greater midfoot height mobility (5.2, 1.78-15.14) and width mobility (4.3, 1.33-14.39), and greater foot mobility magnitude (8.4, 2.32-30.69) than controls. There was no difference in FPPA (knee valgus angle) between groups (15, 0.63-377.99). Conclusion Foot and ankle characteristics were different in individuals with PFOA compared to control participants, however there was no difference in dynamic knee valgus during single leg squat. Clinical interventions to address greater foot mobility may be relevant for PFOA.
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Eijkenboom JFA, Waarsing JH, Oei EHG, Bierma-Zeinstra SMA, van Middelkoop M. Is patellofemoral pain a precursor to osteoarthritis?: Patellofemoral osteoarthritis and patellofemoral pain patients share aberrant patellar shape compared with healthy controls. Bone Joint Res 2018; 7:541-547. [PMID: 30294426 PMCID: PMC6168714 DOI: 10.1302/2046-3758.79.bjr-2018-0112.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives It has been hypothesized that patellofemoral pain, a common knee condition in adolescents and young adults, may be a precursor of degenerative joint changes and may ultimately lead to patellofemoral osteoarthritis. Since both conditions share several mechanical disease characteristics, such as altered contact area between the femur and patella and increased joint stress, we investigated whether these conditions share similar and different shape characteristics of the patella compared with normal controls. Methods This cross-sectional study compared three different study populations: 32 patellofemoral pain subjects (mean age, 32 years (22 to 45); 72% female); 56 isolated radiological patellofemoral osteoarthritis subjects (mean age, 54 years (44 to 58); 89% female); and 80 healthy control subjects (mean age, 52 years (44 to 58); 74% female). Measurements included questionnaires, and lateral and skyline radiographs of the knee. Two separate 30-point 2D statistical shape models of the patella were created from the lateral and skyline radiographs. A general linear model was used to test for differences in standardized shape modes (a specific shape variant of the patella) between patellofemoral osteoarthritis, patellofemoral pain, and controls, using Bonferroni correction and adjustment for body mass index and gender. Results Five shape modes showed statistically significant differences between groups: skyline modes 1 (p < 0.001), 8 (p = 0.004), and 10 (p < 0.001); and lateral modes 5 (p = 0.002) and 7 (p = 0.002). Skyline mode 8 and lateral mode 5 were similar for patellofemoral osteoarthritis and patellofemoral pain populations, while being statistically significant different from the control group. Conclusion Our results indicate that patellofemoral pain and patellofemoral osteoarthritis share similar shape characteristics, which are different from control subjects. These findings support the proposed continuum disease model of patellofemoral pain predisposing to the development of patellofemoral osteoarthritis. Cite this article: J. F. A. Eijkenboom, J. H. Waarsing, E. H. G. Oei, S. M. A. Bierma-Zeinstra, M. van Middelkoop. Is patellofemoral pain a precursor to osteoarthritis? Patellofemoral osteoarthritis and patellofemoral pain patients share aberrant patellar shape compared with healthy controls. Bone Joint Res 2018;7:541–547. DOI: 10.1302/2046-3758.79.BJR-2018-0112.R1.
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Affiliation(s)
- J F A Eijkenboom
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Teng HL, Pedoia V, Link TM, Majumdar S, Souza RB. Local associations between knee cartilage T 1ρ and T 2 relaxation times and patellofemoral joint stress during walking: A voxel-based relaxometry analysis. Knee 2018; 25:406-416. [PMID: 29681528 PMCID: PMC6049815 DOI: 10.1016/j.knee.2018.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/22/2017] [Accepted: 02/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to utilize voxel-based relaxometry (VBR) to examine local correlations between patellofemoral joint (PFJ) stress during gait and PFJ cartilage relaxation times. METHODS Eighty-three subjects with and without PFJ osteoarthritis (OA) underwent knee magnetic resonance (MR) images using fast spin-echo, T1ρ and T2 relaxation time sequences. Patellar and trochlear cartilage relaxation times were computed for each voxel. Peak PFJ stress was computed during the stance phase from three-dimensional gait analysis. Statistical Parametric Mapping was used to perform VBR analyses. Pearson partial correlations were used to evaluate the associations between peak PFJ stress and cartilage relaxation times while controlling for age, sex, and body mass index. RESULTS A higher percentage of the trochlear cartilage (15.9-29.1%) showed significant positive correlations between PFJ stress and T1ρ and T2 than the patellar cartilage (7.4-13.6%). Average correlation coefficient (R) of the voxels showing significant positive correlations ranged from 0.27 to 0.29. Subcompartment analysis revealed a higher percentage of lateral compartment cartilage (trochlea: 30.2-34.7%, patella: 8.1-14.8%) showed significant correlations between peak PFJ stress and T1ρ and T2 than the medial compartment cartilage (trochlea: 7.1-27.2%, patella: 5.5-5.9%). Subgroup analysis showed that larger percentages of PFJ cartilage demonstrated significant positive correlations with PFJ stress in subjects with PFJ OA than those without PFJ OA. CONCLUSIONS The findings of this study suggest that peak PFJ stress has a greater influence on the biochemical composition of the trochlear than the patellar cartilage, and the lateral than the medial PFJ compartment.
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Affiliation(s)
- Hsiang-Ling Teng
- Musculoskeletal Quantitative Imaging Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, San Francisco, CA, USA; Department of Physical Therapy, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA, USA.
| | - Valentina Pedoia
- Musculoskeletal Quantitative Imaging Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, San Francisco, CA, USA
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, San Francisco, CA, USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, San Francisco, CA, USA
| | - Richard B. Souza
- Musculoskeletal Quantitative Imaging Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, San Francisco, CA, USA,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, San Francisco, CA, USA
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16
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Nunes GS, Scattone Silva R, Dos Santos AF, Fernandes RAS, Serrão FV, de Noronha M. Methods to assess patellofemoral joint stress: A systematic review. Gait Posture 2018; 61:188-196. [PMID: 29353744 DOI: 10.1016/j.gaitpost.2017.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 02/02/2023]
Abstract
Changes in patellofemoral joint (PFJ) stress are related to the development and course of PFJ dysfunctions. Different methods for PFJ stress calculation have been used, making the comparison of PFJ stress values across different studies difficult. The purpose of this study was to systematically review the methods for PFJ stress calculation and highlight the differences among the methods. A systematic literature search was conducted in Medline, Embase, CINAHL, SPORTDiscus and Web of Science databases. Included studies examined PFJ stress in subjects with or without musculoskeletal conditions. Of 12,670 identified studies, 53 were included, with a total of 1134 subjects evaluated. The main differences among the methods to calculate PFJ stress were: i) method to calculate PFJ contact area; ii) method to calculate a constant (coefficient k) that defines the relation between quadriceps force and PFJ reaction force; iii) the inclusion of adjustments for sagittal plane forces. Considerable variability in PFJ stress results was observed. The greatest PFJ stress value was 55.03 MPa during a dance jump and the lowest value was 1.9 MPa during walking at the speed of 1.4 m/s. Most studies applied methods which use data from previous studies. However, methods which use data from their own participants for most parts of the calculation might be preferred to minimize potential errors. When direct measures are not possible, a standard method could be applied to facilitate comparisons among studies.
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Affiliation(s)
- Guilherme S Nunes
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil.
| | - Rodrigo Scattone Silva
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | | - Ricardo A S Fernandes
- Department of Electrical Engineering, Federal University of São Carlos, São Carlos, Brazil
| | | | - Marcos de Noronha
- Department of Community and Allied Health, La Trobe University, Bendigo, VIC, Australia
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Crossley KM, Schache AG, Ozturk H, Lentzos J, Munanto M, Pandy MG. Pelvic and Hip Kinematics During Walking in People With Patellofemoral Joint Osteoarthritis Compared to Healthy Age-Matched Controls. Arthritis Care Res (Hoboken) 2017; 70:309-314. [PMID: 28437567 DOI: 10.1002/acr.23261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/18/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patellofemoral (PF) joint osteoarthritis (OA) is common, yet little is known about how this condition influences lower-extremity biomechanical function. This study compared pelvis and lower-extremity kinematics in people with and without PF joint OA. METHODS Sixty-nine participants (64% women, mean ± SD age 56 ± 10 years) with anterior knee pain aggravated by PF joint-loaded activities (e.g., stair ambulation, rising from sitting, or squatting) and radiographic lateral PF joint OA on skyline radiographs were compared with 18 controls (78% women, mean ± SD age 53 ± 7 years) with no lower-extremity pain or radiographic OA. Knee Injury and Osteoarthritis Outcome Score (KOOS) data were collected from participants with PF joint OA. Quantitative gait analyses were conducted during overground walking at a self-selected speed. Pelvis and lower-extremity kinematics were calculated across the stance phase. Data were statistically analyzed using analyses of covariance, with age and sex as covariates (P < 0.05). RESULTS Participants with PF joint OA reported a mean ± SD KOOS pain subscale score of 65 ± 15, KOOS symptoms subscale score of 63 ± 16, KOOS activities of daily living subscale score of 73 ± 13, KOOS sports/recreation subscale score of 45 ± 23, and KOOS quality of life subscale score of 43 ± 16. Participants with PF joint OA walked with greater anterior pelvic tilt throughout the stance phase, as well as greater lateral pelvic tilt (i.e., pelvis lower on the contralateral side), greater hip adduction, and lower hip extension during the late stance phase. No differences in knee and ankle joint angles were observed between groups. CONCLUSION People with PF joint OA walk with altered pelvic and hip movement patterns compared with aged-matched controls. Restoring normal movement patterns during walking in people with PF joint OA may be warranted to help alleviate symptoms.
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Affiliation(s)
- Kay M Crossley
- La Trobe University, Bundoora, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | | | - Hannah Ozturk
- University of Melbourne, Parkville, Victoria, Australia
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18
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Teng HL, Wu D, Su F, Pedoia V, Souza RB, Ma CB, Li X. Gait Characteristics Associated With a Greater Increase in Medial Knee Cartilage T 1ρ and T 2 Relaxation Times in Patients Undergoing Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45:3262-3271. [PMID: 28898105 DOI: 10.1177/0363546517723007] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoarthritis of the medial tibiofemoral joint (MTFJ) is prevalent among patients undergoing anterior cruciate ligament reconstruction (ACLR). Magnetic resonance T1ρ and T2 relaxation times provide noninvasive methods to quantify early cartilage degeneration. Altered sagittal-plane gait biomechanics have been observed after ACLR, but their associations with longitudinal changes in MTFJ cartilage T1ρ and T2 remain unclear. Hypothesis/Purpose: To examine whether the peak knee flexion moment (KFM), knee flexion angle (KFA), and vertical ground-reaction force (vGRF) during gait are associated with prospective changes in medial tibiofemoral cartilage T1ρ and T2 in ACL-reconstructed knees and to compare these gait characteristics between patients undergoing ACLR and healthy control participants. We hypothesized that a higher KFM, KFA, and vGRF would be associated with greater increases in cartilage relaxation times and that patients undergoing ACLR would demonstrate altered gait characteristics compared with healthy controls. STUDY DESIGN Controlled laboratory study. METHODS Thirty-three patients undergoing ACLR underwent gait analysis before and 6 months and 1 year after ACLR and knee magnetic resonance imaging (MRI) before and 6 months, 1 year, and 2 years after ACLR. Twelve healthy controls underwent knee MRI and gait analysis at baseline and 1 year. Cartilage T1ρ and T2 were calculated for the medial tibia and medial femoral condyle. Linear regressions were used to evaluate associations between gait characteristics and changes in cartilage relaxation times from before ACLR to follow-up time points. Independent t tests were used to compare differences in gait between patients undergoing ACLR and control participants. RESULTS A higher KFM and KFA before ACLR were related to greater increases in medial femoral condyle T1ρ and T2 at 6 months after ACLR. Similarly, a higher KFM, KFA, and vGRF at 6 months were associated with greater increases in medial tibia and medial femoral condyle T1ρ and T2 at 1 and 2 years after ACLR. Gait characteristics at 1 year were not associated with changes in cartilage relaxation times at 2 years after ACLR. Compared with healthy controls, patients undergoing ACLR demonstrated a lower KFM at 6 months after ACLR. CONCLUSION/CLINICAL RELEVANCE The findings of this study revealed that a higher KFM, KFA, and vGRF during gait, especially at 6 months after ACLR, were associated with greater deterioration of MTFJ cartilage health at later time points.
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Affiliation(s)
- Hsiang-Ling Teng
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Physical Therapy, California State University, Long Beach, Long Beach, California, USA
| | - Daniel Wu
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Favian Su
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Richard B Souza
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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Thoma LM, McNally MP, Chaudhari AM, Best TM, Flanigan DC, Siston RA, Schmitt LC. Differential knee joint loading patterns during gait for individuals with tibiofemoral and patellofemoral articular cartilage defects in the knee. Osteoarthritis Cartilage 2017; 25:1046-1054. [PMID: 28232097 DOI: 10.1016/j.joca.2017.02.794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/31/2017] [Accepted: 02/14/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine compartment-specific loading patterns during gait, quantified as joint reaction forces (JRF), of individuals with knee articular cartilage defects (ACD) compared to healthy controls (HC). METHODS Individuals with ACDs and HC participated. Individuals with ACDs were divided into groups according to ACD location: PF (only a patellofemoral ACD), TF (only a tibiofemoral ACD), and MIX (both PF and TF ACDs). Participants underwent three-dimensional gait analysis at self-selected speed. TF joint reaction force (TF-JRF) was calculated using inverse dynamics. PF joint reaction force (PF-JRF) was derived from estimated quadriceps force (FQUAD) and knee flexion angle. Primary variables of interest were the PF- and TF-JRF peaks (body weight [×BW]). Related secondary variables (gait speed, quadriceps strength, knee function, activity level) were evaluated as covariates. RESULTS First peak PF-JRF and TF-JRF were similar in the TF and MIX groups (0.75-1.0 ×BW, P = 0.6-0.9). Both peaks were also similar in the PF and HC groups (1.1-1.3 ×BW, P = 0.7-0.8), and higher than the TF and MIX groups (P = 0.004-0.02). For the second peak PF-JRF, only the HC group was higher than the TF group (P = 0.02). The PF group walked at a similar speed as the HC group; both groups walked faster than the TF and MIX groups (P < 0.001). With gait speed and quadriceps strength as covariates, no differences were observed in JRF peaks. CONCLUSIONS The results suggest the presence of a TF ACD (TF and MIX groups), but not a PF ACD (PF group), may affect joint loading patterns during walking. Walking slower may be a protective gait modification to reduce load.
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Affiliation(s)
- L M Thoma
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - M P McNally
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - A M Chaudhari
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Orthopedics, The Ohio State University, Columbus, OH, USA; Department of Mechanical and Aerospace Engineering, College of Engineering, The Ohio State University, Columbus, OH, USA
| | - T M Best
- Departments of Orthopedics, Family Medicine, Biomedical Engineering, University of Miami, Miami, FL, USA; UHealth Sports Medicine Institute, Miami, FL, USA
| | - D C Flanigan
- OSU Sports Medicine, Columbus, OH, USA; Department of Orthopedics, The Ohio State University, Columbus, OH, USA
| | - R A Siston
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Orthopedics, The Ohio State University, Columbus, OH, USA; Department of Mechanical and Aerospace Engineering, College of Engineering, The Ohio State University, Columbus, OH, USA
| | - L C Schmitt
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Russell C, Pedoia V, Souza R, Majumdar S. Cross-sectional and longitudinal study of the impact of posterior meniscus horn lesions on adjacent cartilage composition, patient-reported outcomes and gait biomechanics in subjects without radiographic osteoarthritis. Osteoarthritis Cartilage 2017; 25:708-717. [PMID: 27838383 PMCID: PMC7263373 DOI: 10.1016/j.joca.2016.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/03/2016] [Accepted: 10/31/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to assess cross-sectional and longitudinal effects of meniscal lesions on adjacent cartilage T1ρ and T2 relaxation times, patient-reported outcomes and gait biomechanics. DESIGN Thirty patients with no cartilage morphological defects reported by Whole Organ MRI Score (WORMS) magnetic resonance imaging (MRI) grading and no radiographic osteoarthritis (OA) (Kellgren--Lawrence (KL) ≤ 1) were selected, 15 with posterior meniscus horn lesions and 15 matched controls without meniscal lesions. All were imaged on a 3T MR scanner for three consecutive years, except those who dropped from the study. Sagittal and frontal plane kinematic gait data were acquired at baseline. The Knee Injury and Osteoarthritis Outcome Score (KOOS) survey was taken each time. All images were automatically segmented and registered to an atlas for voxel-by-voxel cross-sectional and longitudinal analyses. RESULTS Relaxation time comparisons between groups showed elevated T1ρ of the lateral tibia (LP) and elevated T2 of the medial tibia (MT) and LT at 1 and 2 years in the lesion group. Longitudinal comparisons within each group revealed greater relaxation time elevations over one and 2 years in the group with lesions. KOOS Quality of Life (QOL) was significantly different between the groups at all time points (P < 0.05), as were other KOOS subcategories. No significant differences in the frontal or sagittal biomechanics were observed between the groups at baseline. CONCLUSIONS Individuals with healthy cartilage and posterior meniscal horn lesions have increased relaxation times when compared to matched controls, increased relaxation time changes over 2 years, and consistently report a lower KOOS QOL, yet show no difference in gait biomechanics.
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Affiliation(s)
- C. Russell
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - V. Pedoia
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - R.B. Souza
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA,Department of Physical Therapy, University of California, San Francisco, San Francisco, CA, USA
| | - S. Majumdar
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA,Address correspondence and reprint requests to: S. Majumdar, Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1700 4th Street, Suite 203, San Francisco, CA 94158, USA. Fax: 1-(415)-353-9423. (C. Russell)
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21
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Samaan MA, Schwaiger BJ, Gallo MC, Sada K, Link TM, Zhang AL, Majumdar S, Souza RB. Joint Loading in the Sagittal Plane During Gait Is Associated With Hip Joint Abnormalities in Patients With Femoroacetabular Impingement. Am J Sports Med 2017; 45:810-818. [PMID: 28006109 PMCID: PMC5429741 DOI: 10.1177/0363546516677727] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a morphological abnormality of the hip joint that results in functional impairments during various activities of daily living (ADL) such as walking. Purpose/Hypothesis: The purpose of this study was to determine if lower extremity joint loading differed between patients with FAI and controls and to determine whether these altered biomechanical parameters were associated with intra-articular abnormalities. It was hypothesized that patients with FAI would exhibit altered lower extremity joint loading during walking when compared with healthy controls and that these altered joint loading patterns would be associated with intra-articular abnormalities. STUDY DESIGN Controlled laboratory study. METHODS Lower extremity kinetics was assessed during walking at a self-selected speed in 15 presurgical patients with FAI and 34 healthy controls matched for age and body mass index. All participants underwent unilateral hip magnetic resonance imaging (MRI) to assess hip joint abnormalities. Hip joint abnormalities were assessed using a semiquantitative MRI-based scoring system. Self-reported outcomes of pain and function were obtained using the Hip disability and Osteoarthritis Outcome Score (HOOS), and physical performance was measured using the 6-minute walk test (6MWT). Group differences were assessed using an independent t test and analysis of variance. In the patients with FAI, associations of joint kinetics with HOOS subscores and intra-articular abnormalities were assessed using the Pearson ( r) and Spearman (ρ) correlation coefficients, respectively. RESULTS Compared with the control group, the FAI group exhibited a significantly increased severity of acetabular (FAI: 1.87 ± 1.55; control: 0.47 ± 0.79; P < .001) and femoral (FAI: 3.27 ± 2.79; control: 1.21 ± 1.55; P = .002) cartilage abnormalities, increased levels of pain (FAI: 65.0 ± 18.8; control: 98.2 ± 3.4; P = .001), and reduced function (FAI: 67.2 ± 21.5; control: 98.9 ± 3.4; P < .001) but similar walking speeds (FAI: 1.55 ± 0.19 m/s; control: 1.63 ± 0.22 m/s; P = .20) and 6MWT performance (FAI: 628.0 ± 91.2 m; control: 667.2 ± 73.4 m; P = .13). The FAI group demonstrated increased hip flexion moment impulses (FAI: 0.14 ± 0.04 N·m·s/kg; control: 0.11 ± 0.03 N·m·s/kg; P = .03), peak ankle dorsiflexion moments (FAI: 1.64 ± 0.16 N·m/kg; control: 1.46 ± 0.31 N·m/kg; P = .04), and ankle dorsiflexion moment impulses (FAI: 0.39 ± 0.07 N·m·s/kg; control: 0.31 ± 0.07 N·m·s/kg; P = .01) compared with the control group. Within the FAI group, an increased hip flexion moment impulse during walking was significantly correlated with increased pain ( r = -0.60, P = .03), decreased ADL ( r = -0.57, P = .04), and increased severity of acetabular cartilage abnormalities (ρ = 0.82, P < .01). CONCLUSION Patients with FAI exhibited altered hip and ankle joint loading patterns during walking. These data suggest that patients with FAI demonstrate both local and distal joint alterations during walking and that hip joint loading is directly related to hip joint abnormalities. CLINICAL RELEVANCE The results of this study suggest that the hip flexion moment impulse may be an important biomechanical parameter to understand FAI, as the hip flexion moment impulse during walking was shown to be directly related to hip joint abnormalities on MRI.
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Affiliation(s)
- Michael A. Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA,Address correspondence to Michael A. Samaan, PhD, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA ()
| | - Benedikt J. Schwaiger
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Matthew C. Gallo
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Kiyoshi Sada
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Richard B. Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
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22
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van der List JP, Chawla H, Villa JC, Pearle AD. Why do patellofemoral arthroplasties fail today? A systematic review. Knee 2017; 24:2-8. [PMID: 27825938 DOI: 10.1016/j.knee.2015.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/13/2015] [Accepted: 11/15/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Historically poor results of patellofemoral arthroplasty (PFA) were reported in the setting of isolated patellofemoral osteoarthritis (OA). In order to lower PFA failure rates, it is important to identify failure modes using a standardized method. In this systematic review, PFA failure modes were assessed and compared in early vs. late failures and older vs. recent studies. METHODS Databases of PubMed, Embase and Cochrane and annual registries were searched for studies reporting PFA failures. Failure modes in studies with mean follow-up <5years were classified as early failures while >5years were classified late failures. Cohorts started before 2000 were classified as older studies and started after 2000 as recent studies. RESULTS Thirty-nine cohort studies (10 level II and 29 level III or IV studies) and three registries were included with overall low quality of studies (GRADE criteria). A total of 938 PFA failures were included and were caused by OA progression (38%), pain (16%), aseptic loosening (14%) and patellar maltracking (10%). Pain was responsible for most early failures (31%), while OA progression was most common in late failures (46%). In older studies, OA progression was more commonly reported as failure mode than in more recent studies (53% vs. 39%, p=0.005). CONCLUSION This level IV systematic review with low quality of studies identified OA progression and pain as major failure modes. Reviewing these studies, appropriate patient selection could prevent PFA failures in select cases. Future studies assessing the role of PFA in isolated patellofemoral OA are necessary.
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Affiliation(s)
- J P van der List
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
| | - H Chawla
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
| | - J C Villa
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
| | - A D Pearle
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
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23
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Teng HL, Calixto N, MacLeod T, Nardo L, Link T, Majumdar S, Souza R. Associations between patellofemoral joint cartilage T1ρ and T2 and knee flexion moment and impulse during gait in individuals with and without patellofemoral joint osteoarthritis. Osteoarthritis Cartilage 2016; 24:1554-64. [PMID: 27084352 PMCID: PMC6348063 DOI: 10.1016/j.joca.2016.04.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/10/2016] [Accepted: 04/04/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to investigate the associations between patellofemoral cartilage T1ρ and T2 relaxation times and knee flexion moment (KFM) and KFM impulse during gait. METHOD Knee magnetic resonance (MR) images were obtained from 99 subjects with and without patellofemoral joint (PFJ) osteoarthritis (OA), using fast spin-echo, T1ρ and T2 relaxation time sequences. Patellar and trochlear cartilage relaxation times were computed for the whole cartilage, and superficial and deep layers (laminar analysis). Subjects also underwent three-dimensional (3D) gait analysis. Peak KFM and KFM impulse were calculated during the stance phase. Linear regressions were used to examine whether cartilage relaxation times were associated with knee kinetics during walking while adjusting age, sex, body mass index (BMI) and walking speed. RESULTS Higher peak KFM and KFM impulse were significantly related to higher T1ρ and T2 relaxation times of the trochlear and patellar cartilage, with standardized regression coefficients ranging from 0.21 to 0.28. Laminar analysis showed that overall the superficial layer of patellofemoral cartilage showed stronger associations with knee kinetics. Subgroup analysis revealed that in subjects with PFJ OA, every standard deviation change in knee kinetics was related to greater increases in PFJ cartilage T1ρ and T2 (standardized coefficients: 0.29 to 0.41). Conversely, in subjects without OA, weaker relationships were observed between knee kinetics and PFJ cartilage T1ρ and T2. CONCLUSIONS Our findings suggest that increased peak KFM and KFM impulse were related to worse cartilage health at the PFJ. This association is more prominent in superficial layer cartilage and cartilage with morphological lesions.
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Affiliation(s)
- H.-L. Teng
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging,
University of California, San Francisco, San Francisco, CA, United States,Address correspondence and reprint requests to: H.-L. Teng, 185 Berry Street, Suite 350, Lobby 6,
San Francisco, CA, 94107, United States. Tel: 1 (415) 514 8266
| | - N.E. Calixto
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging,
University of California, San Francisco, San Francisco, CA, United States
| | - T.D. MacLeod
- Department of Physical Therapy, California State University, Sacramento, CA, USA
| | - L. Nardo
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging,
University of California, San Francisco, San Francisco, CA, United States
| | - T.M. Link
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging,
University of California, San Francisco, San Francisco, CA, United States
| | - S. Majumdar
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging,
University of California, San Francisco, San Francisco, CA, United States
| | - R.B. Souza
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging,
University of California, San Francisco, San Francisco, CA, United States,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco,
San Francisco, CA, United States
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24
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Culvenor AG, Perraton L, Guermazi A, Bryant AL, Whitehead TS, Morris HG, Crossley KM. Knee kinematics and kinetics are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction. Osteoarthritis Cartilage 2016; 24:1548-53. [PMID: 27188685 DOI: 10.1016/j.joca.2016.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patellofemoral osteoarthritis (PFOA) commonly occurs following anterior cruciate ligament reconstruction (ACLR). Our study aimed to compare knee kinematics and kinetics during a hop-landing task between individuals with and without early PFOA post-ACLR. DESIGN Forty-five individuals (mean ± SD 26 ± 5 years) 1-2 years post-ACLR underwent 3T isotropic MRI scans and 3D biomechanical assessment of a standardised forward hop task. Knee kinematics (initial contact, peak, excursion) in all three planes and sagittal plane kinetics (peak) were compared between 15 participants with early PFOA (MRI-defined patellofemoral cartilage lesion) and 30 participants with no PFOA (absence of patellofemoral cartilage lesion on MRI) using analysis of covariance (ANCOVA), adjusted for age, BMI, sex and the presence of early tibiofemoral OA. RESULTS Compared to participants without PFOA, those with early PFOA exhibited smaller peak knee flexion angles (mean difference, 95% confidence interval [CI]: -5.2°, -9.9 to -0.4; P = 0.035) and moments (-4.2 Nm/kg.m, -7.8 to -0.6; P = 0.024), and greater knee internal rotation excursion (5.3°, 2.0 to 8.6; P = 0.002). CONCLUSIONS Individuals with early PFOA within the first 2-years following ACLR exhibit distinct kinematic and kinetic features during a high-load landing task. These findings provide new information regarding common post-ACLR biomechanical patterns and PFOA. Since management strategies, such as altering knee load, are more effective during the early stages of disease, this knowledge will help to inform clinical management of early PFOA post-ACLR.
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Affiliation(s)
- A G Culvenor
- Paracelsus Medical University, Institute of Anatomy Salzburg & Nuremberg, Salzburg, Austria; La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Bundoora, Australia; Australian Hip and Knee Institute, Melbourne, Australia.
| | - L Perraton
- The University of Melbourne, Department of Physiotherapy, School of Medicine, Dentistry and Health Sciences, Parkville, Australia.
| | - A Guermazi
- Boston University School of Medicine, Department of Radiology, Boston, USA.
| | - A L Bryant
- The University of Melbourne, Department of Physiotherapy, School of Medicine, Dentistry and Health Sciences, Parkville, Australia.
| | - T S Whitehead
- OrthoSport Victoria, Epworth Richmond, Melbourne, Australia.
| | - H G Morris
- The Park Clinic, St Vincent's Private Hospital, Melbourne, Australia.
| | - K M Crossley
- La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Bundoora, Australia.
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25
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Teng HL, Powers CM. Hip-Extensor Strength, Trunk Posture, and Use of the Knee-Extensor Muscles During Running. J Athl Train 2016; 51:519-24. [PMID: 27513169 DOI: 10.4085/1062-6050-51.8.05] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Diminished hip-muscle performance has been proposed to contribute to various knee injuries. OBJECTIVE To determine the association between hip-extensor muscle strength and sagittal-plane trunk posture and the relationships among hip-extensor muscle strength and hip- and knee-extensor work during running. DESIGN Descriptive laboratory study. SETTING Musculoskeletal biomechanical laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 40 asymptomatic recreational runners, 20 men (age = 27.1 ± 7.0 years, height = 1.74 ± 0.69 m, mass = 71.1 ± 8.2 kg) and 20 women (age = 26.2 ± 5.8 years, height = 1.65 ± 0.74 m, mass = 60.6 ± 6.6 kg), participated. MAIN OUTCOME MEASURE(S) Maximum isometric strength of the hip extensors was assessed using a dynamometer. Sagittal-plane trunk posture (calculated relative to the global vertical axis) and hip- and knee-extensor work (sum of energy absorption and generation) during the stance phase of running were quantified while participants ran over ground at a controlled speed of 3.4 m/s. We used Pearson product moment correlations to examine the relationships among hip-extensor strength, mean sagittal-plane trunk-flexion angle, hip-extensor work, and knee-extensor work. RESULTS Hip-extensor strength was correlated positively with trunk-flexion angle (r = 0.55, P < .001) and hip-extensor work (r = 0.46, P = .003). It was correlated inversely with knee-extensor work (r = -0.39, P = .01). All the correlations remained after adjusting for sex. CONCLUSIONS Our findings suggest that runners with hip-extensor weakness used a more upright trunk posture. This strategy led to an overreliance on the knee extensors and may contribute to overuse running injuries at the knee.
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Affiliation(s)
- Hsiang-Ling Teng
- Department of Physical Therapy, California State University, Long Beach;,Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
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26
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Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier JF, Morrissey D, Callaghan MJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med 2016; 50:839-43. [PMID: 27343241 PMCID: PMC4975817 DOI: 10.1136/bjsports-2016-096384] [Citation(s) in RCA: 325] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/01/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Joshua J Stefanik
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
| | - James Selfe
- Faculty of Health, Psychology and Social Care, Department of Health Professions. Manchester Metropolitan University, Manchester, UK
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Centre, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Christopher M Powers
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Jenny McConnell
- McConnell Physiotherapy Group, Mosman, New South Wales, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Jean-Francois Esculier
- Faculty of Medicine, Centre for Interdisciplinary Research in Rehabilitation and Social Integration Universite Laval, Quebec, Quebec, Canada
| | - Dylan Morrissey
- Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK Physiotherapy Department, Bart's Health NHS Trust, London, UK
| | - Michael J Callaghan
- Faculty of Health, Psychology and Social Care, School of Health Professions. Manchester Metropolitan University, Manchester, UK Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
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27
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Higher Knee Flexion Moment During the Second Half of the Stance Phase of Gait Is Associated With the Progression of Osteoarthritis of the Patellofemoral Joint on Magnetic Resonance Imaging. J Orthop Sports Phys Ther 2015; 45:656-64. [PMID: 26161626 PMCID: PMC4718079 DOI: 10.2519/jospt.2015.5859] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study, longitudinal design. OBJECTIVE To examine whether baseline knee flexion moment or impulse during walking is associated with the progression of osteoarthritis (OA) with magnetic resonance imaging of the patellofemoral joint (PFJ) at 1 year. BACKGROUND Patellofemoral joint OA is highly prevalent and a major source of pain and dysfunction. The biomechanical factors associated with the progression of PFJ OA remain unclear. METHODS Three-dimensional gait analyses were performed at baseline. Magnetic resonance imaging of the knee (high-resolution, 3-D, fast spin-echo sequence) was used to identify PFJ cartilage and bone marrow edema-like lesions at baseline and a 1-year follow-up. The severity of PFJ OA progression was defined using the modified Whole-Organ Magnetic Resonance Imaging Score when new or increased cartilage or bone marrow edema-like lesions were observed at 1 year. Peak external knee flexion moment and flexion moment impulse during the first and second halves of the stance phase of gait were compared between progressors and nonprogressors, and used to predict progression after adjusting for age, sex, body mass index, and presence of baseline PFJ OA. RESULTS Sixty-one participants with no knee OA or isolated PFJ OA were included. Patellofemoral joint OA progressors (n = 10) demonstrated significantly higher peak knee flexion moment (P = .01) and flexion moment impulse (P = .04) during the second half of stance at baseline compared to nonprogressors. Logistic regression showed that higher peak knee flexion moment during the second half of the stance phase was significantly associated with progression at 1 year (adjusted odds ratio = 3.3, P = .01). CONCLUSION Peak knee flexion moment and flexion moment impulse during the second half of stance are related to the progression of PFJ OA and may need to be considered when treating individuals who are at risk of or who have PFJ OA.
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