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Koller W, Wallnöfer E, Holder J, Kranzl A, Mindler G, Baca A, Kainz H. Increased knee flexion in participants with cerebral palsy results in altered stresses at the distal femoral growth plate compared to a typically developing cohort. Gait Posture 2024; 113:158-166. [PMID: 38905850 DOI: 10.1016/j.gaitpost.2024.06.012] [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: 12/09/2023] [Revised: 05/21/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Femoral deformities are highly prevalent in children with cerebral palsy (CP) and can have a severe impact on patients' gait abilities. While the mechanical stress regime within the distal femoral growth plate remains underexplored, understanding it is crucial given bone's adaptive response to mechanical stimuli. We quantified stresses at the distal femoral growth plate to deepen our understanding of the relationship between healthy and pathological gait patterns, internal loading, and femoral growth patterns. METHODS This study included three-dimensional motion capture data and magnetic resonance images of 13 typically developing children and twelve participants with cerebral palsy. Employing a multi-scale mechanobiological approach, integrating musculoskeletal simulations and subject-specific finite element analysis, we investigated the orientation of the distal femoral growth plate and the stresses within it. Limbs of participants with CP were grouped depending on their knee flexion kinematics during stance phase as this potentially changes the stresses induced by knee and patellofemoral joint contact forces. RESULTS Despite similar growth plate orientation across groups, significant differences were observed in the shape and distribution of growth values. Higher growth rates were noted in the anterior compartment in CP limbs with high knee flexion while CP limbs with normal knee flexion showed high similarity to the group of healthy participants. DISCUSSION Results indicate that the knee flexion angle during the stance phase is of high relevance for typical bone growth at the distal femur. The evaluated growth rates reveal plausible results, as long-term promoted growth in the anterior compartment leads to anterior bending of the femur which was confirmed for the group with high knee flexion through analyses of the femoral geometry. The framework for these multi-scale simulations has been made accessible on GitHub, empowering peers to conduct similar mechanobiological studies. Advancing our understanding of femoral bone development could ultimately support clinical decision-making.
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Affiliation(s)
- Willi Koller
- Department of Sport and Human Movement Science, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria; Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria; Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, Vienna, Austria.
| | - Elias Wallnöfer
- Department of Sport and Human Movement Science, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria; Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Jana Holder
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Andreas Kranzl
- Laboratory for Gait and Human Movements, Orthopaedic Hospital Speising, Vienna, Austria; Vienna Bone and Growth Center, Vienna, Austria
| | - Gabriel Mindler
- Department of Pediatric Orthopaedics, Orthopaedic Hospital Speising, Vienna, Austria; Vienna Bone and Growth Center, Vienna, Austria
| | - Arnold Baca
- Department of Sport and Human Movement Science, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Hans Kainz
- Department of Sport and Human Movement Science, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria; Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
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Rabbi MF, Davico G, Lloyd DG, Carty CP, Diamond LE, Pizzolato C. Muscle synergy-informed neuromusculoskeletal modelling to estimate knee contact forces in children with cerebral palsy. Biomech Model Mechanobiol 2024; 23:1077-1090. [PMID: 38459157 PMCID: PMC11101562 DOI: 10.1007/s10237-024-01825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 03/10/2024]
Abstract
Cerebral palsy (CP) includes a group of neurological conditions caused by damage to the developing brain, resulting in maladaptive alterations of muscle coordination and movement. Estimates of joint moments and contact forces during locomotion are important to establish the trajectory of disease progression and plan appropriate surgical interventions in children with CP. Joint moments and contact forces can be estimated using electromyogram (EMG)-informed neuromusculoskeletal models, but a reduced number of EMG sensors would facilitate translation of these computational methods to clinics. This study developed and evaluated a muscle synergy-informed neuromusculoskeletal modelling approach using EMG recordings from three to four muscles to estimate joint moments and knee contact forces of children with CP and typically developing (TD) children during walking. Using only three to four experimental EMG sensors attached to a single leg and leveraging an EMG database of walking data of TD children, the synergy-informed approach estimated total knee contact forces comparable to those estimated by EMG-assisted approaches that used 13 EMG sensors (children with CP, n = 3, R2 = 0.95 ± 0.01, RMSE = 0.40 ± 0.14 BW; TD controls, n = 3, R2 = 0.93 ± 0.07, RMSE = 0.19 ± 0.05 BW). The proposed synergy-informed neuromusculoskeletal modelling approach could enable rapid evaluation of joint biomechanics in children with unimpaired and impaired motor control within a clinical environment.
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Affiliation(s)
- Mohammad Fazle Rabbi
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, and Advanced Design and Prototyping Technologies Institute, Gold Coast, QLD, 4222, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Giorgio Davico
- Department of Industrial Engineering, Alma Mater Studiorum, University of Bologna, 40136, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, and Advanced Design and Prototyping Technologies Institute, Gold Coast, QLD, 4222, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Christopher P Carty
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, and Advanced Design and Prototyping Technologies Institute, Gold Coast, QLD, 4222, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Orthopaedic Surgery, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, 4101, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, and Advanced Design and Prototyping Technologies Institute, Gold Coast, QLD, 4222, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Claudio Pizzolato
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Gold Coast, and Advanced Design and Prototyping Technologies Institute, Gold Coast, QLD, 4222, Australia.
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, 4222, Australia.
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Kainz H, Koller W, Wallnöfer E, Bader TR, Mindler GT, Kranzl A. A framework based on subject-specific musculoskeletal models and Monte Carlo simulations to personalize muscle coordination retraining. Sci Rep 2024; 14:3567. [PMID: 38347085 PMCID: PMC10861532 DOI: 10.1038/s41598-024-53857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024] Open
Abstract
Excessive loads at lower limb joints can lead to pain and degenerative diseases. Altering joint loads with muscle coordination retraining might help to treat or prevent clinical symptoms in a non-invasive way. Knowing how much muscle coordination retraining can reduce joint loads and which muscles have the biggest impact on joint loads is crucial for personalized gait retraining. We introduced a simulation framework to quantify the potential of muscle coordination retraining to reduce joint loads for an individuum. Furthermore, the proposed framework enables to pinpoint muscles, which alterations have the highest likelihood to reduce joint loads. Simulations were performed based on three-dimensional motion capture data of five healthy adolescents (femoral torsion 10°-29°, tibial torsion 19°-38°) and five patients with idiopathic torsional deformities at the femur and/or tibia (femoral torsion 18°-52°, tibial torsion 3°-50°). For each participant, a musculoskeletal model was modified to match the femoral and tibial geometry obtained from magnetic resonance images. Each participant's model and the corresponding motion capture data were used as input for a Monte Carlo analysis to investigate how different muscle coordination strategies influence joint loads. OpenSim was used to run 10,000 simulations for each participant. Root-mean-square of muscle forces and peak joint contact forces were compared between simulations. Depending on the participant, altering muscle coordination led to a maximum reduction in hip, knee, patellofemoral and ankle joint loads between 5 and 18%, 4% and 45%, 16% and 36%, and 2% and 6%, respectively. In some but not all participants reducing joint loads at one joint increased joint loads at other joints. The required alteration in muscle forces to achieve a reduction in joint loads showed a large variability between participants. The potential of muscle coordination retraining to reduce joint loads depends on the person's musculoskeletal geometry and gait pattern and therefore showed a large variability between participants, which highlights the usefulness and importance of the proposed framework to personalize gait retraining.
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Affiliation(s)
- Hans Kainz
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria.
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria.
| | - Willi Koller
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, Vienna, Austria
| | - Elias Wallnöfer
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, Vienna, Austria
| | - Till R Bader
- Department of Radiology, Orthopaedic Hospital Speising, Vienna, Austria
| | - Gabriel T Mindler
- Department of Paediatric Orthopaedics and Foot Surgery, Orthopaedic Hospital Speising, Vienna, Austria
- Vienna Bone and Growth Center, Vienna, Austria
| | - Andreas Kranzl
- Vienna Bone and Growth Center, Vienna, Austria
- Laboratory for Gait and Movement Analysis, Orthopaedic Hospital Speising, Vienna, Austria
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Koller W, Baca A, Kainz H. The gait pattern and not the femoral morphology is the main contributor to asymmetric hip joint loading. PLoS One 2023; 18:e0291789. [PMID: 37751435 PMCID: PMC10522038 DOI: 10.1371/journal.pone.0291789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
Gait asymmetry and skeletal deformities are common in many children with cerebral palsy (CP). Changes of the hip joint loading, i.e. hip joint contact force (HJCF), can lead to pathological femoral growth. A child's gait pattern and femoral morphology affect HJCFs. The twofold aim of this study was to (1) evaluate if the asymmetry in HJCFs is higher in children with CP compared to typically developing (TD) children and (2) identify if the bony morphology or the subject-specific gait pattern is the main contributor to asymmetric HJCFs. Magnetic resonance images (MRI) and three-dimensional gait analysis data of twelve children with CP and fifteen TD children were used to create subject-specific musculoskeletal models and calculate HJCF using OpenSim. Root-mean-square-differences between left and right HJCF magnitude and orientation were computed and compared between participant groups (CP versus TD). Additionally, the influence on HJCF asymmetries solely due to the femoral morphology and solely due to the gait pattern was quantified. Our findings demonstrate that the gait pattern is the main contributor to asymmetric HJCFs in CP and TD children. Children with CP have higher HJCF asymmetries which is probably the result of larger asymmetries in their gait pattern compared to TD children. The gained insights from our study highlight that clinical interventions should focus on normalizing the gait pattern and therefore the hip joint loading to avoid the development of femoral deformities.
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Affiliation(s)
- Willi Koller
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, Vienna, Austria
| | - Arnold Baca
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Hans Kainz
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
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Valente G, Benedetti MG, De Paolis M, Donati DM, Taddei F. Differences in hip musculoskeletal loads between limbs during daily activities in patients with 3D-printed hemipelvic reconstructions following tumor surgery. Gait Posture 2023; 102:56-63. [PMID: 36924596 DOI: 10.1016/j.gaitpost.2023.03.005] [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: 08/05/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Anatomical custom-made prostheses, thanks to computer-aided design and 3D-printing technology, help improve osseointegration and reduce mechanical complications in bone reconstructions following bone tumors. A recent quantitative analysis of long-term recovery in patients with 3D-printed reconstructions following pelvic tumor surgery showed asymmetries in ground reaction forces between limbs during different motor activities, while standing very good motor performance and quality of life. RESEARCH QUESTION We analyzed hip contact forces and muscle forces in that cohort of six patients with an innovative custom-made reconstruction of the hemipelvis, and we tested the hypothesis that asymmetries in ground reaction forces would result in more marked differences in musculoskeletal forces. METHODS State-of-the-art musculoskeletal modeling in an optimization-based inverse-dynamics workflow was used to calculate hip contact forces and muscle forces during five motor activities, and the differences between limbs were statistically evaluated across the motor activity cycles and on the force peaks. RESULTS The musculoskeletal loads were found to be not symmetric, as hip loads were generally higher in the contralateral limb. We found significant differences in considerable portions of the motor activities cycles except squat, load symmetry indices indicating a load increase (median up to 25%) on the contralateral limb, especially during stair descent and chair rise/sit, and significantly higher values in the contralateral limb at force peaks. SIGNIFICANCE We confirmed the hypothesis that residual asymmetries found in ground reaction forces were amplified when hip musculoskeletal loads were investigated, reflecting a shift of the loads toward the intact limb. Despite the general trend of higher loads found in the contralateral hip, this cannot be considered a risk of overloading, as both hips supported loads in a physiological range or lower, indicating a likely optimal recovery.
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Affiliation(s)
- Giordano Valente
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano De Paolis
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Koller W, Gonçalves B, Baca A, Kainz H. Intra- and inter-subject variability of femoral growth plate stresses in typically developing children and children with cerebral palsy. Front Bioeng Biotechnol 2023; 11:1140527. [PMID: 36911204 PMCID: PMC9999378 DOI: 10.3389/fbioe.2023.1140527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/14/2023] [Indexed: 03/14/2023] Open
Abstract
Little is known about the influence of mechanical loading on growth plate stresses and femoral growth. A multi-scale workflow based on musculoskeletal simulations and mechanobiological finite element (FE) analysis can be used to estimate growth plate loading and femoral growth trends. Personalizing the model in this workflow is time-consuming and therefore previous studies included small sample sizes (N < 4) or generic finite element models. The aim of this study was to develop a semi-automated toolbox to perform this workflow and to quantify intra-subject variability in growth plate stresses in 13 typically developing (TD) children and 12 children with cerebral palsy (CP). Additionally, we investigated the influence of the musculoskeletal model and the chosen material properties on the simulation results. Intra-subject variability in growth plate stresses was higher in cerebral palsy than in typically developing children. The highest osteogenic index (OI) was observed in the posterior region in 62% of the TD femurs while in children with CP the lateral region was the most common (50%). A representative reference osteogenic index distribution heatmap generated from data of 26 TD children's femurs showed a ring shape with low values in the center region and high values at the border of the growth plate. Our simulation results can be used as reference values for further investigations. Furthermore, the code of the developed GP-Tool ("Growth Prediction-Tool") is freely available on GitHub (https://github.com/WilliKoller/GP-Tool) to enable peers to conduct mechanobiological growth studies with larger sample sizes to improve our understanding of femoral growth and to support clinical decision making in the near future.
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Affiliation(s)
- Willi Koller
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria.,Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria.,Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, Vienna, Austria
| | - Basílio Gonçalves
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria.,Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Arnold Baca
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Hans Kainz
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria.,Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
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Comellas E, Shefelbine SJ. The role of computational models in mechanobiology of growing bone. Front Bioeng Biotechnol 2022; 10:973788. [PMID: 36466331 PMCID: PMC9715592 DOI: 10.3389/fbioe.2022.973788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/09/2022] [Indexed: 11/09/2023] Open
Abstract
Endochondral ossification, the process by which long bones grow in length, is regulated by mechanical forces. Computational models, specifically finite element models, have been used for decades to understand the role of mechanical loading on endochondral ossification. This perspective outlines the stages of model development in which models are used to: 1) explore phenomena, 2) explain pathologies, 3) predict clinical outcomes, and 4) design therapies. As the models progress through the stages, they increase in specificity and biofidelity. We give specific examples of models of endochondral ossification and expect models of other mechanobiological systems to follow similar development stages.
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Affiliation(s)
- Ester Comellas
- Serra Húnter Fellow, Department of Physics, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Sandra J. Shefelbine
- Department of Mechanical and Industrial Engineering and Department of Bioengineering, Northeastern University, Boston, MA, United States
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Kubo T, Uritani D, Ogaya S, Kita S, Fukumoto T, Fujii T, Inagaki Y, Tanaka Y, Imagita H. Association between foot posture and tibiofemoral contact forces during barefoot walking in patients with knee osteoarthritis. BMC Musculoskelet Disord 2022; 23:660. [PMID: 35820878 PMCID: PMC9275029 DOI: 10.1186/s12891-022-05624-y] [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: 12/29/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Accumulating evidence indicates that abnormal foot posture are risk factors for knee osteoarthritis (OA). However, the relationship between foot posture and tibiofemoral contact force (CF) during habitual weight-bearing activities remains unclear. This study aimed to determine the association between tibiofemoral CF and foot posture while walking. Methods In total, 18 patients with knee OA and 18 healthy individuals participated in this cross-sectional study. Foot parameters were evaluated by Foot Posture Index (FPI), Staheli Arch Index (SAI), hallux valgus angle, calcaneus inverted angle relative to the floor as a static rearfoot posture, navicular height, and toe grip strength. In addition, all participants underwent kinetic and kinematic measurements during a self-selected speed gait. The measurement device used was the three-dimensional motion analysis system with a sampling rate of 120 Hz. The musculoskeletal model, which has 92 Hill-type muscle–tendon units with 23 degrees of freedom, was used to calculate tibiofemoral CF. Partial correlations was used to investigate the association between foot parameters and total, medial, and lateral tibiofemoral CF of the first and second peaks while controlling for gait speed. Results A significant negative correlation was observed between Walking SAI and first peak medial tibiofemoral CF in control participants (r = -0.505, p = 0.039). SAI was also significantly positively correlated with first peak medial tibiofemoral CF in patients with knee OA (r = 0.482, p = 0.042). Conclusions Our findings revealed a correlation between the medial first peak tibiofemoral CF and the SAI. This study indicates that people with knee OA and flatfoot have excessive first medial tibiofemoral CF during walking. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05624-y.
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Affiliation(s)
- Takanari Kubo
- Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan. .,Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka, Osaka, 597-0104, Japan. .,Department of Physical Medicine and Rehabilitation, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Daisuke Uritani
- Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Shinya Ogaya
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama, 343-8540, Japan
| | - Shunsuke Kita
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama, 343-8540, Japan.,Soka Orthopedics Internal Medicine, 1-1-18 Chuo, Soka, Saitama, 340-0016, Japan
| | - Takahiko Fukumoto
- Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Tadashi Fujii
- Department of Orthopaedic Surgery, Kashiba Asahigaoka Hospital, 839 Kaminaka, Kashiba, Nara, Japan
| | - Yusuke Inagaki
- Department of Orthopaedic Surgery, Kashiba Asahigaoka Hospital, 839 Kaminaka, Kashiba, Nara, Japan.,Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, Kashihara, Nara, 634-8522, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, Kashihara, Nara, 634-8522, Japan
| | - Hidetaka Imagita
- Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan
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Mancuso ME, Wilzman AR, Murdock KE, Troy KL. Effect of External Mechanical Stimuli on Human Bone: a narrative review. PROGRESS IN BIOMEDICAL ENGINEERING (BRISTOL, ENGLAND) 2022; 4:012006. [PMID: 36310606 PMCID: PMC9616042 DOI: 10.1088/2516-1091/ac41bc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bone is a living composite material that has the capacity to adapt and respond to both internal and external stimuli. This capacity allows bone to adapt its structure to habitual loads and repair microdamage. Although human bone evolved to adapt to normal physiologic loading (for example from gravitational and muscle forces), these same biological pathways can potentially be activated through other types of external stimuli such as pulsed electromagnetic fields, mechanical vibration, and others. This review summarizes what is currently known about how human bone adapts to various types of external stimuli. We highlight how studies on sports-specific athletes and other exercise interventions have clarified the role of mechanical loading on bone structure. We also discuss clinical scenarios, such as spinal cord injury, where mechanical loading is drastically reduced, leading to rapid bone loss and permanent alterations to bone structure. Finally, we highlight areas of emerging research and unmet clinical need.
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