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Kim S, So J, Jeon Y, Moon J. Effect of changes in motor skill induced by educational video program to decrease lower-limb joint load during cutting maneuvers: based on musculoskeletal modeling. BMC Musculoskelet Disord 2024; 25:527. [PMID: 38982445 PMCID: PMC11232243 DOI: 10.1186/s12891-024-07642-4] [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: 02/09/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND This study investigated the effects of changes in motor skills from an educational video program on the kinematic and kinetic variables of the lower extremity joints and knee ligament load. METHODS Twenty male participants (age: 22.2 ± 2.60 y; height: 1.70 ± 6.2 m; weight: 65.4 ± 7.01 kg; BMI: 23.32 ± 2.49 [Formula: see text]) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their foot on the force plate, and perform the cutting maneuver on the left. The educational video program for cutting maneuvers consisted of preparatory posture, foot landing orientation, gaze and trunk directions, soft landing, and eversion angle. The measured variables were the angle, angular velocity of lower extremity joints, ground reaction force (GRF), moment, and anterior cruciate ligament (ACL) and medial collateral ligament (MCL) forces through musculoskeletal modeling. RESULTS After the video feedback, the hip joint angles increased in flexion, abduction, and external rotation (p < 0.05), and the angular velocity increased in extension (p < 0.05). The ankle joint angles increased in dorsiflexion (p < 0.05), and the angular velocity decreased in dorsiflexion (p < 0.05) but increased in abduction (p < 0.05). The GRF increased in the anterior-posterior and medial-lateral directions and decreased vertically (p < 0.05). The hip joint moments decreased in extension and external rotation (p < 0.05) but increased in adduction (p < 0.05). The knee joint moments were decreased in extension, adduction, and external rotation (p < 0.05). The abduction moment of the ankle joint decreased (p < 0.001). There were differences in the support zone corresponding to 64‒87% of the hip frontal moment (p < 0.001) and 32‒100% of the hip horizontal moment (p < 0.001) and differences corresponding to 32‒100% of the knee frontal moment and 21‒100% of the knee horizontal moment (p < 0.001). The GRF varied in the support zone at 44‒95% in the medial-lateral direction and at 17‒43% and 73‒100% in the vertical direction (p < 0.001). CONCLUSIONS Injury prevention feedback reduced the load on the lower extremity joints during cutting maneuvers, which reduced the knee ligament load, mainly on the MCL.
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Affiliation(s)
- Sungmin Kim
- Institute of School Physical Education, Korea National University of Education, Cheongju, Republic of Korea
| | - Jiho So
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Youngju Jeon
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jeheon Moon
- Department of Physical Education, Korea National University of Education, Cheongju, Republic of Korea.
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Wang L, Jiang H, Wan F, Sun H, Yang Y, Li W, Qian Z, Sun X, Chen P, Chen S, Peng H. High-Performance Artificial Ligament Made from Helical Polyester Fibers Wrapped with Aligned Carbon Nanotube Sheets. Adv Healthc Mater 2023; 12:e2301610. [PMID: 37717208 DOI: 10.1002/adhm.202301610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/09/2023] [Indexed: 09/18/2023]
Abstract
Repairing high-load connective tissues, such as ligaments, by surgically implanting artificial grafts after injury is challenging because they lack biointegration with host bones for stable interfaces. Herein, a high-performance helical composite fiber (HCF) ligament by wrapping aligned carbon nanotube (CNT) sheets around polyester fibers is proposed. Anterior cruciate ligament (ACL) reconstruction surgery shows that HCF grafts could induce effective bone regeneration, thus allowing the narrowing of bone tunnel defects. Such repair of the bone tunnel is in strong contrast to the tunnel enlargement of more than 50% for commercial artificial ligaments made from bare polyester fibers. Rats reconstructed with this HCF ligament show normal jumping, walking, and running without limping. This work allows bone regeneration in vivo through a one-step surgery without seeding cells or transforming growth factors, thereby opening an avenue for high-performance artificial tissues.
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Affiliation(s)
- Liyuan Wang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Institute of Fiber Materials and Devices, and Laboratory of Advanced Materials, Fudan University, Shanghai, 200438, China
| | - Hongyu Jiang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Institute of Fiber Materials and Devices, and Laboratory of Advanced Materials, Fudan University, Shanghai, 200438, China
| | - Fang Wan
- Department of Orthopedic Sports Medicine, Huashan Hospital, The Sports Medicine Institute, Fudan University, Shanghai, 200433, China
| | - Hongji Sun
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Institute of Fiber Materials and Devices, and Laboratory of Advanced Materials, Fudan University, Shanghai, 200438, China
| | - Yiqing Yang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Institute of Fiber Materials and Devices, and Laboratory of Advanced Materials, Fudan University, Shanghai, 200438, China
| | - Wenjun Li
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Institute of Fiber Materials and Devices, and Laboratory of Advanced Materials, Fudan University, Shanghai, 200438, China
| | - Zheyan Qian
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Institute of Fiber Materials and Devices, and Laboratory of Advanced Materials, Fudan University, Shanghai, 200438, China
| | - Xuemei Sun
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Institute of Fiber Materials and Devices, and Laboratory of Advanced Materials, Fudan University, Shanghai, 200438, China
| | - Peining Chen
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Institute of Fiber Materials and Devices, and Laboratory of Advanced Materials, Fudan University, Shanghai, 200438, China
| | - Shiyi Chen
- Department of Orthopedic Sports Medicine, Huashan Hospital, The Sports Medicine Institute, Fudan University, Shanghai, 200433, China
| | - Huisheng Peng
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Institute of Fiber Materials and Devices, and Laboratory of Advanced Materials, Fudan University, Shanghai, 200438, China
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Kadlec D, Miller-Dicks M, Nimphius S. Training for "Worst-Case" Scenarios in Sidestepping: Unifying Strength and Conditioning and Perception-Action Approaches. SPORTS MEDICINE - OPEN 2023; 9:22. [PMID: 37017787 PMCID: PMC10076474 DOI: 10.1186/s40798-023-00566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
Sidesteps can impose high demands on the knee joint and lead to non-contact anterior cruciate ligament (ACL) injuries. Understanding how different constraints shape an athlete's movement strategy and the associated joint demands can help design training interventions to increase injury resilience. Motor capacities, such as muscular strength and power, act as boundaries for the safe execution of perceptual-motor skills and co-determine the emergence of unique movement strategies. Increasing single- and multi-joint strength enables a broader solution space for movement strategies and increases load tolerance. Manipulating task constraints during sidesteps can be used in the training process to systematically expose athletes to increasing demands (on the knee joint or any joint or structure) in preparation for "worst-case" scenarios. In particular, the type and timing of information available influence the preparation time, subsequently affecting the movement strategy and the associated magnitude of external knee joint loading (e.g., knee valgus moment). While an athlete's perceptual-cognitive skills contribute to the preparation time during in situ scenarios, attempts to further improve those skills with the aim of increasing athlete preparation time prior to "worst-case" scenarios are yet to demonstrate conclusive evidence of transfer to on-field situations. Therefore, in the current article, we reflect on the impact of different interacting constraints that influence the execution of sidesteps during in situ scenarios and impose high demands on the knee joint. Subsequently, we discuss how an integrated perspective, drawing on knowledge and perspectives from strength and conditioning and perception-action, may enhance an athlete's ability to withstand "worst-case" scenarios and adapt to perform varied movement executions when sidestepping.
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Affiliation(s)
- Daniel Kadlec
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Matt Miller-Dicks
- School of Sport, Health Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Sophia Nimphius
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
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Nasseri A, Akhundov R, Bryant AL, Lloyd DG, Saxby DJ. Limiting the Use of Electromyography and Ground Reaction Force Data Changes the Magnitude and Ranking of Modelled Anterior Cruciate Ligament Forces. Bioengineering (Basel) 2023; 10:bioengineering10030369. [PMID: 36978760 PMCID: PMC10045248 DOI: 10.3390/bioengineering10030369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Neuromusculoskeletal models often require three-dimensional (3D) body motions, ground reaction forces (GRF), and electromyography (EMG) as input data. Acquiring these data in real-world settings is challenging, with barriers such as the cost of instruments, setup time, and operator skills to correctly acquire and interpret data. This study investigated the consequences of limiting EMG and GRF data on modelled anterior cruciate ligament (ACL) forces during a drop–land–jump task in late-/post-pubertal females. We compared ACL forces generated by a reference model (i.e., EMG-informed neural mode combined with 3D GRF) to those generated by an EMG-informed with only vertical GRF, static optimisation with 3D GRF, and static optimisation with only vertical GRF. Results indicated ACL force magnitude during landing (when ACL injury typically occurs) was significantly overestimated if only vertical GRF were used for either EMG-informed or static optimisation neural modes. If 3D GRF were used in combination with static optimisation, ACL force was marginally overestimated compared to the reference model. None of the alternative models maintained rank order of ACL loading magnitudes generated by the reference model. Finally, we observed substantial variability across the study sample in response to limiting EMG and GRF data, indicating need for methods incorporating subject-specific measures of muscle activation patterns and external loading when modelling ACL loading during dynamic motor tasks.
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Affiliation(s)
- Azadeh Nasseri
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia
- Correspondence:
| | - Riad Akhundov
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia
| | - Adam L. Bryant
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, VIC 3010, Australia
| | - David G. Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia
| | - David J. Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia
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Saxby DJ, Catelli DS, Lloyd DG, Sawacha Z. Editorial: The role of biomechanics in anterior cruciate ligament injuries prevention. Front Sports Act Living 2023; 5:1134969. [PMID: 36969959 PMCID: PMC10034354 DOI: 10.3389/fspor.2023.1134969] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Affiliation(s)
- David J. Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Danilo S. Catelli
- Department of Movement Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - David G. Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Zimi Sawacha
- Department of Information Engineering, University of Padua, Padua, Veneto, Italy
- Department of Medicine, University of Padua, Padua, Veneto, Italy
- Correspondence: Zimi Sawacha
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Englander ZA, Foody JN, Cutcliffe HC, Wittstein JR, Spritzer CE, DeFrate LE. Use of a Novel Multimodal Imaging Technique to Model In Vivo Quadriceps Force and ACL Strain During Dynamic Activity. Am J Sports Med 2022; 50:2688-2697. [PMID: 35853157 PMCID: PMC9875882 DOI: 10.1177/03635465221107085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quadriceps loading of the anterior cruciate ligament (ACL) may play a role in the noncontact mechanism of ACL injury. Musculoskeletal modeling techniques are used to estimate the intrinsic force of the quadriceps acting at the knee joint. PURPOSE/HYPOTHESIS The purpose of this paper was to develop a novel musculoskeletal model of in vivo quadriceps force during dynamic activity. We used the model to estimate quadriceps force in relation to ACL strain during a single-leg jump. We hypothesized that quadriceps loading of the ACL would reach a local maximum before initial ground contact with the knee positioned in extension. STUDY DESIGN Descriptive laboratory study. METHODS Six male participants underwent magnetic resonance imaging in addition to high-speed biplanar radiography during a single-leg jump. Three-dimensional models of the knee joint, including the femur, tibia, patellofemoral cartilage surfaces, and attachment-site footprints of the patellar tendon, quadriceps tendon, and ACL, were created from the magnetic resonance imaging scans. The bone models were registered to the biplanar radiographs, thereby reproducing the positions of the knee joint at the time of radiographic imaging. The magnitude of quadriceps force was determined for each knee position based on a 3-dimensional balance of the forces and moments of the patellar tendon and the patellofemoral cartilage contact acting on the patella. Knee kinematics and ACL strain were determined for each knee position. RESULTS A local maximum in average quadriceps force of approximately 6500 N (8.4× body weight) occurred before initial ground contact. ACL strain increased concurrently with quadriceps force when the knee was positioned in extension. CONCLUSION This novel participant-specific modeling technique provides estimates of in vivo quadriceps force during physiologic dynamic loading. A local maximum in quadriceps force before initial ground contact may tension the ACL when the knee is positioned in extension. CLINICAL RELEVANCE These data contribute to understanding noncontact ACL injury mechanisms and the potential role of quadriceps activation in these injuries.
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Affiliation(s)
- Zoë A. Englander
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Jacqueline N. Foody
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Hattie C. Cutcliffe
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | | | | | - Louis E. DeFrate
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.,Address correspondence to Louis E. DeFrate, ScD, Duke University Medical Center, Room 379, Medical Sciences Research Bldg, Box 3093, Durham, NC 27710, USA ()
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Effects of Footwear on Anterior Cruciate Ligament Forces during Landing in Young Adult Females. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081119. [PMID: 35892920 PMCID: PMC9332041 DOI: 10.3390/life12081119] [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: 06/24/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022]
Abstract
Rates of anterior cruciate ligament (ACL) rupture in young people have increased markedly over the past two decades, with females experiencing greater growth in their risk compared to males. In this study, we determined the effects of low- and high-support athletic footwear on ACL loads during a standardized drop–land–lateral jump in 23 late-/post-pubertal females. Each participant performed the task unshod, wearing low- (Zaraca, ASICS) or high- (Kayano, ASICS) support shoes (in random order), and three-dimensional body motions, ground-reaction forces, and surface electromyograms were synchronously acquired. These data were then used in a validated computational model of ACL loading. One-dimensional statistical parametric mapping paired t-tests were used to compare ACL loads between footwear conditions during the stance phase of the task. Participants generated lower ACL forces during push-off when shod (Kayano: 624 N at 71–84% of stance; Zaraca: 616 N at 68–86% of stance) compared to barefoot (770 N and 740 N, respectively). No significant differences in ACL force were observed between the task performed wearing low- compared to high-support shoes. Compared to barefoot, both shoe types significantly lowered push-off phase peak ACL forces, potentially lowering risk of ACL injury during performance of similar tasks in sport and recreation.
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Heinrich D, van den Bogert AJ, Nachbauer W. Predicting neuromuscular control patterns that minimize ACL forces during injury prone jump landing maneuvers in downhill skiing using a musculoskeletal simulation model. Eur J Sport Sci 2022; 23:703-713. [PMID: 35400304 DOI: 10.1080/17461391.2022.2064770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Competitive skiers encounter a high risk of sustaining an ACL injury during jump-landing in downhill ski racing. Facing an injury-prone landing manoeuvre, there is a lack of knowledge regarding optimum control strategies. So, the purpose of the present study was to investigate possible neuromuscular control patterns to avoid injury during injury-prone jump-landing manoeuvres. A computational approach was used to generate a series of 190 injury-prone jump-landing manoeuvres based on a 25-degree-of-freedom sagittal plane musculoskeletal skier model. Using a dynamic optimization framework, each injury-prone landing manoeuvre was resolved to identify muscle activation patterns of the lower limbs and corresponding kinematic changes that reduce peak ACL force. In the 190 injury-prone jump-landing simulations, ACL forces peaked during the first 50 ms after ground contact. Optimized muscle activation patterns, that reduced peak ACL forces, showed increased activation of the monoarticular hip flexors, ankle dorsi- and plantar flexors as well as hamstrings prior to or during the early impact phase (<50 ms). The corresponding kinematic changes were characterized by increased hip and knee flexion and less backward lean of the skier at initial ground contact and the following impact phase. Injury prevention strategies should focus on increased activation of the monoarticular hip flexors, ankle plantar flexors and rapid and increased activation of the hamstrings in combination with a flexed landing position and decreased backward lean to reduce ACL injury risk during the early impact phase (<50 ms) of jump landing.HighlightsFirst study investigating advantageous control strategies during injury-prone jump-landing manoeuvres in downhill skiing using a musculoskeletal simulation model and dynamic optimization framework.The simulation results predicted high injury risk during the first 50 ms after initial ground contact.Optimized neuromuscular control patterns showed adapted activation patterns (timing and amplitude) of muscles crossing the knee as well as the hip and ankle joints prior to and after initial ground contact, respectively.An optimized control strategy during an injury-prone landing manoeuvre was characterized kinematically by increasing hip and knee flexion and less backward lean of the skier at initial ground contact and the following impact phase.
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Affiliation(s)
- Dieter Heinrich
- Department of Sport Science, University of Innsbruck, Innsbruck 6020, Austria
| | | | - Werner Nachbauer
- Department of Sport Science, University of Innsbruck, Innsbruck 6020, Austria
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Farshidfar SS, Cadman J, Deng D, Appleyard R, Dabirrahmani D. The effect of modelling parameters in the development and validation of knee joint models on ligament mechanics: A systematic review. PLoS One 2022; 17:e0262684. [PMID: 35085320 PMCID: PMC8794118 DOI: 10.1371/journal.pone.0262684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The ligaments in the knee are prone to injury especially during dynamic activities. The resulting instability can have a profound impact on a patient's daily activities and functional capacity. Musculoskeletal knee modelling provides a non-invasive tool for investigating ligament force-strain behaviour in various dynamic scenarios, as well as potentially complementing existing pre-planning tools to optimise surgical reconstructions. However, despite the development and validation of many musculoskeletal knee models, the effect of modelling parameters on ligament mechanics has not yet been systematically reviewed. OBJECTIVES This systematic review aimed to investigate the results of the most recent studies using musculoskeletal modelling techniques to create models of the native knee joint, focusing on ligament mechanics and modelling parameters in various simulated movements. DATA SOURCES PubMed, ScienceDirect, Google Scholar, and IEEE Xplore. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Databases were searched for articles containing any numerical ligament strain or force data on the intact, ACL-deficient, PCL-deficient, or lateral extra-articular reconstructed (LER) knee joints. The studies had to derive these results from musculoskeletal modelling methods. The dates of the publications were between 1 January 1995 and 30 November 2021. METHOD A customised data extraction form was created to extract each selected study's critical musculoskeletal model development parameters. Specific parameters of the musculoskeletal knee model development used in each eligible study were independently extracted, including the (1) musculoskeletal model definition (i.e., software used for modelling, knee type, source of geometry, the inclusion of cartilage and menisci, and articulating joints and joint boundary conditions (i.e., number of degrees of freedom (DoF), subjects, type of activity, collected data and type of simulation)), (2) specifically ligaments modelling techniques (i.e., ligament bundles, attachment points, pathway, wrapping surfaces and ligament material properties such as stiffness and reference length), (3) sensitivity analysis, (4) validation approaches, (5) predicted ligament mechanics (i.e., force, length or strain) and (6) clinical applications if available. The eligible papers were then discussed quantitatively and qualitatively with respect to the above parameters. RESULTS AND DISCUSSION From the 1004 articles retrieved by the initial electronic search, only 25 met all inclusion criteria. The results obtained by aggregating data reported in the eligible studies indicate that considerable variability in the predicted ligament mechanics is caused by differences in geometry, boundary conditions and ligament modelling parameters. CONCLUSION This systematic review revealed that there is currently a lack of consensus on knee ligament mechanics. Despite this lack of consensus, some papers highlight the potential of developing translational tools using musculoskeletal modelling. Greater consistency in model design, incorporation of sensitivity assessment of the model outcomes and more rigorous validation methods should lead to better agreement in predictions for ligament mechanics between studies. The resulting confidence in the musculoskeletal model outputs may lead to the development of clinical tools that could be used for patient-specific treatments.
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Affiliation(s)
- Sara Sadat Farshidfar
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joseph Cadman
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Danny Deng
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard Appleyard
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Danè Dabirrahmani
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Weir G. Anterior cruciate ligament injury prevention in sport: biomechanically informed approaches. Sports Biomech 2021:1-21. [PMID: 34965847 DOI: 10.1080/14763141.2021.2016925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 12/06/2021] [Indexed: 01/14/2023]
Abstract
This paper reviews a series of studies contributing to a framework for preventing anterior cruciate ligament (ACL) injuries in sport. As the majority of these injuries are non-contact in nature, theoretically, these injuries are preventable. The studies presented in this paper focus on understanding biomechanical countermeasures of ACL injury and how this knowledge can inform both screening and training intervention research and practice in sport. These countermeasures include: 1) modifying an athlete's technique to reduce externally applied loads to the knee; 2) increasing the muscle support around the knee and hip to counter elevated loads applied to the knee and; 3) improving an athlete's perception during dynamic sports tasks to increase planning time to coordinate desirable movement patterns. By furthering the empirical evidence of modifiable biomechanical countermeasures of ACL injury risk, we can better understand best practices for developing interventions on a mass scale to prevent ACL injuries in the sporting community.
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Affiliation(s)
- Gillian Weir
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA, USA
- School of Human Sciences, University of Western Australia, Perth, Australia
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11
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Csapo R, Heinrich D, Vigotsky AD, Marx C, Sinha S, Fink C. Developing a Technique for the Imaging-Based Measurement of ACL Elongation: A Proof of Principle. Diagnostics (Basel) 2021; 11:diagnostics11112126. [PMID: 34829473 PMCID: PMC8622620 DOI: 10.3390/diagnostics11112126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Towards the goal of obtaining non-invasive biomarkers reflecting the anterior cruciate ligament’s (ACL) loading capacity, this project aimed to develop a magnetic resonance imaging (MRI)-based method facilitating the measurement of ACL elongations during the execution of knee stress tests. An MRI-compatible, computer-controlled, and pneumatically driven knee loading device was designed to perform Lachman-like tests and induce ACL strain. A human cadaveric leg was used for test purposes. During the execution of the stress tests, a triggered real-time cine MRI sequence with a temporal resolution of 10 Hz was acquired in a parasagittal plane to capture the resultant ACL elongations. To test the accuracy of these measurements, the results were compared to in situ data of ACL elongation that were acquired by measuring the length changes of a surgical wire directly sutured to the ACL’s anteromedial bundle. The MRI-based ACL elongations ranged between 0.7 and 1.7 mm and agreed very well with in situ data (root mean square errors, RMSEs ≤ 0.25 mm), although peak elongation rates were underestimated by the MRI (RMSEs 0.19–0.36 mm/s). The high accuracy of elongation measurements underlines the potential of the technique to yield an imaging-based biomarker of the ACL’s loading capacity.
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Affiliation(s)
- Robert Csapo
- Centre for Sport Science and University Sports, University of Vienna, 1150 Wien, Austria
- Correspondence: ; Tel.: +43-1-4277-59160
| | - Dieter Heinrich
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria;
| | - Andrew D. Vigotsky
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, IL 60208, USA;
| | - Christian Marx
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, UMIT Tirol, 6060 Hall, Austria; (C.M.); (C.F.)
| | - Shantanu Sinha
- Department of Radiology, University of California San Diego, San Diego, CA 92093, USA;
| | - Christian Fink
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, UMIT Tirol, 6060 Hall, Austria; (C.M.); (C.F.)
- Gelenkpunkt Sports and Joint Surgery, 6020 Innsbruck, Austria
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12
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Nasseri A, Lloyd DG, Minahan C, Sayer TA, Paterson K, Vertullo CJ, Bryant AL, Saxby DJ. Effects of Pubertal Maturation on ACL Forces During a Landing Task in Females. Am J Sports Med 2021; 49:3322-3334. [PMID: 34494904 DOI: 10.1177/03635465211038332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rates of anterior cruciate ligament (ACL) rupture in young people have increased by >70% over the past two decades. Adolescent and young adult females are at higher risk of ACL injury as compared with their prepubertal counterparts. PURPOSE To determine ACL loading during a standardized drop-land-lateral jump in females at different stages of pubertal maturation. STUDY DESIGN Controlled laboratory study. METHODS On the basis of the Tanner classification system, 19 pre-, 19 early-/mid-, and 24 late-/postpubertal females performed a standardized drop-land-lateral jump while 3-dimensional body motion, ground-reaction forces, and surface electromyography data were acquired. These data were used to model external biomechanics, lower limb muscle forces, and knee contact forces, which were subsequently used in a validated computational model to estimate ACL loading. Statistical parametric mapping analysis of variance was used to compare ACL force and its causal contributors among the 3 pubertal maturation groups during stance phase of the task. RESULTS When compared with pre- and early-/midpubertal females, late-/postpubertal females had significantly higher ACL force with mean differences of 471 and 356 N during the first 30% and 48% to 85% of stance, and 343 and 274 N during the first 24% and 59% to 81% of stance, respectively, which overlapped peaks in ACL force. At the point of peak ACL force, contributions from sagittal and transverse plane loading mechanisms to ACL force were higher in late-/postpubertal compared with pre- and early-/midpubertal groups (medium effect sizes from 0.44 to 0.77). No differences were found between pre- and early-/midpubertal groups in ACL force or its contributors. CONCLUSION The highest ACL forces were observed in late-/postpubertal females, consistent with recently reported rises of ACL injury rates in females aged 15 to 19 years. It is important to quantify ACL force and its contributors during dynamic tasks to advance our understanding of the loading mechanism and thereby provide guidance to injury prevention. CLINICAL RELEVANCE Growth of ACL volume plateaus around 10 years of age, before pubertal maturation, meaning that a late-/postpubertal female could have an ACL of similar size to their less mature counterparts. However, late-/postpubertal females have higher body mass requiring higher muscle forces to accelerate the body during dynamic tasks, which may increase ACL loading. Thus, if greater forces develop in these females, in part because of their increased body mass, these higher forces will be applied to an ACL that is not proportionally larger. This may partially explain the higher rates of ACL injury in late-/postpubertal females.
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Affiliation(s)
- Azadeh Nasseri
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - David G Lloyd
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Clare Minahan
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Timothy A Sayer
- Centre for Exercise, Health and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Kade Paterson
- Centre for Exercise, Health and Sports Medicine, University of Melbourne, Melbourne, Australia
| | | | - Adam L Bryant
- Centre for Exercise, Health and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - David J Saxby
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Lloyd D. The future of in-field sports biomechanics: wearables plus modelling compute real-time in vivo tissue loading to prevent and repair musculoskeletal injuries. Sports Biomech 2021:1-29. [PMID: 34496728 DOI: 10.1080/14763141.2021.1959947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023]
Abstract
This paper explores the use of biomechanics in identifying the mechanistic causes of musculoskeletal tissue injury and degeneration. It appraises how biomechanics has been used to develop training programmes aiming to maintain or recover tissue health. Tissue health depends on the functional mechanical environment experienced by tissues during daily and rehabilitation activities. These environments are the result of the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing musculoskeletal tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and deformation), which may be enabled by appropriate real-time biofeedback. Recent research shows that biofeedback technologies may increase their quality and effectiveness by integrating a personalised neuromusculoskeletal modelling driven by real-time motion capture and medical imaging. Model personalisation is crucial in obtaining physically and physiologically valid predictions of tissue biomechanics. Model real-time execution is crucial and achieved by code optimisation and artificial intelligence methods. Furthermore, recent work has also shown that laboratory-based motion capture biomechanical measurements and modelling can be performed outside the laboratory with wearable sensors and artificial intelligence. The next stage is to combine these technologies into well-designed easy to use products to guide training to maintain or recover tissue health in the real-world.
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Affiliation(s)
- David Lloyd
- School of Health Sciences and Social Work, Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), in the Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Griffith University, Australia
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14
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Nasseri A, Lloyd DG, Bryant AL, Headrick J, Sayer TA, Saxby DJ. Mechanism of Anterior Cruciate Ligament Loading during Dynamic Motor Tasks. Med Sci Sports Exerc 2021; 53:1235-1244. [PMID: 33731661 DOI: 10.1249/mss.0000000000002589] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This study determined anterior cruciate ligament (ACL) force and its contributors during a standardized drop-land-lateral jump task using a validated computational model. METHODS Three-dimensional whole-body kinematics, ground reaction forces, and muscle activation patterns from eight knee-spanning muscles were collected during dynamic tasks performed by healthy recreationally active females (n = 24). These data were used in a combined neuromusculoskeletal and ACL force model to determine lower limb muscle and ACL forces. RESULTS Peak ACL force (2.3 ± 0.5 bodyweight) was observed at ~14% of stance during the drop-land-lateral jump. The ACL force was primarily generated through the sagittal plane, and muscle was the dominant source of ACL loading. The main ACL antagonists (i.e., loaders) were the gastrocnemii and quadriceps, whereas the hamstrings were the main ACL agonists (i.e., supporters). CONCLUSION Combining neuromusculoskeletal and ACL force models, the roles of muscle in ACL loading and support were determined during a challenging motor task. Results highlighted the importance of the gastrocnemius in ACL loading, which could be considered more prominently in ACL injury prevention and rehabilitation programs.
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Affiliation(s)
| | | | - Adam L Bryant
- Centre for Exercise, Health & Sports Medicine, University of Melbourne, Melbourne, AUSTRALIA
| | | | - Timothy A Sayer
- Centre for Exercise, Health & Sports Medicine, University of Melbourne, Melbourne, AUSTRALIA
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15
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Sikidar A, Marieswaran M, Kalyanasundaram D. Estimation of forces on anterior cruciate ligament in dynamic activities. Biomech Model Mechanobiol 2021; 20:1533-1546. [PMID: 33880694 DOI: 10.1007/s10237-021-01461-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/10/2021] [Indexed: 01/13/2023]
Abstract
In this work, a nonlinear strain rate dependent plugin developed for the OpenSim® platform was used to estimate the instantaneous strain rate (ISR) and the forces on the ACL's anteromedial (aACL) and posterolateral (pACL) bundles during walking and sudden change of direction of running termed as 'plant-and-cut' (PC). The authors obtained the kinematics data for walking via optical motion capture. PC movements, along with running kinematics, were obtained from the literature. A nonlinear plugin developed for ligaments was interfaced with OpenSim® platform to simulate walking and PC motions with a flexed knee and an extended knee. PC phase is sandwiched between an approach phase and take-off phase and was studied at various event velocities (1.8, 3, and 4.2 m s-1), and angles of PC (23°, 34°, and 45°) as encountered in adult ball games. In both cases of PC-with-extended knee and PC-with-flexed-knee, the maximum forces on both the ACL bundles were observed after the take-off phase. A maximum force of ~ 35 N kg-1 of body weight (BW) was observed on aACL after the take-off phase for an event velocity of 4.2 m s-1. In the posterolateral bundle (pACL), the maximum forces (~ 40 N kg-1 of BW) were observed towards the end of the mid-swing phase (after the take-off phase) for the various combinations of the parameters studied. The forces observed in the simulation of PC-with-flexed-knee and PC-with-extended-knee has resulted in magnitude higher than sustainable by the adults. This study is novel in attempting to incorporate differing rates-of-strain that have been shown to alter soft tissue properties into the OpenSim® musculoskeletal model. The proposed model can be used by researchers to predict the forces during various kinematic activities for other soft tissues.
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Affiliation(s)
- Arnab Sikidar
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India
| | - M Marieswaran
- Department of Sports Biomechanics, School of Sports Sciences, Central University of Rajasthan, Bandar Sindi, Ajmer, Rajasthan, 305817, India
| | - Dinesh Kalyanasundaram
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India.
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Charles JP, Fu FH, Anderst WJ. Predictions of Anterior Cruciate Ligament Dynamics From Subject-Specific Musculoskeletal Models and Dynamic Biplane Radiography. J Biomech Eng 2021; 143:031006. [PMID: 33030199 PMCID: PMC7871995 DOI: 10.1115/1.4048710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/17/2020] [Indexed: 01/13/2023]
Abstract
In vivo knee ligament forces are important to consider for informing rehabilitation or clinical interventions. However, they are difficult to directly measure during functional activities. Musculoskeletal models and simulations have become the primary methods by which to estimate in vivo ligament loading. Previous estimates of anterior cruciate ligament (ACL) forces range widely, suggesting that individualized anatomy may have an impact on these predictions. Using ten subject-specific (SS) lower limb musculoskeletal models, which include individualized musculoskeletal geometry, muscle architecture, and six degree-of-freedom knee joint kinematics from dynamic biplane radiography (DBR), this study provides SS estimates of ACL force (anteromedial-aACL; and posterolateral-pACL bundles) during the full gait cycle of treadmill walking. These forces are compared to estimates from scaled-generic (SG) musculoskeletal models to assess the effect of musculoskeletal knee joint anatomy on predicted forces and the benefit of SS modeling in this context. On average, the SS models demonstrated a double force peak during stance (0.39-0.43 xBW per bundle), while only a single force peak during stance was observed in the SG aACL. No significant differences were observed between continuous SG and SS ACL forces; however, root mean-squared differences between SS and SG predictions ranged from 0.08 xBW to 0.27 xBW, suggesting SG models do not reliably reflect forces predicted by SS models. Force predictions were also found to be highly sensitive to ligament resting length, with ±10% variations resulting in force differences of up to 84%. Overall, this study demonstrates the sensitivity of ACL force predictions to SS anatomy, specifically musculoskeletal joint geometry and ligament resting lengths, as well as the feasibility for generating SS musculoskeletal models for a group of subjects to predict in vivo tissue loading during functional activities.
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Affiliation(s)
- James P. Charles
- Evolutionary Morphology and Biomechanics Lab, Musculoskeletal Biology, University of Liverpool, Liverpool L7 8TX, UK; Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15260
| | - Freddie H. Fu
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15260
| | - William J. Anderst
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15260
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Li L, Baur M, Baldwin K, Kuehn T, Zhu Q, Herman D, Dai B. Falling as a strategy to decrease knee loading during landings: Implications for ACL injury prevention. J Biomech 2020; 109:109906. [PMID: 32807342 DOI: 10.1016/j.jbiomech.2020.109906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/13/2020] [Accepted: 06/17/2020] [Indexed: 01/14/2023]
Abstract
Anterior cruciate ligament (ACL) injuries often occur when individuals land primarily on a single leg. Falling has been proposed as a potential strategy to decrease knee loading during landings. The purpose of this study was to compare impact forces, knee angles, and knee moments during natural landings, soft landings, and landings followed by falling after forward and vertical jumps, each under single or double-leg conditions. Sixteen male and sixteen female participants (age: 22.0 ± 2.9 years) completed each landing condition while kinematics and ground reaction forces were collected. In the natural landing condition, participants landed as they would in a sport setting. In the soft landing condition, participants landed as softly as possible with increased knee and hip flexion. In the falling condition, participants landed softly and then fell forward or backward onto a mat after forward and vertical jumps, respectively. The falling condition demonstrated the greatest initial and peak knee flexion angles, the least peak vertical ground reaction forces, and the least peak knee extension and adduction moments compared to the natural landing and soft landing conditions. The soft landing condition resulted in similar changes in landing mechanics compared to the natural landing, but the effect was limited for single-leg landings compared to double-leg landings. When the sports environment allows, falling appears to be a potential strategy to decrease knee loading when individuals must land on a single leg with sub-optimal body postures. Future studies are needed to develop progressive training of effective and safe falling techniques.
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Affiliation(s)
- Ling Li
- Division of Kinesiology and Health, University of Wyoming, Laramie, USA
| | - Marten Baur
- Division of Kinesiology and Health, University of Wyoming, Laramie, USA
| | - Kevin Baldwin
- Division of Kinesiology and Health, University of Wyoming, Laramie, USA
| | - Taylor Kuehn
- Division of Kinesiology and Health, University of Wyoming, Laramie, USA
| | - Qin Zhu
- Division of Kinesiology and Health, University of Wyoming, Laramie, USA
| | - Daniel Herman
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, USA.
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