Uphill walking: Biomechanical demand on the lower extremities of obese adolescents

The impact of pediatric obesity on biomechanical differences across the gait cycle at three walking speeds

BACKGROUND

Obesity impacts a child's ability to walk with resulting biomechanical adaptations; however, existing research has not comprehensively compared differences across the gait cycle. We examined differences in lower extremity biomechanics across the gait cycle between children with and without obesity at three walking speeds.

METHODS

Full gait cycles of age-matched children with obesity (N = 10; BMI: 25.7 ± 4.2 kg/m2) and without obesity (N = 10; BMI: 17.0 ± 1.9 kg/m2) were analyzed at slow, normal, and fast walking speeds. Main and interaction effects of group and speed across hip, knee, and ankle joint angles and moments in sagittal, frontal, and transverse planes were analyzed using one-dimensional statistical parametric mapping.

FINDINGS

Compared to children without obesity, children with obesity had greater hip adduction during mid-stance, while also producing greater hip extensor moments during early stance phase, abductor moments throughout most of stance, and hip external rotator moments during late stance. Children with obesity recorded greater knee flexor, knee extensor and knee internal rotator moments during early stance, and knee external rotator moments in late stance than children without obesity; children with obesity also demonstrated greater ankle plantarflexor moments throughout mid and late stance. Interaction effects existed within joint kinetics data; children with obesity produced greater hip extensor moments at initial contact and toe-off when walking at fast compared to normal walking speed.

INTERPRETATION

While few kinematic differences existed between the two groups, children with obesity exhibited greater moments at the hip, knee, and ankle during critical periods of controlling and stabilizing mass.

Biomechanical variations in children who are overweight and obese during high-impact activities: A systematic review and meta-analysis

Youth who are obese or overweight demonstrate evidence of poor lower extremity joint health and alterations in gait characteristics compared with youth who are healthy weight. However, there is no consensus if altered movement patterns are still present during high-impact activities. The purpose of this review was to determine if spatiotemporal and kinematic and kinetic variables during high-impact activities were significantly different between youth who are overweight and obese compared with youth who are healthy weight. An electronic search of five databases was conducted, and a meta-analysis and qualitative evidence synthesis was performed to determine the level of evidence, analyzing three tasks: running, jumping, and hopping. The findings of this review include the following: (1) overweight/obese (OW/OB) had higher stance phase time during running, (2) OW/OB had decreased hip flexion angles during running and stationary running, (3) OW/OB had decreased knee flexion angles during landing phase of jumping and hopping, and (4) OW/OB had increased hip abduction moments during running and jumping. These altered kinematic and kinetic variables at the hip and knee may result in mechanical inefficiency with high-impact activities, as well as potentially increased risk of joint degradation and poor joint health into adulthood.

Simultaneous Treatment of Osteochondral Lesion Does Not Affect the Mid- to Long-Term Outcomes of Ligament Repair for Acute Ankle Sprain: A Retrospective Comparative Study with a 3–11-Year Follow-up

Purpose

This study aims to evaluate the mid- to long-term outcome of concurrent arthroscopic treatment of osteochondral lesion (OCL) and open anatomical repair of lateral ankle ligaments for severe acute ankle sprain patients and compare them to the outcome of those without OCL.

Methods

A total of 166 patients with grade III acute lateral ankle ligament injuries underwent concurrent ankle arthroscopy and open anatomic ligament repair. Forty-three patients (group A) with OCL underwent arthroscopic treatment followed by open ligament repair. A total of 105 patients (group B) without OCL were followed up as the control. The evaluation parameters included sports recovery, postoperative visual analog scale (VAS) pain score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner score, sprain recurrence, satisfaction, and range of motion. Patients in group A were then subgroup-analyzed according to age, sex, body mass index, injury side, OCL location, and stage (Ferkel and Cheng’s staging system).

Results

The postoperative exercise level of the two groups recovered to more than 90% of the normal level (91.2% ± 11.2% in group A and 90.9% ± 13.3% in group B, n.s.). The average time of group A and group B to return to preinjury sports activity was respectively 4.4 ± 1.0 months and 4.4 ± 1.2 months with no significant difference (p = 0.716). No significant differences were found in the preoperation VAS pain score, AOFAS score, and Tegner score between the two groups. The postoperative VAS pain score in group A was significantly higher than that in group B (0.8 ± 1.7 vs. 0.3 ± 0.8, p = 0.027), but the difference was not clinically important. The postoperative VAS pain score of patients with stage D–F lesions was significantly higher than that of patients with stage B–C lesions (1.3 ± 2.1 vs. 0.3 ± 0.9, p = 0.038).

Conclusions

For the severe acute ankle sprain combined with OCL, the simultaneous arthroscopic treatment and open lateral ankle ligament repair achieved good mid- to long-term outcomes. Except that the pain was more pronounced than in the control group, there were no differences in other outcomes. Postoperative pain was positively correlated with the grade of OCL.

Gait on slopes: Differences in temporo-spatial, kinematic and kinetic gait parameters between walking on a ramp and on a treadmill

BACKGROUND

Inclined treadmills or static ramp constructions can be used to investigate downhill gait in a standardised laboratory condition. There is a lack of information how the gait patterns are affected when walking on a ramp or an inclined treadmill during uphill and downhill walking.

RESEARCH QUESTION

Is there a difference in temporo-spatial parameters, sagittal ankle, knee and hip joint angle as well as ground reaction force when walking uphill and downhill on a ramp and a treadmill.

METHODS

Uphill and downhill gait of 15 healthy participants was assessed during walking on a treadmill and on a ramp with slope gradients of 12 °, 6 ° and 0 °. Participants were instructed to walk with the same speed on each slope-system. Kinematic and temporo-spatial paramters were collected using a 3D motion capture system (Qualisys, Gothenburgh, Sweden), kinetic data were collected using pressure insoles (loadsol®, Novel, Germany). Temporo-spatial parameters were analysed using a Friedman ANOVA, time series of kinematic and kinetic data were compared using statistical parametric mapping with a sigificance level of 5%.

RESULTS

On the treadmill participants walked with significantly shorter steps and shorter contact times, while they significantly increased step frequency compared to walking on a ramp, regardless of slope gradient. In uphill conditions, treadmill gait increased hip and knee flexion angles during the stance phase and increased the forward tilt of the thorax during the entire gait cycle. During downhill walking a significant decrease in dorsiflexion during initial contact, midstance and the second half of the swing phase was observed. Peak resultant forces remained similar compared to walking on the ramp. These alterations might be due to mechanical and psychological effects.

SIGNIFICANCE

Knowledge about these differences is important in future study design and data interpretation from existing literature.

Association of Body Mass Index With Severity and Lesion Location in Adolescents With Osteochondritis Dissecans of the Knee

BACKGROUND

The association between body mass index (BMI) and severity of osteochondritis dissecans (OCD) of the knee at presentation is poorly understood.

HYPOTHESIS

We hypothesized that adolescents in higher BMI percentiles for age and sex would have OCD lesions that were more severe at their initial presentation and located more posteriorly on the condyle as compared with adolescents in lower BMI percentiles.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

This study included patients aged 10 to 18 years who were treated for knee OCD at a tertiary care hospital from 2006 to 2017. Patients with noncondylar OCD or missing BMI data within 3 months of presentation were excluded. Patients were stratified per the Centers for Disease Control and Prevention guidelines as underweight, normal weight, overweight, or obese, and the groups were compared according to age, side of lesion, 4 markers of lesion severity (cystic changes, loose fragments, subchondral fluid, and subchondral edema), and surgical treatment. Lesion angle was measured in reference to a line parallel to the femoral axis drawn through the center of a best-fit circle covering the distal condyle. Data were analyzed using chi-square tests, relative risk, Student t tests, analysis of variance, and linear regression of cumulative running percentages. Bonferroni correction was performed when applicable.

RESULTS

A total of 77 patients met our inclusion criteria (mean age, 14.2 years; range, 10.1-18.8): 2 were underweight, 50 had normal BMI, 13 were overweight, and 12 were obese. We found correlations between BMI percentile and surgical treatment (R 2 = .732), subchondral fluid (R 2 = .716), subchondral edema (R 2 = .63), loose fragments (R 2 = .835), and the presence of at least 1 marker of lesion severity (R 2 = .857) (P < .0001 for all). No correlation was observed for cystic changes (R 2 = .026). There were significant associations between BMI ≥80th percentile and subchondral edema (risk ratio, 2.5; 95% CI, 1.3-4.8), medial condylar lesions (risk ratio, 1.3; 95% CI, 1.01-1.7), and lesions more anterior on the condyle (P < .05).

CONCLUSION

Higher BMI in adolescents was strongly correlated with multiple markers of severity of knee OCD at initial presentation as well as with more anterior lesions.

Effects of real-time feedback during decline walking on kinematic and kinetic gait parameters in a healthy population: study protocol for a randomized trial - up and down

BACKGROUND

The control of the dynamic functional leg alignment (dFLA) and biomechanical load are important joint-related aspects regarding the development of osteoarthritis (OA). Research on level walking with feedback on load-related parameters has provided innovative treatment possibilities. With regard to walking on sloped surfaces, fundamental biomechanical knowledge exists. However, comprehensive data on the agreement of kinematics and kinetics of self-paced ramp versus sloped treadmill walking is lacking. Further, deeper insights into the control of the dFLA during decline walking and the usefulness of real-time feedback are missing.

METHODS/DESIGN

Thirty healthy participants aged between 18 and 35 years will be included. They will complete a three-dimensional gait analysis walking self-paced up and down on a 5-m ramp with a 10° inclination. Subsequently, speed-matched to ramp-up walking and self-paced 10° incline split-belt treadmill walking will be assessed. Afterwards, the participants will be observed under four different conditions of 10° declined walking on the same treadmill (a) self-paced walking, (b) self-paced walking with an internal focus of attention, (c) self-paced walking with real-time feedback, and (d) condition c speed-matched walking. The primary outcome parameter will be the frontal knee range of motion (fKROM). Secondary outcomes include the ground reaction force loading rate, spatial-temporal parameters, as well as sagittal, frontal and transversal kinematics, and kinetics for the lower extremities.

DISCUSSION

The findings aim at improving the understanding of the effects of real-time feedback on the control of the dFLA and lower limb loading. Following clinical practicable methods for effective feedback devices can be developed and evaluated. Additionally, the first dataset comparing kinematic and kinetic parameters for decline and incline ramp walking versus walking on an instrumented treadmill will be available for appropriate intervention planning.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04763850 . Prospectively registered on 21 February 2021.

Obesity Is Preferentially Associated With Patellofemoral Compartment Wear: A Magnetic Resonance Imaging Assessment

BACKGROUND

A well-known association exists between obesity and knee osteoarthritis (OA) for both incidence and progression of the disease. However, the cartilage wear patterns in OA associated with obesity are less well studied.

METHODS

The OA initiative, a prospective sample of 4,796 patients, was used for this study. After the application of inclusion and exclusion criteria, patients were stratified into increasing body mass index (BMI) cohorts (BMI < 25, 25 ≤ BMI < 30, 30 ≤ BMI < 40, and 40 ≤ BMI). Knee MRIs were assessed using the semiquantitative MRI Osteoarthritis Knee Score scores. Patellofemoral (PF), medial, and lateral compartment cartilage scores were compared among BMI cohorts, controlling for confounders using linear regression models.

RESULTS

In total, 2,006 patients were present in our cohort, 773 men (38.5%) and 1,233 women (61.5%); the mean age was 61.7 ± 8.9 years. Increasing BMI was independently associated with increasing grades of PF wear for both right and left knees in the lateral patella facet (right knee β: 0.208, 95% confidence interval [CI]: 0.128 to 0.288, P < 0.001, left knee β: 0.147, 95% CI: 0.056 to 0.237, P = 0.002), medial femoral trochlea (right knee β: 0.135, 95% CI: 0.065 to 0.204, P < 0.001, left knee β: 0.142, 95% CI: 0.063 to 0.221, P < 0.001), and lateral femoral trochlea (right knee β: 0.163, 95% CI: 0.093 to 0.232, P < 0.001, left knee β: 0.147, 95% CI: 0.067 to 0.226, P < 0.001). For the right knee, increasing BMI was associated with medial compartment wear in the posterior femoral area (β: 0.070, 95% CI: 0.015 to 0.126, P = 0.013) and lateral compartment wear in the central tibial area (β: 0.070, 95% CI: 0.002 to 0.138, P = 0.045). For the left knee, increasing BMI was associated with medial compartment wear in the central femoral area (β: 0.093, 95% CI: 0.016 to 0.171, P = 0.018).

DISCUSSION

Obesity is preferentially associated with increasing cartilage wear in the PF compartment in comparison to the tibiofemoral compartment. Physical therapy and exercise programs that promote weight loss should be modified to decrease forces on the PF joint.

Effects of Increased Step-Width on Knee Biomechanics During Inclined and Declined Walking

The purpose of this study was to investigate effects of preferred step width and increased step width modification on knee biomechanics of obese and healthy-weight participants during incline and decline walking. Seven healthy-weight participants and 6 participants who are obese (body mass index ≥ 30) performed 5 walking trials on level ground and a 10° inclined and declined instrumented ramp system at both preferred and wide step-widths. A 2 × 2 (step-width × group) mixed-model analysis of variance was used to examine selected variables. There were significant increases in step-width between the preferred and wide step-width conditions for all 3 walking conditions (all P < .001). An interaction was found for peak knee extension moment (P = .048) and internal knee abduction moment (KAM) (P = .025) in uphill walking. During downhill walking, there were no interaction effects. As step-width increased, KAM was reduced (P = .007). In level walking, there were no interaction effects for peak medial ground reaction force and KAM (P = .007). There was a step-width main effect for KAM (P = .007). As step-width increased, peak medial ground reaction force and peak knee extension moment increased, while KAM decreased for both healthy weight and individuals who are obese. The results suggest that increasing step-width may be a useful strategy for reducing KAM in healthy and young populations.

A systematic review on biomechanical characteristics of walking in children and adolescents with overweight/obesity: Possible implications for the development of musculoskeletal disorders

It is known that obesity is associated with biomechanical alterations during locomotor tasks, which is considered a potential risk factor for the development of musculoskeletal disorders (MSKD). However, the association of obesity with biomechanical alterations of walking in the early stages of life have not yet been systematically reviewed. Thus, this review aims to summarize the biomechanical characteristics of walking in children and adolescents with overweight/obesity (OW/OB) versus their normal-weight (NW) counterparts. PubMed and Web of Science were systematically searched until November 2018. We found strong and moderate evidence supporting biomechanical differences in the gait pattern of OW/OB with respect to NW. Based on strong evidence, the gait patterns of OW/OB present greater pelvis transversal plane motion, higher hip internal rotation, higher hip flexion, extension and abduction moments and power generation/absorption, greater knee abduction/adduction motion, and higher knee abduction/adduction moments and power generation/absorption. Based on moderate evidence, OW/OB walk with greater step width, longer stance phase, higher tibiofemoral contact forces, higher ankle plantarflexion moments and power generation, and greater gastrocnemius and soleus activation/forces. These biomechanical alterations during walking in OW/OB could play a major role in the onset and progression of MSKD.