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Mahendrakar P, Kumar D, Patil U. A Comprehensive Review on MRI-based Knee Joint Segmentation and Analysis Techniques. Curr Med Imaging 2024; 20:e150523216894. [PMID: 37189281 DOI: 10.2174/1573405620666230515090557] [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: 08/26/2022] [Revised: 11/29/2022] [Accepted: 12/28/2022] [Indexed: 05/17/2023]
Abstract
Using magnetic resonance imaging (MRI) in osteoarthritis pathogenesis research has proven extremely beneficial. However, it is always challenging for both clinicians and researchers to detect morphological changes in knee joints from magnetic resonance (MR) imaging since the surrounding tissues produce identical signals in MR studies, making it difficult to distinguish between them. Segmenting the knee bone, articular cartilage and menisci from the MR images allows one to examine the complete volume of the bone, articular cartilage, and menisci. It can also be used to assess certain characteristics quantitatively. However, segmentation is a laborious and time-consuming operation that requires sufficient training to complete correctly. With the advancement of MRI technology and computational methods, researchers have developed several algorithms to automate the task of individual knee bone, articular cartilage and meniscus segmentation during the last two decades. This systematic review aims to present available fully and semi-automatic segmentation methods for knee bone, cartilage, and meniscus published in different scientific articles. This review provides a vivid description of the scientific advancements to clinicians and researchers in this field of image analysis and segmentation, which helps the development of novel automated methods for clinical applications. The review also contains the recently developed fully automated deep learning-based methods for segmentation, which not only provides better results compared to the conventional techniques but also open a new field of research in Medical Imaging.
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Affiliation(s)
- Pavan Mahendrakar
- BLDEA’s V.P.Dr. P.G., Halakatti College of Engineering and Technology, Vijayapur, Karnataka, India
| | | | - Uttam Patil
- Jain College of Engineering, T.S Nagar, Hunchanhatti Road, Machhe, Belagavi, Karnataka, India
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2
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Morelli KM, Newkirk-Pulliam NE, Angelich CM, Buckner QT, Homan CM, Irwin JP, Butler AJ, Tsai LC. Bilateral lower extremity gait and function after unilateral total ankle arthroplasty: a case report. Physiother Theory Pract 2023; 39:2490-2500. [PMID: 35608622 DOI: 10.1080/09593985.2022.2078752] [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: 05/02/2021] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND End-stage ankle osteoarthritis is one of the leading causes of chronic disability in North America. The main purpose of this case report was to describe the functional recovery of a person following total ankle arthroplasty (TAA) surgery using the INFINITY™ system for end stage osteoarthritis of the left ankle. CASE DESCRIPTION We report a case of a 55-year-old male who had attempted conservative management for end stage ankle osteoarthritis in his left ankle but ultimately elected to undergo TAA using The INFINITY™ Total Ankle System. He not only had significant left ankle pain limiting his daily function, but also had developed severe right knee pain. We performed gait analysis both before and 6 months after his TAA surgery to examine the sagittal and frontal-plane motions of bilateral ankle, knee, and hip joints during gait. OUTCOMES At 6 months post-surgery, the patient demonstrated a 44-point improvement in his Foot and Ankle Outcome questionnaire scores as well as an increase in both left knee and left ankle motion in the sagittal and frontal planes. Kinematic deviations in the left ankle, hip, and knee joints during gait also reduced post-surgery. Despite improvement in his left ankle and overall function, the participant's right knee pain and altered kinematics of the right limb during gait worsened after surgery. DISCUSSION Interventions, either before or after ankle surgery, should consider bilateral lower extremities simultaneously in order to optimize patient care and minimize future secondary complications for individuals with unilateral ankle osteoarthritis.
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Affiliation(s)
- Kimberly M Morelli
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | | | - Claire M Angelich
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Quinton T Buckner
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Conner M Homan
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Jake P Irwin
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Andrew J Butler
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
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Bairagi S, Abdollahifar MA, Atake OJ, Dust W, Wiebe S, Belev G, Chapman LD, Webb MA, Zhu N, Cooper DML, Eames BF. MRI overestimates articular cartilage thickness and volume compared to synchrotron radiation phase-contrast imaging. PLoS One 2023; 18:e0291757. [PMID: 37788257 PMCID: PMC10547194 DOI: 10.1371/journal.pone.0291757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Accurate evaluation of morphological changes in articular cartilage are necessary for early detection of osteoarthritis (OA). 3T magnetic resonance imaging (MRI) has highly sensitive contrast resolution and is widely used clinically to detect OA. However, synchrotron radiation phase-contrast imaging computed tomography (SR-PCI) can also provide contrast to tissue interfaces that do not have sufficient absorption differences, with the added benefit of very high spatial resolution. Here, MRI was compared with SR-PCI for quantitative evaluation of human articular cartilage. Medial tibial condyles were harvested from non-OA donors and from OA patients receiving knee replacement surgery. Both imaging methods revealed that average cartilage thickness and cartilage volume were significantly reduced in the OA group, compared to the non-OA group. When comparing modalities, the superior resolution of SR-PCI enabled more precise mapping of the cartilage surface relative to MRI. As a result, MRI showed significantly higher average cartilage thickness and cartilage volume, compared to SR-PCI. These data highlight the potential for high-resolution imaging of articular cartilage using SR-PCI as a solution for early OA diagnosis. Recognizing current limitations of using a synchrotron for clinical imaging, we discuss its nascent utility for preclinical models, particularly longitudinal studies of live animal models of OA.
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Affiliation(s)
- Suranjan Bairagi
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mohammad-Amin Abdollahifar
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Oghenevwogaga J. Atake
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - William Dust
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sheldon Wiebe
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - George Belev
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - L. Dean Chapman
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - M. Adam Webb
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - Ning Zhu
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - David M. L. Cooper
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - B. Frank Eames
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Li Y, Zhu T, Liang J, Wu Y, Guan X, Liu T, Lü S, Li Y, Wang Y, Ping Y. The First Discovery of a Microstructure in Black Plaster and Its Performance Characterization. Drug Des Devel Ther 2023; 17:2223-2237. [PMID: 37533971 PMCID: PMC10392905 DOI: 10.2147/dddt.s409064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Background Black plaster is one of the classic dosage forms of traditional Chinese medicine for external use and has been widely utilized since the Tang and Song Dynasties. In this paper, we take Goupi Gao as the research object and discuss the scientific characteristics of the black plaster dosage form. Goupi Gao ointment is a plaster for external use of traditional Chinese medicine. Methods Methods for the morphological and quantitative characterization of black plaster's microstructure, based on FESEM-IPP (Field Emission Scanning Electron Microscope IPP Image Processing) technology, were established. According to the actual operating temperature of Goupi Gao, three temperatures were selected: 28°C, 35°C, and 45°C. A UPLC analysis method was applied to the cinnamaldehyde and eugenol in Goupi Gao, and the release behavior of Goupi Gao from three samples at three temperatures was investigated using the paddle over disk method. Preparation of rabbit model of knee osteoarthritis of cold blood stasis type by cold stimulation combined with drug induction. Results In terms of morphology, Goupi Gao and the blank black plaster matrix both formed a double continuous phase system with a thicker vegetable oil phase and crossed "branched" soap crystal fibers. Based on the IPP image quantification parameters, the pore area (A) was highly positively correlated with temperature. After the 28 °C treatment, A1 = (216.8±59.5) μm2; after the 35 °C treatment, A2 = (259.7±52.8) μm2; after the 45 °C treatment, A3 = (408.0±57.7) μm2, and there were no significant differences in other pore parameters. Conclusion The black plaster matrix's unique structure makes it highly applicable in numerous medications; it exhibits slow-release and performs well in extreme temperatures, with good adhesion and peeling properties.
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Affiliation(s)
- Yingpeng Li
- College of Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, People’s Republic of China
| | - Ting Zhu
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, 150040, People’s Republic of China
- Center of Pharmaceutical Engineering and Technology, College of Pharmacy, Harbin University of Commerce, Harbin, 150076, People’s Republic of China
| | - Jingxian Liang
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, 150040, People’s Republic of China
| | - Yuanqun Wu
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, 150040, People’s Republic of China
| | - Xiantong Guan
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, 150040, People’s Republic of China
| | - Tingting Liu
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, 150040, People’s Republic of China
| | - Shaowa Lü
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, 150040, People’s Republic of China
| | - Yongji Li
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, 150040, People’s Republic of China
| | - Yanhong Wang
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, 150040, People’s Republic of China
| | - Yang Ping
- College of Pharmacy, Jiamusi University, Jiamusi, Heilongjiang, 154007, People’s Republic of China
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Watanabe K, Mutsuzaki H, Fukaya T, Aoyama T, Nakajima S, Sekine N, Mori K. Simulating Knee-Stress Distribution Using a Computed Tomography-Based Finite Element Model: A Case Study. J Funct Morphol Kinesiol 2023; 8:jfmk8010015. [PMID: 36810499 PMCID: PMC9944518 DOI: 10.3390/jfmk8010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
This study aimed to evaluate the mechanism of progression involved in knee osteoarthritis (OA). We used the computed tomography-based finite element method (CT-FEM) of quantitative X-ray CT imaging to calculate and create a model of the load response phase, wherein the greatest burden is placed on the knee joint while walking. Weight gain was simulated by asking a male individual with a normal gait to carry sandbags on both shoulders. We developed a CT-FEM model that incorporated walking characteristics of individuals. Upon simulating changes owing to a weight gain of approximately 20%, the equivalent stress increased extensively in both medial and lower leg aspects of the femur and increased medio-posteriorly by approximately 230%. As the varus angle increased, stress on the surface of the femoral cartilage did not change significantly. However, the equivalent stress on the surface of the subchondral femur was distributed over a wider area, increasing by approximately 170% in the medio-posterior direction. The range of equivalent stress affecting the lower-leg end of the knee joint widened, and stress on the posterior medial side also increased significantly. It was reconfirmed that weight gain and varus enhancement increase knee-joint stress and cause the progression of OA.
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Affiliation(s)
- Kunihiro Watanabe
- Department of Radiology, Shin-Oyama City Hospital, Oyama-shi 323-0827, Tochigi, Japan
- Correspondence:
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Faculty of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Ibaraki, Japan
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Ibaraki, Japan
| | - Takashi Fukaya
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, Tsuchiura 300-0051, Ibaraki, Japan
| | - Toshiyuki Aoyama
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Ibaraki, Japan
| | - Syuichi Nakajima
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Ibaraki, Japan
| | - Norio Sekine
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa 116-8551, Tokyo, Japan
| | - Koichi Mori
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Ibaraki, Japan
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Evans-Pickett A, Lisee C, Zachary Horton W, Lalush D, Nissman D, Troy Blackburn J, Spang JT, Pietrosimone B. Worse Tibiofemoral Cartilage Composition Is Associated with Insufficient Gait Kinetics After ACL Reconstruction. Med Sci Sports Exerc 2022; 54:1771-1781. [PMID: 35700436 PMCID: PMC9481723 DOI: 10.1249/mss.0000000000002969] [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] [Indexed: 11/21/2022]
Abstract
PURPOSE Greater articular cartilage T1ρ magnetic resonance imaging relaxation times indicate less proteoglycan density and are linked to posttraumatic osteoarthritis development after anterior cruciate ligament reconstruction (ACLR). Although changes in T1ρ relaxation times are associated with gait biomechanics, it is unclear if excessive or insufficient knee joint loading is linked to greater T1ρ relaxation times 12 months post-ACLR. The purpose of this study was to compare external knee adduction (KAM) and flexion (KFM) moments in individuals after ACLR with high versus low tibiofemoral T1ρ relaxation profiles and uninjured controls. METHODS Gait biomechanics were collected in 26 uninjured controls (50% females; age, 22 ± 4 yr; body mass index, 23.9 ± 2.8 kg·m -2 ) and 26 individuals after ACLR (50% females; age, 22 ± 4 yr; body mass index, 24.2 ± 3.5 kg·m -2 ) at 6 and 12 months post-ACLR. ACLR-T1ρ High ( n = 9) and ACLR-T1ρ Low ( n = 17) groups were created based on 12-month post-ACLR T1ρ relaxation times using a k-means cluster analysis. Functional analyses of variance were used to compare KAM and KFM. RESULTS ACLR-T1ρ High exhibited lesser KAM than ACLR-T1ρ Low and uninjured controls 6 months post-ACLR. ACLR-T1ρ Low exhibited greater KAM than uninjured controls 6 and 12 months post-ACLR. KAM increased in ACLR-T1ρ High and decreased in ACLR-T1ρ Low between 6 and 12 months, both groups becoming more similar to uninjured controls. There were scant differences in KFM between ACLR-T1ρ High and ACLR-T1ρ Low 6 or 12 months post-ACLR, but both groups demonstrated lesser KFM compared with uninjured controls. CONCLUSIONS Associations between worse T1ρ profiles and increases in KAM may be driven by the normalization of KAM in individuals who initially exhibit insufficient KAM 6 months post-ACLR.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Lisee
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - W. Zachary Horton
- Department of Statistics, University of California at Santa Cruz, Santa Cruz, CA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, NC
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
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7
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Rapagna S, Roberts BC, Solomon LB, Reynolds KJ, Thewlis D, Perilli E. Relationships between tibial articular cartilage, in vivo external joint moments and static alignment in end-stage knee osteoarthritis: A micro-CT study. J Orthop Res 2022; 40:1125-1134. [PMID: 34191337 DOI: 10.1002/jor.25140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/16/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
Biomechanical factors (e.g., joint loading) have a significant role in the progression of osteoarthritis (OA). However, some relationships between in vivo joint loading indices and tibial cartilage thickness are conflicting. This study investigated relationships between pre-operative in vivo external knee joint moments, joint alignment and regional tibial cartilage thickness using micro-CT in subjects with end-stage knee OA. Tibial plateaus from 25 patients that underwent knee replacement for OA were micro-CT scanned (17 µm/voxel). Prior to surgery, subjects underwent gait analysis to calculate external knee moments. The mechanical axis deviation (MAD) was obtained from pre-operative radiographs. Cartilage thickness (Cart.Th) was analyzed from micro-CT images, in anteromedial, anterolateral, posteromedial and posterolateral subregions of interest. Medial-to-lateral Cart.Th ratios were also explored. Relationships between Cart.Th and joint loading indices were examined using Pearson's correlations. Significant correlations were found between Cart.Th and joint loading indices, positive anteromedially with the first peak knee adduction moment (r = 0.55, p < 0.01) and external rotation moment (ERM; r = 0.52, p < 0.01), and negative with MAD (r = -0.76, p < 0.001). In the lateral regions, these correlations had opposite signs. The medial-to-lateral Cart.Th ratio correlated strongly with ERM (r = 0.63, p = 0.001) and MAD (r = -0.75, p < 0.001). Joint loading indices correlated with regional cartilage thickness values and their medial-to-lateral ratios in end-stage knee OA subjects, with higher regional loads corresponding to thinner cartilage. These relationships have the opposite sign compared to the subchondral bone microarchitecture found in our previous study on the same specimens, which may suggest a complementary bone-cartilage interplay in response to loading.
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Affiliation(s)
- Sophie Rapagna
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Bryant C Roberts
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.,Department of Oncology & Metabolism and Insigneo Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen J Reynolds
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
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Gatti AA, Keir PJ, Noseworthy MD, Maly MR. Investigating acute changes in osteoarthritic cartilage by integrating biomechanics and statistical shape models of bone: data from the osteoarthritis initiative. MAGNETIC RESONANCE MATERIALS IN PHYSICS, BIOLOGY AND MEDICINE 2022; 35:861-873. [PMID: 35286512 PMCID: PMC8919909 DOI: 10.1007/s10334-022-01004-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/06/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022]
Abstract
Objective Methods Results Discussion Supplementary Information
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Affiliation(s)
- Anthony A Gatti
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
- NeuralSeg Ltd., Hamilton, Canada
| | - Peter J Keir
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Michael D Noseworthy
- School of Biomedical Engineering, McMaster University, Hamilton, Canada
- School of Electrical and Computer Engineering, McMaster University, Hamilton, Canada
| | - Monica R Maly
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada.
- Department of Kinesiology, McMaster University, Hamilton, Canada.
- Department of Kinesiology, University of Waterloo, Waterloo, Canada.
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Mochizuki T, Omori G, Nishino K, Tanaka M, Tanifuji O, Koga H, Mori T, Koga Y, Kawashima H. The medial inclination of the proximal tibia is associated with the external knee adduction moment in advanced varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:574-583. [PMID: 33067660 DOI: 10.1007/s00167-020-06323-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Whether the inclined articular surface on the medial proximal tibia and the external knee adduction moment (KAM) correlate remains unclear. The hypothesis was that a steeper inclined articular surface correlated with a larger KAM in advanced knee osteoarthritis (OA). METHODS A total of 44 females (non-OA, 9 knees; early OA, 14 knees; advanced OA, 21 knees; mean age, 58 ± 16 years) were examined. Three-dimensional (3D) assessment was used on biplanar long-leg radiographs and 3D bone models using a 3D to 2D image registration technique. The approximation plane in the proximal tibia was determined using the least-square method. The joint moments were mathematically calculated in a gait analysis, applying a motion capture system and force plates. The main evaluation parameters were the femorotibial angle (FTA), the coronal inclination of the approximation plane in the medial proximal tibia (coronal inclination), and internal knee joint moments. The KAM means the external moments balanced with the internal knee abduction moments. RESULTS The advanced OA showed a larger internal abduction moment (p = 0.017) at the loading response than the other groups. The larger FTA and steeper coronal inclination correlated with the larger internal abduction moment (FTA, p < 0.001; coronal inclination, p = 0.003) at the loading response. CONCLUSIONS As the clinical relevance, the association among the coronal inclination of the medial proximal tibia, lower extremity alignment, and KAM is one of the key factors to help better understand the etiology of knee OA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | | | - Masaei Tanaka
- Niigata Institute for Health and Sports Medicine, Niigata, Japan
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Hiroshi Koga
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Takahiro Mori
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopaedic Surgery, Nioji Onsen Hospital, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
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10
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Aljehani MS, Christensen JC, Snyder-Mackler L, Crenshaw J, Brown A, Zeni JA. Knee biomechanics and contralateral knee osteoarthritis progression after total knee arthroplasty. Gait Posture 2022; 91:266-275. [PMID: 34775230 PMCID: PMC8963526 DOI: 10.1016/j.gaitpost.2021.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 09/24/2021] [Accepted: 10/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the success rate of Total Knee Arthroplasty (TKA), many patients undergo contralateral TKA. It is possible that altered gait mechanics after unilateral TKA play a role in the progression of contralateral OA progression. RESEARCH QUESTION The purpose of this study was to identify biomechanical predictors of radiographic OA progression in the contralateral (non-surgical) knee after unilateral (primary/initial) TKA. In addition, this study quantified for patients who had contralateral OA progression. METHODS Biomechanical outcomes were collected 6-24 months after unilateral primary TKA and were used to predict changes in contralateral OA severity at follow-up. Participants were divided into "Progressor" and "Non-Progressor" groups based on changes in Kellgren-Lawrence (KL) OA grade and Joint Space Width (JSW) between baseline and follow-up testing sessions. Biomechanical factors during walking were peak knee adduction moment, knee flexion/extension excursions, knee angle at initial foot contact, and peak knee flexion/extension. Multiple independent t-tests were used to examine the magnitude of differences in biomechanical variables between the groups. Logistic regression was used to examine the association between the biomechanical predictors and change in KL scores and JSW. RESULTS The mean time between surgery and follow-up x-rays was 8.8 (2.4) years. Of 40 participants, 62.5-78% had contralateral radiographic knee OA progression by follow-up. There were no significant differences in the biomechanical variables between groups. For the regression analysis, none of the biomechanical variables were found to be predictors for contralateral OA progression. SIGNIFICANCE Although abnormal biomechanics are known risk factors for primary knee OA, it is possible that the mechanisms that result in OA progression of the contralateral limb are different than primary knee OA progression. Future work should evaluate other objective measures of OA progression and determine if cumulative measures of joint loading are related to OA worsening.
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Affiliation(s)
- Moiyad Saleh Aljehani
- University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE 19713, USA; Umm Al-Qura University, Department of Physical Therapy, P.O. Box 715, Makkah 21421, Saudi Arabia.
| | - Jesse C Christensen
- University of Utah, Department of Physical Therapy & Athletic Training, Veterans Affairs Salt Lake City Health Care System, Department of Physical Medicine and Rehabilitation, 520 So. Wakara Way, Salt Lake City, UT 84108, USA
| | - Lynn Snyder-Mackler
- University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE 19713, USA
| | - Jeremy Crenshaw
- University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE 19713, USA
| | - Allison Brown
- Rutgers, The State University of New Jersey, School of Health Professions, Department of Rehabilitation and Movement Sciences, Physical Therapy Program North, 65 Bergen Street - Office 714 A, Newark, NJ 07107, USA
| | - Joseph A Zeni
- Rutgers, The State University of New Jersey, School of Health Professions, Department of Rehabilitation and Movement Sciences, Physical Therapy Program North, 65 Bergen Street - Office 714 A, Newark, NJ 07107, USA
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11
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Cudejko T, Button K, Willott J, Al-Amri M. Applications of Wearable Technology in a Real-Life Setting in People with Knee Osteoarthritis: A Systematic Scoping Review. J Clin Med 2021; 10:5645. [PMID: 34884347 PMCID: PMC8658504 DOI: 10.3390/jcm10235645] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
With the growing number of people affected by osteoarthritis, wearable technology may enable the provision of care outside a traditional clinical setting and thus transform how healthcare is delivered for this patient group. Here, we mapped the available empirical evidence on the utilization of wearable technology in a real-world setting in people with knee osteoarthritis. From an analysis of 68 studies, we found that the use of accelerometers for physical activity assessment is the most prevalent mode of use of wearable technology in this population. We identify low technical complexity and cost, ability to connect with a healthcare professional, and consistency in the analysis of the data as the most critical facilitators for the feasibility of using wearable technology in a real-world setting. To fully realize the clinical potential of wearable technology for people with knee osteoarthritis, this review highlights the need for more research employing wearables for information sharing and treatment, increased inter-study consistency through standardization and improved reporting, and increased representation of vulnerable populations.
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Affiliation(s)
- Tomasz Cudejko
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, College House, King George V Drive East, Heath Park, Cardiff CF14 4EP, UK; (K.B.); (J.W.); (M.A.-A.)
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12
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Li S, Ng WH, Abujaber S, Shaharudin S. Effects of resistance training on gait velocity and knee adduction moment in knee osteoarthritis patients: a systematic review and meta-analysis. Sci Rep 2021; 11:16104. [PMID: 34373507 PMCID: PMC8352951 DOI: 10.1038/s41598-021-95426-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/23/2021] [Indexed: 01/08/2023] Open
Abstract
The systematic review aimed to analyze the effects of resistance training in knee osteoarthritis (OA) rehabilitation from a biomechanical perspective. A meta-analysis was performed to determine the potential benefits of resistance training on patients with knee OA. Relevant studies based on the inclusion and exclusion criteria were selected from CENTRAL, PubMed, Scopus, and Web of Science databases inception to August 2020. Outcome measures included gait velocity and knee adduction moment (KAM). The mean differences of the data with a 95% confidence interval were analyzed using STATA 15.1 software The search identified eight studies that satisfied all the inclusion criteria, in which 164 patients were involved in gait velocity studies and another 122 patients were part of KAM studies. Analysis of the pooled data showed that resistance training significantly improved the gait velocity in patients with knee OA (p < 0.01, z = 2.73), ES (95% CI) = 0.03 (0.01, 0.06) m/s. However, resistance training had no significant effect on improving KAM in patients with knee OA (p = 0.98, z = 0.03), ES (95% CI) = 0.00 (− 0.16, 0.16) percentage of body weight × height (%BW × Ht). Therefore, resistance training may enhance gait velocity but not KAM in knee OA patients. The protocol was registered at PROSPERO (registration number: CRD42020204897).
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Affiliation(s)
- Shuoqi Li
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Wei Hui Ng
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.,Klinik Kesihatan Putrajaya Presint 9, Kementerian Kesihatan Malaysia, 62300, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
| | - Sumayeh Abujaber
- School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Shazlin Shaharudin
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.
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13
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van Helvoort EM, Hodgins D, Mastbergen SC, Marijnissen AK, Guehring H, Loef M, Kloppenburg M, Blanco F, Haugen IK, Berenbaum F, Lafeber FPJG, Welsing PMJ. Relationship between motion, using the GaitSmartTM system, and radiographic knee osteoarthritis: an explorative analysis in the IMI-APPROACH cohort. Rheumatology (Oxford) 2021; 60:3588-3597. [PMID: 33367896 PMCID: PMC8328500 DOI: 10.1093/rheumatology/keaa809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/16/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives To assess underlying domains measured by GaitSmartTMparameters and whether these are additional to established OA markers including patient reported outcome measures (PROMs) and radiographic parameters, and to evaluate if GaitSmart analysis is related to the presence and severity of radiographic knee OA. Methods GaitSmart analysis was performed during baseline visits of participants of the APPROACH cohort (n = 297). Principal component analyses (PCA) were performed to explore structure in relationships between GaitSmart parameters alone and in addition to radiographic parameters and PROMs. Logistic and linear regression analyses were performed to analyse the relationship of GaitSmart with the presence (Kellgren and Lawrence grade ≥2 in at least one knee) and severity of radiographic OA (ROA). Results Two hundred and eighty-four successful GaitSmart analyses were performed. The PCA identified five underlying GaitSmart domains. Radiographic parameters and PROMs formed additional domains indicating that GaitSmart largely measures separate concepts. Several GaitSmart domains were related to the presence of ROA as well as the severity of joint damage in addition to demographics and PROMs with an area under the receiver operating characteristic curve of 0.724 and explained variances (adjusted R2) of 0.107, 0.132 and 0.147 for minimum joint space width, osteophyte area and mean subchondral bone density, respectively. Conclusions GaitSmart analysis provides additional information over established OA outcomes. GaitSmart parameters are also associated with the presence of ROA and extent of radiographic severity over demographics and PROMS. These results indicate that GaitsmartTM may be an additional outcome measure for the evaluation of OA.
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Affiliation(s)
- Eefje M van Helvoort
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Anne Karien Marijnissen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | - Marieke Loef
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisco Blanco
- Department of Rheumatology, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade de A Coruña (UDC), A Coruña, Spain
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Francis Berenbaum
- Institut national de la santé et de la recherché médicale (INSERM), Sorbonne Université, APHP hôpital Saint-Antoine, Paris, France
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
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14
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Biomechanical Effect of 3D-Printed Foot Orthoses in Patients with Knee Osteoarthritis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11094200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lateral wedges are a common conservative treatment for medial knee osteoarthritis (OA). However, use of lateral wedges might increase the ankle eversion moment. To minimize the risk of ankle symptoms, lateral wedges with custom arch support are suggested. However, the manufacturing process of a custom foot orthosis (FO) is complicated, labor-intensive, and time-consuming. The technology of 3D printing is an ideal method for mass customization. Therefore, the purpose of this study was to develop custom FOs using 3D-printing techniques and to evaluate the effects of 3D-printed FOs in patients with knee OA. Fifteen patients with medial knee OA were enrolled into this study. Kinematic and kinetic data were collected during walking by using an optical motion capture system. A paired-sample t-test was conducted to compare biomechanical variables under two conditions: walking in standard shoes (Shoe) and walking in shoes embedded with 3D-printed FOs (Shoe + FO). The results show that the first and second peak knee adduction moments were significantly reduced by 4.08% and 9.09% under the Shoe + FO condition. The FOs alter the biomechanical environment in a way that reduces the variables used to infer abnormal loads at the knee and ankle that could result in painful symptoms.
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15
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Nguyen LY, Harris KD, Morelli KM, Tsai LC. Increased knee flexion and varus moments during gait with high-heeled shoes: A systematic review and meta-analysis. Gait Posture 2021; 85:117-125. [PMID: 33548909 DOI: 10.1016/j.gaitpost.2021.01.017] [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: 04/28/2020] [Revised: 09/25/2020] [Accepted: 01/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND High-heeled shoes have been thought to alter lower extremity joint mechanics during gait, however its effects on the knee remain unclear. RESEARCH QUESTION This systematic review and meta-analysis aimed to determine the effects of high-heeled shoes on the sagittal- and frontal-plane knee kinetics/kinematics during gait. METHODS 1449 studies from 6 databases were screened for the following criteria: 1) healthy adult females, 2) knee joint kinematics/kinetics reported for the early stance phase during gait under varying shoe heel heights (including barefoot). Excluded studies included those mixing different shoe styles in addition to altering the heel heights. A total of 14 studies (203 subjects) met the selection criteria, resulting in 51 and 21 Cohen's d effect sizes (ESs) comparing the differences in knee sagittal- (flexion) and frontal-plane (varus) moment/angle, respectively, between shoes with higher heels and shoes with lower heels/barefoot. RESULTS Meta-analyses yielded a significant medium-to-large effect of higher heels compared to lower heels on increasing knee flexion moment (overall ES = 0.83; P < 0.01), flexion angle (overall ES=0.46; P < 0.01), and varus moment (overall ES=0.52; P < 0.01) during the early stance phase of gait. The results of meta-regressions used to explore factors explaining the heterogeneity among study ESs revealed that a greater ES in the knee flexion moment was associated with an elevated heel height of the high-heeled shoes (P = 0.02) and greater body mass of the individuals (P = 0.012). A greater ES in the knee varus moment during high-heeled gait was associated with a greater body height (P = 0.003) and mass (P = 0.006). SIGNIFICANCE Given the association between increased knee flexion/varus moments and risk of developing knee osteoarthritis (OA), women who wear high-heel shoes frequently and for a long period may be more susceptible to knee OA. Preventive treatments, such as lower extremity muscle strengthening, may help improve shock absorption to decrease knee loading in high-heel users.
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Affiliation(s)
- Linh Y Nguyen
- Department of Physical Therapy, Georgia State University, Atlanta GA, USA
| | - Kelsey D Harris
- Department of Physical Therapy, Georgia State University, Atlanta GA, USA
| | - Kimberly M Morelli
- Department of Physical Therapy, Georgia State University, Atlanta GA, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, Georgia State University, Atlanta GA, USA.
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16
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Is good muscle function a protective factor for early signs of knee osteoarthritis after anterior cruciate ligament reconstruction? The SHIELD cohort study protocol. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100102. [DOI: 10.1016/j.ocarto.2020.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
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17
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Hunt MA, Charlton JM, Esculier JF. Osteoarthritis year in review 2019: mechanics. Osteoarthritis Cartilage 2020; 28:267-274. [PMID: 31877382 DOI: 10.1016/j.joca.2019.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/25/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
Mechanics play a critical - but not sole - role in the pathogenesis of osteoarthritis, and recent research has highlighted how mechanical constructs are relevant at the cellular, joint, and whole-body level related to osteoarthritis outcomes. This review examined papers from April 2018 to April 2019 that reported on the role of mechanics in osteoarthritis etiology, with a particular emphasis on studies that focused on the interaction between movement and tissue biomechanics with other clinical outcomes relevant to the pathophysiology of osteoarthritis. Studies were grouped by themes that were particularly prevalent from the past year. Results of the search highlighted the large exposure of knee-related research relative to other body areas, as well as studies utilizing laboratory-based motion capture technology. New research from this past year highlighted the important role that rate of exerted loads and rate of muscle force development - rather than simply force capacity (strength) - have in OA etiology and treatment. Further, the role of muscle activation patterns in functional and structural aspects of joint health has received much interest, though findings remain equivocal. Finally, new research has identified potential mechanical outcome measures that may be related to osteoarthritis disease progression. Future research should continue to combine knowledge of mechanics with other relevant research techniques, and to identify mechanical markers of joint health and structural and functional disease progression that are needed to best inform disease prevention, monitoring, and treatment.
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Affiliation(s)
- M A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - J M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada.
| | - J-F Esculier
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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18
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Selistre LFA, Gonçalves GH, Vasilceac FA, Serrão PRMDS, Nakagawa TH, Petrella M, Jones RK, Mattiello SM. The relationship between urinary C-Telopeptide fragments of type II collagen, knee joint load, pain, and physical function in individuals with medial knee osteoarthritis. Braz J Phys Ther 2020; 25:62-69. [PMID: 32151525 DOI: 10.1016/j.bjpt.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Considering the osteoarthritis (OA) model that integrates the biological, mechanical, and structural components of the disease, the present study aimed to investigate the association between urinary C-Telopeptide fragments of type II collagen (uCTX-II), knee joint moments, pain, and physical function in individuals with medial knee OA. METHODS Twenty-five subjects radiographically diagnosed with knee OA were recruited. Participants were evaluated through three-dimensional gait analysis, uCTX-II level, the WOMAC pain and physical function scores, and the 40m walk test. The association between these variables was investigated using Pearson's product-moment correlation, followed by a hierarchical linear regression, controlled by OA severity and body mass index (BMI). RESULTS No relationship was found between uCTX-II level and knee moments. A significant correlation between uCTX-II level and pain, physical function, and the 40m walk test was found. The hierarchical linear regression controlling for OA severity and BMI showed that uCTX-II level explained 9% of the WOMAC pain score, 27% of the WOMAC physical function score, and 7% of the 40m walk test. CONCLUSION Greater uCTX-II level is associated with higher pain and reduced physical function and 40m walk test performance in individuals with medial knee OA.
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Affiliation(s)
| | - Glaucia Helena Gonçalves
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | | | - Theresa Helissa Nakagawa
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Marina Petrella
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | - Stela Márcia Mattiello
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
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19
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Watanabe K, Mutsuzaki H, Fukaya T, Aoyama T, Nakajima S, Sekine N, Mori K. Development of a Knee Joint CT-FEM Model in Load Response of the Stance Phase During Walking Using Muscle Exertion, Motion Analysis, and Ground Reaction Force Data. ACTA ACUST UNITED AC 2020; 56:medicina56020056. [PMID: 32013100 PMCID: PMC7074273 DOI: 10.3390/medicina56020056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/16/2020] [Accepted: 01/26/2020] [Indexed: 02/04/2023]
Abstract
Background and objectives: There are no reports on articular stress distribution during walking based on any computed tomography (CT)-finite element model (CT-FEM). This study aimed to develop a calculation model of the load response (LR) phase, the most burdensome phase on the knee, during walking using the finite element method of quantitative CT images. Materials and Methods: The right knee of a 43-year-old man who had no history of osteoarthritis or surgeries of the knee was examined. An image of the knee was obtained using CT and the extension position image was converted to the flexion angle image in the LR phase. The bone was composed of heterogeneous materials. The ligaments were made of truss elements; therefore, they do not generate strain during expansion or contraction and do not affect the reaction force or pressure. The construction of the knee joint included material properties of the ligament, cartilage, and meniscus. The extensor and flexor muscles were calculated and set as the muscle exercise tension around the knee joint. Ground reaction force was vertically applied to suppress the rotation of the knee, and the thigh was restrained. Results: An FEM was constructed using a motion analyzer, floor reaction force meter, and muscle tractive force calculation. In a normal knee, the equivalent stress and joint contact reaction force in the LR phase were distributed over a wide area on the inner upper surface of the femur and tibia. Conclusions: We developed a calculation model in the LR phase of the knee joint during walking using a CT-FEM. Methods to evaluate the heteromorphic risk, mechanisms of transformation, prevention of knee osteoarthritis, and treatment may be developed using this model.
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Affiliation(s)
- Kunihiro Watanabe
- Department of Radiology, Saitama Prefecture Saiseikai Kurihashi Hospital, Kuki, Saitama 349-1105, Japan;
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa, Tokyo 116-8551, Japan;
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki 300-0394, Japan;
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Ibaraki 300-0331, Japan
| | - Takashi Fukaya
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, Tsuchiura, Ibaraki 300-0051, Japan;
| | - Toshiyuki Aoyama
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki 300-0394, Japan;
| | - Syuichi Nakajima
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki 300-0394, Japan;
| | - Norio Sekine
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa, Tokyo 116-8551, Japan;
| | - Koichi Mori
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki 300-0394, Japan;
- Correspondence: ; Tel.: +81-29-888-4000
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20
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Willwacher S, Mählich D, Trudeau MB, Hamill J, Weir G, Brüggemann GP, Bratke G. The habitual motion path theory: Evidence from cartilage volume reductions in the knee joint after 75 minutes of running. Sci Rep 2020; 10:1363. [PMID: 31992793 PMCID: PMC6987217 DOI: 10.1038/s41598-020-58352-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/08/2020] [Indexed: 11/21/2022] Open
Abstract
The habitual motion path theory predicts that humans tend to maintain their habitual motion path (HMP) during locomotion. The HMP is the path of least resistance of the joints defined by an individual's musculoskeletal anatomy and passive tissue properties. Here we tested whether participants with higher HMP deviation and whether using footwear that increases HMP deviation during running show higher reductions of knee joint articular cartilage volume after 75 minutes of running. We quantified knee joint articular cartilage volumes before and after the run using a 3.0-Tesla MRI. We performed a 3D movement analysis of runners in order to quantify their HMP from a two-legged squat motion and the deviation from the HMP when running in different footwear conditions. We found significantly more cartilage volume reductions in the medial knee compartment and patella for participants with higher HMP deviation. We also found higher cartilage volume reductions on the medial tibia when runners wore a shoe that maximized their HMP deviation compared with the shoe that minmized their HMP deviation. Runners might benefit from reducing their HMP deviation and from selecting footwear by quantifying HMP deviation in order to minimize joint cartilage loading in sub-areas of the knee.
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Affiliation(s)
- Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University, Cologne, Germany.
| | - Daniela Mählich
- Institute of Biomechanics and Orthopaedics, German Sport University, Cologne, Germany
| | | | - Joseph Hamill
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA, USA
| | - Gillian Weir
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA, USA
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University, Cologne, Germany
| | - Grischa Bratke
- Department of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
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21
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Pejhan S, Chong HC, Tennant LM, Acker SM. A comparison of knee joint moments during high flexion squatting and kneeling postures in healthy individuals. Work 2019; 65:79-88. [PMID: 31868714 DOI: 10.3233/wor-193060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Deep knee bending has been reported as an occupational hazard to workers who have to adopt such postures. High knee joint moments have been associated with knee osteoarthritis initiation and progression. OBJECTIVE This study aimed to compare four high knee flexion postures (dorsiflexed and plantarflexed kneeling, and flat-foot and heels-up squatting) to determine which one results in lower knee joint flexion and ab/adduction moments. METHODS Forty-three participants performed five trials of each posture. Peak (for descent/ascent) and mean (for the static hold) external knee flexion and ab/adduction moments were analyzed for each posture using 2-way ANOVAs and post-hoc pairwise comparisons. RESULTS It was observed that the flat-foot squat resulted in significantly lower knee flexion moment compared to the other three postures (4.63±0.99 % BW·H during the static phase, and 5.83±1.24 % BW·H and 5.94±1.24 % BW·H during descent and ascent phases, respectively). During ascent phase, significant differences was indicated in peak adduction moments for the flat-foot squat in comparison to both styles of kneeling. CONCLUSIONS When high knee flexion is required but posture is not dictated, flat-foot squat will reduce exposures to high knee moments.
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Affiliation(s)
- Shabnam Pejhan
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Helen C Chong
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Liana M Tennant
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Stacey M Acker
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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22
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Pejhan S, Denroche SK, Frew GJ, Acker SM. Effects of Knee Savers on the quadriceps muscle activation across deep knee bending postures. APPLIED ERGONOMICS 2019; 80:193-199. [PMID: 31280805 DOI: 10.1016/j.apergo.2019.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/08/2019] [Accepted: 05/24/2019] [Indexed: 06/09/2023]
Abstract
Workers who kneel or squat frequently are at a high risk of developing knee pathologies. Knee Savers® are wedge-shaped pads, worn on the lower calf by baseball catchers that aim to reduce this risk. This study examined how Knee Savers® change the bilateral quadriceps muscle activity during dorsiflexed kneeling, and heels-up and flat-foot squatting. For twenty participants, integrated and peak electromyography (EMG) during descent and ascent phases, mean EMG during a 10-s static phase, and participants' subjective perception of muscle fatigue were compared between equipment conditions (with (W) and without (WO) Knee Savers®). Knee Savers® did not significantly reduce integrated or peak EMG during transitions into and out of the postures; however, they significantly reduced (p < .03) mean EMG in five of six muscles during the static phase. These findings indicate potential for Knee Savers® to reduce cumulative muscular effort and fatigue in applications where prolonged static kneeling or squatting are required.
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Affiliation(s)
- Shabnam Pejhan
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
| | - Sean K Denroche
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
| | - Geena J Frew
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
| | - Stacey M Acker
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
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Selistre LFA, Gonçalves GH, Nakagawa TH, Petrella M, Jones RK, Mattiello SM. The role of hip abductor strength on the frontal plane of gait in subjects with medial knee osteoarthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1779. [PMID: 31012216 DOI: 10.1002/pri.1779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/13/2019] [Accepted: 03/17/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship of hip abductor strength with external hip and knee adduction moments, pain and physical function, and trunk, pelvis, and hip kinematics in the frontal plane during walking in subjects with medial knee osteoarthritis. METHODS Twenty-five subjects with medial knee osteoarthritis were evaluated through an isokinetic strength test for hip abductor, three-dimensional gait analysis (kinetics and kinematics), and pain and physical function scores. Regression models were used to control the influence of other parameters such as pain, age, gender, severity, walking speed, mass, and height. RESULTS No relationship was found of hip abductor strength with peak of external knee adduction moment and knee adduction angular impulse. Hip abductor strength explained 17% of contralateral pelvic drop and 21% of hip adduction angle. In addition, hip abductor strength explained 4% and 1% of the variance in the WOMAC physical function score and 40-m fast paced walk test, respectively. CONCLUSION Considering the relationship of hip abductor strength with contralateral pelvic drop and hip adduction angle, specific exercises might improve physical function and lower limb dynamic alignment during gait.
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Affiliation(s)
| | | | | | - Marina Petrella
- Departamento de Fisioterapia, São Carlos, Universidade Federal de São Carlos, São Paulo, Brazil
| | - Richard Keith Jones
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
| | - Stela Márcia Mattiello
- Departamento de Fisioterapia, São Carlos, Universidade Federal de São Carlos, São Paulo, Brazil
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24
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Xu R, Ming D, Ding Z, Bull AMJ. Extra excitation of biceps femoris during neuromuscular electrical stimulation reduces knee medial loading. ROYAL SOCIETY OPEN SCIENCE 2019; 6:181545. [PMID: 31032011 PMCID: PMC6458370 DOI: 10.1098/rsos.181545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Medial knee joint osteoarthritis (OA) is a debilitating and prevalent condition. Surgical treatment consists of redistributing the forces from the medial to the lateral compartment through osteotomy, or replacing the joint surfaces. As the mediolateral load distribution is related to the action of the musculature around the knee, the aim of this study was to devise a technique to redistribute these forces non-surgically through changes in muscle excitation. Eight healthy subjects participated in the experiment, and neuromuscular electrical stimulation was used to change the muscle forces around the knee. A musculoskeletal model was used to quantify the loading on the medial compartment of the knee, and a novel algorithm devised and implemented to simulate neuromuscular electrical stimulation. The forces and moments at the knee, ground reaction forces, walking velocity and step length were quantified before and after stimulation. Stimulation of the biceps femoris resulted in a significant decrease in the second peak of the medial knee joint loading by up to 0.17 body weight (p = 0.016). Kinematic parameters were not significantly affected. Neuromuscular electrical stimulation can decrease the peak loads on the medial compartment of the knee, and thus offers a promising therapy for medial knee joint OA.
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Affiliation(s)
- Rui Xu
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, People's Republic of China
- Department of Bioengineering, Imperial College, London SW7 2AZ, UK
| | - Dong Ming
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, People's Republic of China
| | - Ziyun Ding
- Department of Bioengineering, Imperial College, London SW7 2AZ, UK
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25
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Marriott K, Birmingham TB, Pinto R, Primeau C, Bryant D, Degen R, Giffin JR. Gait biomechanics after combined HTO-ACL reconstruction versus HTO alone: A matched cohort study. J Orthop Res 2019; 37:124-130. [PMID: 30303555 DOI: 10.1002/jor.24157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
The purpose of the present study was to compare bilateral external knee moments during gait in patients with concomitant medial compartment knee OA, varus alignment and chronic anterior cruciate ligament (ACL) deficiency who underwent either medial opening-wedge high tibial osteotomy alone (HTO) or simultaneous HTO and ACL reconstruction (HTO-ACLR). Fifty-two patients (26 matched pairs) completed 3D gait analysis preoperatively and at a minimum 5 years postoperatively. Patients were matched for preoperative age, sex, body mass index and magnitude of correction. Primary outcomes selected a priori were the peak knee adduction moment (KAM) and knee flexion (KFM) moment during stance. Moments were compared using mixed model repeated measures analysis of variance (ANOVA). For the peak KAM, there was a significant time by limb interaction. For both groups, there were similar reductions in the peak KAM 5 years postoperatively in the surgical limb only [-1.34 %BW × Ht (-1.71, -0.96) and -1.72 %BW × Ht (-1.99, -1.44) for HTO and HTO-ACLR, respectively]. For the peak KFM, there was a significant time by group by limb interaction. There was a decrease in the peak KFM 5 years postoperatively in the HTO group [-0.88 %BW × Ht (-1.45, -0.31)] but not in the HTO-ACLR group [0.03 %BW × Ht (-0.43, 0.48)]. These results suggest that individuals with medial knee OA, varus alignment and chronic ACL deficiency who undergo simultaneous medial opening-wedge HTO and ACL reconstruction may not experience the same long-term (5 year) changes in sagittal plane knee biomechanics observed in patients undergoing HTO alone. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Kendal Marriott
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Ryan Pinto
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Codie Primeau
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Ryan Degen
- The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Edd SN, Omoumi P, Andriacchi TP, Jolles BM, Favre J. Modeling knee osteoarthritis pathophysiology using an integrated joint system (IJS): a systematic review of relationships among cartilage thickness, gait mechanics, and subchondral bone mineral density. Osteoarthritis Cartilage 2018; 26:1425-1437. [PMID: 30056214 DOI: 10.1016/j.joca.2018.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/08/2018] [Accepted: 06/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce an integrated joint system (IJS) model of joint health and osteoarthritis (OA) pathophysiology through a systematic review of the cross-sectional relationships among three knee properties (cartilage thickness, gait mechanics, and subchondral bone mineral density). METHODS Searches using keywords associated with the three knee properties of interest were performed in PubMed, Scopus, and Ovid databases. English-language articles reporting cross-sectional correlations between at least two knee properties in healthy or tibiofemoral OA human knees were included. A narrative synthesis of the data was conducted. RESULTS Of the 5600 retrieved articles, 13 were included, eight of which reported relationships between cartilage thickness and gait mechanics. The 744 tested knees were separated into three categories based on knee health: 199 healthy, 340 at-risk/early OA, and 205 late OA knees. Correlations between knee adduction moment and medial-to-lateral cartilage thickness ratios were generally positive in healthy, inconclusive in at-risk/early OA, and negative in late OA knees. Knee adduction moment was positively correlated with medial-to-lateral tibial subchondral bone mineral density ratios in knees of all health categories. One study reported a positive correlation between lateral tibial subchondral bone mineral density and femoral cartilage thickness in at-risk/early OA knees. CONCLUSIONS The correlations identified between knee properties in this review agreed with the proposed relationship-based IJS model of OA pathophysiology. Accordingly, the IJS model could provide insights into overcoming current barriers to developing disease-modifying treatments by considering multiple aspects of OA disease, aspects that could be assessed simultaneously at an in vivo system level.
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Affiliation(s)
- S N Edd
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
| | - P Omoumi
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland.
| | - T P Andriacchi
- Department of Mechanical Engineering, Stanford, CA, USA; Palo Alto Veterans Affairs, Palo Alto, CA, USA; Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA.
| | - B M Jolles
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland; Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland.
| | - J Favre
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
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Association between gait mechanics and ultrasonographic measures of femoral cartilage thickness in individuals with ACL reconstruction. Gait Posture 2018; 65:221-227. [PMID: 30558935 DOI: 10.1016/j.gaitpost.2018.07.174] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/02/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with anterior cruciate ligament reconstruction (ACLR) are at greater risk for knee osteoarthritis, which may be in part due to altered gait biomechanics. Articular cartilage thickness is typically imaged using magnetic resonance imaging, which is costly and lacks portability. Ultrasonography may provide an alternative imaging method for articular cartilage. It is unclear if ultrasonographic measurements of cartilage thickness are associated with gait biomechanics in individuals with ACLR. RESEARCH QUESTION To evaluate the association between sagittal and frontal plane knee mechanics during gait and resting femoral cartilage thickness from ultrasonography. METHODS Twenty-five females with ACLR (age = 21.7 ± 2.6 years, time since ACLR = 60.6 ± 24.8 months) completed assessments of walking biomechanics and resting femoral cartilage thickness. Linear regression examined the association between gait biomechanics and cartilage thickness at the medial (MC) and lateral (LC) femoral condyles, and intercondylar notch (IC) after accounting for time since ACLR, meniscal injury, and gait speed. RESULTS In the ACLR limb, larger vertical ground reaction force (ΔR2 = 0.21, pΔ = 0.03), knee flexion angle (ΔR2 = 0.15, pΔ = 0.05), knee flexion excursion (KFE) (ΔR2 = 0.16, pΔ = 0.04), and knee flexion impulse (KFI) (ΔR2 = 0.23, pΔ = 0.02) were associated with thicker MC cartilage. A larger knee adduction angle (ΔR2 = 0.20, pΔ = 0.03) and knee adduction moment (KAM) (ΔR2 = 0.20, pΔ = 0.03) were associated with thinner MC thickness. Larger KFE (ΔR2 = 0.20, pΔ = 0.03) was associated with thicker LC cartilage. Gait biomechanics were not associated with IC cartilage thickness. After accounting for co-variates, the combination of KFI and KAM was predictive of MC thickness (ΔR2 = 0.37, pΔ = 0.01; Total R2 = 0.52, p = 0.02). Meniscal injury, KAM, and KFI were significant predictors in the model. In the contralateral limb, KFE was associated with thicker MC cartilage (ΔR2 = 0.16, pΔ = 0.05). SIGNIFICANCE Sagittal and frontal plane knee mechanics during gait are uniquely associated with ultrasonographic measurements of femoral cartilage thickness in individuals with ACLR. Furthermore, concomitant medial meniscal injury was associated with thinner MC cartilage.
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Brisson NM, Wiebenga EG, Stratford PW, Beattie KA, Totterman S, Tamez-Peña JG, Callaghan JP, Adachi JD, Maly MR. Baseline knee adduction moment interacts with body mass index to predict loss of medial tibial cartilage volume over 2.5 years in knee Osteoarthritis. J Orthop Res 2017; 35:2476-2483. [PMID: 28323351 DOI: 10.1002/jor.23564] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 03/16/2017] [Indexed: 02/04/2023]
Abstract
This study aimed to determine the extent to which changes over 2.5 years in medial knee cartilage thickness and volume were predicted by: (1) Peak values of the knee adduction (KAM) and flexion moments; and (2) KAM impulse and loading frequency, representing cumulative load, after controlling for age, sex and body mass index (BMI). Adults with clinical knee osteoarthritis participated. At baseline and approximately 2.5 years follow-up, cartilage thickness and volume of the medial tibia and femur were segmented from magnetic resonance imaging scans. Gait kinematics and kinetics, and daily knee loading frequency were also collected at baseline. Multiple linear regressions predicted changes in cartilage morphology from baseline gait mechanics. Data were collected from 52 participants (41 women) [age 61.0 (6.9) y; BMI 28.5 (5.7) kg/m2 ] over 2.56 (0.51) years. There were significant KAM peak-by-BMI (p = 0.023) and KAM impulse-by-BMI (p = 0.034) interactions, which revealed that larger joint loads in those with higher BMIs were associated with greater loss of medial tibial cartilage volume. In conclusion, with adjustments for age, sex, and cartilage measurement at baseline, large magnitude KAM peak and KAM impulse each interacted with BMI to predict loss of cartilage volume of the medial tibia over 2.5 years among individuals with knee osteoarthritis. These data suggest that, in clinical knee osteoarthritis, exposure to large KAMs may be detrimental to cartilage in those with larger BMIs. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2476-2483, 2017.
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Affiliation(s)
- Nicholas M Brisson
- School of Rehabilitation Science, Institute for Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, Ontario, L8S 1C7, Canada
| | - Emily G Wiebenga
- School of Rehabilitation Science, Institute for Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, Ontario, L8S 1C7, Canada
| | - Paul W Stratford
- School of Rehabilitation Science, Institute for Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, Ontario, L8S 1C7, Canada
| | - Karen A Beattie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - José G Tamez-Peña
- Qmetrics Technologies, Rochester, New York
- Escuela de Medicina, Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Monica R Maly
- School of Rehabilitation Science, Institute for Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, Ontario, L8S 1C7, Canada
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Malisoux L, Gette P, Chambon N, Urhausen A, Theisen D. Adaptation of running pattern to the drop of standard cushioned shoes: A randomised controlled trial with a 6-month follow-up. J Sci Med Sport 2017; 20:734-739. [DOI: 10.1016/j.jsams.2017.01.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 11/02/2016] [Accepted: 01/17/2017] [Indexed: 11/24/2022]
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30
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Osteoarthritis year in review 2016: mechanics. Osteoarthritis Cartilage 2017; 25:190-198. [PMID: 28100420 DOI: 10.1016/j.joca.2016.09.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/21/2016] [Accepted: 09/24/2016] [Indexed: 02/02/2023]
Abstract
Inappropriate biomechanics, namely wear-and-tear, has been long believed to be a main cause of osteoarthritis (OA). However, this view is now being re-evaluated, especially when examined alongside mechanobiology and new biomechanical studies. These are multiscale experimental and computational studies focussing on cell- and tissue-level mechanobiology through to organ- and whole-body-level biomechanics, which focuses on the biomechanical and biochemical environment of the joint tissues. This review examined papers from April 2015 to April 2016, with a focus on multiscale experimental and computational biomechanical studies of OA. Assessing the onset or progression of OA at organ- and whole-body-levels, gait analysis, medical imaging and neuromusculoskeletal modelling revealed the extent to which tissue damage changes the view of inappropriate biomechanics. Traditional gait analyses studies reported that conservative treatments can alter joint biomechanics, thereby improving pain and function experienced by those with OA. Results of animal models of OA were consistent with these human studies, showing interactions among bone, cartilage and meniscus biomechanics and the onset and/or progression OA. Going down size scales, experimental and computational studies probed the nanosize biomechanics of molecules, cells and extracellular matrix, and demonstrated how the interactions between biomechanics and morphology affect cartilage dynamic poroelastic behaviour and pathways to OA. Finally, integration of multiscale experimental data and computational models were proposed to predict cartilage extracellular matrix remodelling and the development of OA. Summarising, experimental and computational methods provided a nuanced biomechanical understanding of the sub-cellular, cellular, tissue, organ and whole-body mechanisms involved in OA.
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Paterson KL, Bennell KL, Wrigley TV, Metcalf BR, Kasza J, Hinman RS. Effects of footwear on the knee adduction moment in medial knee osteoarthritis: classification criteria for flat flexible vs stable supportive shoes. Osteoarthritis Cartilage 2017; 25:234-241. [PMID: 27729290 DOI: 10.1016/j.joca.2016.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/30/2016] [Accepted: 10/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To validate simple criteria that distinguish flat flexible from stable supportive walking shoes by comparing their effects on the knee adduction moment (KAM) in people with medial knee osteoarthritis (OA). DESIGN This was a cross-sectional biomechanical study. We proposed five criteria to differentiate flat flexible from stable supportive shoes, and selected three pairs of shoes representing each class for biomechanical testing. 28 participants aged ≥50 years with symptomatic medial knee OA underwent gait analysis barefoot and wearing each of the six selected shoes, in random order. Differences in the peak KAM, KAM impulse and peak knee flexion moment (KFM) across test conditions were evaluated with a two-way repeated measures analysis of variance (ANOVA). Immediate changes in walking pain between conditions were also compared. RESULTS Increases in KAM from barefoot were lower with each of the three flat flexible shoe styles (peak KAM: 6.1-8.9%; KAM impulse: 2.4-5.1%) compared to their stable supportive counterparts (peak KAM: 11.6-15.1%; KAM impulse 10.5-13.2%). There was a significant main effect for footwear class on peak KAM and KAM impulse, whereby stable supportive shoes increased the KAM significantly more than flat flexible shoes (P < 0.001). There were no differences in the KFM or immediate walking pain between footwear classes. CONCLUSIONS Our proposed criteria can be used by researchers and clinicians to select flat flexible shoes for people with medial knee OA to minimise knee loading. Future research should evaluate whether wearing shoes based on these criteria translates to improvements in knee OA symptoms and/or slows structural disease progression.
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Affiliation(s)
- K L Paterson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - T V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - B R Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
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Catena RD, Xu X. Hip and knee net joint moments that correlate with success in lateral load transfers over a low friction surface. ERGONOMICS 2016; 59:1637-1645. [PMID: 26883302 DOI: 10.1080/00140139.2016.1154987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 02/11/2016] [Indexed: 06/05/2023]
Abstract
We previously described two different preferred strategies used to perform a lateral load transfer. The wide stance strategy was not used successfully on a low-friction surface, while the narrow stance strategy was successful. Here, we retrospectively examined lower extremity net joint moments between successful and unsuccessful strategies to determine if there is a kinetic benefit consideration that may go into choosing the preferred strategy. Success vs. failure over a novel slippery surface was used to dichotomise 35 healthy working-age individuals into the two groups (successful and unsuccessful). Participants performed lateral load transfers over three sequential surface conditions: high friction, novel low friction and practised low friction. The unsuccessful strategy required larger start torques, but lower dynamic moments during transfer compared to the successful strategy. These results indicate that the periodically unsuccessful strategy may be preferred because it requires less muscle recruitment and lower stresses on lower extremity soft tissues. Practitioner Summary: The reason for this paper is to retrospectively examine the joint moment in two different load transfer strategies that are used in a lateral load transfer. We found that periodically unsuccessful strategies that we previously reported may be a beneficial toward reduced lower extremity joint stresses.
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Affiliation(s)
- Robert D Catena
- a Kinesiology Program , Washington State University , Pullman , WA , USA
| | - Xu Xu
- b Liberty Mutual Research Institute for Safety , Hopkinton , MA , USA
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Cruz-Montecinos C, Flores-Cartes R, Montt-Rodriguez A, Pozo E, Besoaín-Saldaña A, Horment-Lara G. Changes in co-contraction during stair descent after manual therapy protocol in knee osteoarthritis: A pilot, single-blind, randomized study. J Bodyw Mov Ther 2016; 20:740-747. [DOI: 10.1016/j.jbmt.2016.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 01/14/2023]
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