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Lopes HS, Waiteman MC, Priore LB, Glaviano NR, Bazett-Jones DM, Briani RV, Azevedo FM. There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:521-536. [PMID: 37669706 PMCID: PMC11184318 DOI: 10.1016/j.jshs.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/25/2023] [Accepted: 07/10/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Impairments in hamstring strength, flexibility, and morphology have been associated with altered knee biomechanics, pain, and function. Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation. This systematic review aimed to synthesize the literature to determine the presence of impairments in hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. METHODS Five databases (MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science) were searched from inception to September 2022. Only studies comparing hamstring outcomes (e.g., strength, flexibility, and/or morphology) between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation, and evidence gap maps were created. RESULTS Seventy-nine studies across 4 different gradual-onset knee disorders (i.e., knee osteoarthritis (OA), patellofemoral pain (PFP), chondromalacia patellae, and patellar tendinopathy) were included. Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric (standard mean difference (SMD) = -0.76, 95% confidence interval (95%CI) : -1.32 to -0.21) and concentric contractions (SMD = -0.97, 95%CI : -1.49 to -0.45). Individuals with PFP presented with reduced hamstring strength compared to pain-free controls during isometric (SMD = -0.48, 95%CI : -0.82 to -0.14), concentric (SMD = -1.07, 95%CI : -2.08 to -0.06), and eccentric contractions (SMD = -0.59, 95%CI : -0.97 to -0.21). No differences were observed in individuals with patellar tendinopathy. Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls (SMD = -0.76, 95%CI : -1.15 to -0.36). Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders. CONCLUSION Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP.
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Affiliation(s)
- Helder S Lopes
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil.
| | - Marina C Waiteman
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | - Liliam B Priore
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | - Neal R Glaviano
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT 06269, USA
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH 43606, USA
| | - Ronaldo V Briani
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | - Fábio M Azevedo
- School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
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Zhou L, Xu Y, Wang S, Wang S, Xu W. Quadriceps strength and psychological readiness are associated with multiplanar knee kinematics after anterior cruciate ligament reconstruction. Gait Posture 2023; 101:101-105. [PMID: 36773479 DOI: 10.1016/j.gaitpost.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/25/2022] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Gait asymmetry, negative psychological factors and quadriceps strength deficits are common after anterior cruciate ligament reconstruction (ACLR). Whether quadriceps strength and psychological factors have impacts on multiplanar knee kinematics remains unclear. RESEARCH QUESTION What are the relationships of multiplanar knee kinematics during the gait cycle and psychological readiness to quadriceps strength after ACLR? METHOD In total, 45 patients were enrolled in this study at 8.3 ± 1.5 months after ACLR. All patients underwent gait analysis and isokinetic testing. Interlimb differences in the range of motion (ROM) and maximum and initial contact (IC) angles in abduction-adduction, flexion-extension, and internal-external rotation were calculated. The limb symmetry index (LSI) for quadriceps strength was calculated. Psychological readiness was measured using the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. The paired t test analyzed the differences between contralateral and affected limbs in quadriceps and hamstrings strength. Pearson or Spearman correlation was used to assess relationships between the variables of interest. RESULTS Significant differences between contralateral and affected limbs were observed in isokinetic knee quadriceps strength (P < 0.001) and hamstring strength (P = 0.009). The ACL-RSI score correlated negatively with interlimb differences in the knee flexion angle at IC (r = -0.35, P = 0.02) and ROM in the transverse plane (r = -0.41, P = 0.003). The LSI for quadriceps strength correlated negatively with the peak knee flexion angle (r = -0.37, P = 0.02) and positively with the ACL-RSI score (r = 0.3, P = 0.05). SIGNIFICANCE Greater psychological readiness and quadriceps strength are associated with more symmetrical multiplanar knee kinematics. The improvement of these parameters may aid the recovery of knee kinematics after ACLR, and reduce the rate of reinjury and incidence of posttraumatic osteoarthritis.
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Affiliation(s)
- Lan Zhou
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yihong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Siya Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China.
| | - Weidong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China.
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Küpper JC, Zandiyeh P, Ronsky JL. Empirical joint contact mechanics: A comprehensive review. Proc Inst Mech Eng H 2023; 237:147-162. [PMID: 36468563 DOI: 10.1177/09544119221137397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Empirical joint contact mechanics measurement (EJCM; e.g. contact area or force, surface velocities) enables critical investigations of the relationship between changing joint mechanics and the impact on surface-to-surface interactions. In orthopedic biomechanics, understanding the changes to cartilage contact mechanics following joint pathology or aging is critical due to its suggested role in the increased risk of osteoarthritis (OA), which might be due to changed kinematics and kinetics that alter the contact patterns within a joint. This article reviews and discusses EJCM approaches that have been applied to articulating joints such that readers across different disciplines will be informed of the various measurement and analysis techniques used in this field. The approaches reviewed include classical measurement approaches (radiographic and sectioning, dye staining, casting, surface proximity, and pressure measurement), stereophotogrammetry/motion analysis, computed tomography (CT), magnetic resonance imaging (MRI), and high-speed videoradiography. Perspectives on approaches to advance this field of EJCM are provided, including the value of considering relative velocity in joints, tractional stress, quantification of joint contact area shape, consideration of normalization techniques, net response (superposition) of multiple input variables, and establishing linkages to regional cartilage health status. EJCM measures continue to provide insights to advance our understanding of cartilage health and degeneration and provide avenues to assess the efficacy and guide future directions of developing interventions (e.g. surgical, biological, rehabilitative) to optimize joint's health and function long term.
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Affiliation(s)
- Jessica C Küpper
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, Calgary, AB, Canada
| | - Payam Zandiyeh
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX, USA
| | - Janet L Ronsky
- McCaig Institute for Bone and Joint Health, Calgary, AB, Canada.,Departments of Mechanical and Manufacturing Engineering and Biomedical Engineering, University of Calgary, Calgary, AB, Canada
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Zhang M, Cui J, Liu H. Effect of Flat Running Shoes on Hip Kinematics in Male Recreational Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16473. [PMID: 36554352 PMCID: PMC9778694 DOI: 10.3390/ijerph192416473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Patellofemoral joint pain and iliotibial band syndrome are very common running-related injuries. Excessive contralateral pelvic drop, hip adduction, and hip internal rotation have been suggested to be associated with the two injuries. The purpose of this repeated measures and the cross-sectional study was to investigate the effect of flat running shoes on these kinematic variables compared with that of conventional running shoes with a 10 mm drop. Eighteen male recreational runners were recruited to run in flat shoes and conventional shoes with a 10 mm drop, in random order. Impact force data and lower extremity kinematics were synchronously obtained using two Kistler force plates and eight motion infrared cameras, whereas differences in the impact force and hip kinematics were compared using statistical parametric mapping. Regarding hip kinematics, the hip flexion (p = 0.004) and adduction angles (p = 0.004) decreased significantly at 30-70% and 62-85% of the stance phase, respectively, while wearing flat running shoes; the contralateral pelvic drop angle (p = 0.001) decreased significantly at 31-75% of the stance phase while wearing flat running shoes. The knee internal rotation angle (p = 0.035) decreased significantly at 8-17% of the stance phase while wearing flat running shoes compared with conventional running shoes. Given that these kinematic variables are associated with patellofemoral joint pain and iliotibial band syndrome, flat running shoes may have potential benefits for the prevention or treatment of knee injuries.
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Affiliation(s)
- Masen Zhang
- Biomechanics Laboratory, School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Jing Cui
- Biomechanics Laboratory, School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Hui Liu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China
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Xie PP, István B, Liang M. Sex-specific differences in biomechanics among runners: A systematic review with meta-analysis. Front Physiol 2022; 13:994076. [PMID: 36213228 PMCID: PMC9539551 DOI: 10.3389/fphys.2022.994076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Patellofemoral disorders are more common in female runners compared to their male counterparts. Differences in biomechanical characteristics between groups of runners could provide insight into the causes of higher rates of injury in female versus male runners, which would be useful to physical therapists and athletic trainers in development of individualized injury prevention programs. This review compares the differences in biomechanical characteristics between female and male runners. Electronic databases, including PubMed, Scopus, Web of Science, and Embase were searched in December 2021 for studies evaluating sex-specific differences in lower limb mechanics of healthy participants during running. Two independent reviewers determined the inclusion and quality of each research paper. Meta-analyses were used where possible. A total of 13 studies were selected. Means and standard deviations of reported data were retrieved from each selected paper for comparison of results. Three biomechanical variables, including dynamics, muscle activation, and kinematics, were compared between female and male runners. However, no differences were found in kinetic variables or muscle activation between groups due to insufficient data available from the selected studies. Meta-analyses of kinematic variables revealed that female runners exhibited significantly greater hip flexion angle, hip adduction angle, and hip internal rotation angle, but smaller knee flexion angle compared to male runners during running. We found significant differences in kinematic variables between female and male runners, which could influence the training advice of physical therapists and athletic trainers who work with runners, and inform the development of injury prevention programs.
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Affiliation(s)
- Ping-Ping Xie
- College of Science and Technology, Ningbo University, Ningbo, China
| | - Bíró István
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Minjun Liang
- Faculty of Sports Science, Ningbo University, Ningbo, China
- *Correspondence: Minjun Liang,
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Zhou L, Xu Y, Zhang J, Guo L, Zhou T, Wang S, Xu W. Multiplanar knee kinematics-based test battery helpfully guide return-to-sports decision-making after anterior cruciate ligament reconstruction. Front Bioeng Biotechnol 2022; 10:974724. [PMID: 36185444 PMCID: PMC9523368 DOI: 10.3389/fbioe.2022.974724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background: There are currently no well-established criteria to guide return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). In this study, a new test battery consisting of subjective and objective tests, especially multiplanar knee kinematics assessment, was developed to aid RTS decision making after ACLR. Methods: This study was conducted with 30 patients who were assessed a mean of 9.2 ± 0.5 months after ACLR. All patients underwent complete evaluations of both lower limbs with four objective assessments [isokinetic, hop, knee laxity, and 6–degree of freedom (6DOF, angle: flexion-extension, varus-valgus, internal-external rotation; translation: anteroposterior, proximodistal, mediolateral) knee kinematics tests] and two subjective assessments [International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) questionnaires]. Limb symmetry indices (LSIs) of knee strength, hop distance, and range of motion (ROM) of knee kinematics were calculated. LSI ≥90%, IKDC scale score within the 15th percentile for healthy adults, and ACL-RSI score >56 were defined as RTS criteria. Results: Significant differences between affected and contralateral knees were observed in the quadriceps strength (p < 0.001), hamstring strength (p = 0.001), single hop distance (p < 0.001), triple hop distance (p < 0.001), and rotational ROM (p = 0.01). Only four patients fulfilled the overall RTS criteria. The percentages of patients fulfilling individual criteria were: quadriceps strength, 40%; hamstring strength, 40%; single hop distance, 30%; triple hop distance, 36.7%; knee ligament laxity, 80%; flexion-extension, 23.3%; varus-valgus rotation, 20%; internal-external rotation, 66.7%; anteroposterior translation, 20%; proximodistal translation, 33.3%; mediolateral translation, 26.7%; IKDC scale score, 53.3%; and ACL-RSI score, 33.3%. Conclusion: At an average of 9 months after ACLR, objectively and subjectively measured knee functional performance was generally unsatisfactory especially the recovery of knee kinematics, which is an important prerequisite for RTS.
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Affiliation(s)
- Lan Zhou
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Yihong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Jing Zhang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Luqi Guo
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Tianping Zhou
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
- *Correspondence: Shaobai Wang, ; Weidong Xu,
| | - Weidong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China
- *Correspondence: Shaobai Wang, ; Weidong Xu,
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Incorporation of Torsion Springs in a Knee Exoskeleton for Stance Phase Correction of Crouch Gait. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Crouch gait is a motor complication that is commonly associated with cerebral palsy, spastic diplegia, stroke, and motor-neurological pathologies, broadly defined as knee flexion in excess of 20° in the gait cycle. Uncorrected crouch gait results in fatigue, joint degradation, and loss of ambulation. Torsion springs have been used in cycling to store energy in the knee flexion to reduce fatigue in the quadriceps during knee extension. SolidWorks was used to design a passive exoskeleton for the knee, incorporating torsion springs of stiffnesses 20,000 N/mm and 30,000 N/mm at the knee joint, to correct four different crouch gaits. OpenSim was used to gather data from the moments produced, and knee angles from each crouch gait and the normal gait. Motion analysis of the exoskeleton was simulated using knee angles for each crouch gait and compared with the moments produced with the normal gait moments in the stance phase of the gait cycle. All crouch gait moments were significantly reduced, and the correction of peak crouch moments was achieved, corresponding to the normal gait cycle during the stance phase. These results offer significant potential for nonsurgical and less invasive options for wearable exoskeletons in crouch gait correction.
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Patellofemoral Joint Loading in Forward Lunge With Step Length and Height Variations. J Appl Biomech 2022; 38:210-220. [PMID: 35697336 DOI: 10.1123/jab.2021-0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022]
Abstract
The objective was to assess how patellofemoral loads (joint force and stress) change while lunging with step length and step height variations. Sixteen participants performed a forward lunge using short and long steps at ground level and up to a 10-cm platform. Electromyography, ground reaction force, and 3D motion were captured, and patellofemoral loads were calculated as a function of knee angle. Repeated-measures 2-way analysis of variance (P < .05) was employed. Patellofemoral loads in the lead knee were greater with long step at the beginning of landing (10°-30° knee angle) and the end of pushoff (10°-40°) and greater with short step during the deep knee flexion portion of the lunge (50°-100°). Patellofemoral loads were greater at ground level than 10-cm platform during lunge descent (50°-100°) and lunge ascent (40°-70°). Patellofemoral loads generally increased as knee flexion increased and decreased as knee flexion decreased. To gradually increase patellofemoral loads, perform forward lunge in the following sequence: (1) minimal knee flexion (0°-30°), (2) moderate knee flexion (0°-60°), (3) long step and deep knee flexion (0°-100°) up to a 10-cm platform, and (4) long step and deep knee flexion (0°-100°) at ground level.
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Thompson K, Chang G, Alaia M, Jazrawi L, Gonzalez-Lomas G. Lower extremity injuries in U.S. national fencing team members and U.S. fencing Olympians. PHYSICIAN SPORTSMED 2022; 50:212-217. [PMID: 33625317 DOI: 10.1080/00913847.2021.1895693] [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] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Fencing is growing rapidly in popularity and competitiveness with fencers beginning at a younger age and competing in more tournaments. Even though fencing has a low risk of time-loss injury, fencers are inevitably going to experience injuries if proper athletic training and prevention does not occur. We aim to describe and compare the lower extremity injuries experienced by fencers that have trained at the highest level in the sport. We hypothesized that athletes who fenced longer would suffer more knee and hip injuries and report lower IKDC and HOS scores. METHODS This is an epidemiology study distributed to members of the U.S. national team and Olympic team from 1980 to 2018. The electronic survey included questions regarding age, weapon, number of years fencing, number of national and Olympic teams, injuries on the dominant and nondominant hip and knee, time missed due to injury, and methods for treatment. The survey also included the International Knee Demographic Committee (IKDC) and Hip Outcome Score (HOS). RESULTS There were 153 national team members between July 1980 and July 2018, 110 with contact information. A total of 77 athletes submitted the survey, consisting of 30 females and 47 males. Female fencers had more hip injuries and lower IKDC and HOS scores than their male counterparts. In total, there were 71 injuries to the dominant (front) knee and 28 injuries to the nondominant (back) knee. There were 32 dominant hip injuries and 5 nondominant hip injuries. Saber fencers reported the most dominant and nondominant hip and knee injuries. CONCLUSION The intense, repetitive and asymmetrical movements involved in fencing affect the weight bearing leg and the nondominant leg in all weapons. Special attention should be paid to female fencers as they experience more hip and knee injuries resulting in impaired joint function.
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Affiliation(s)
- Kamali Thompson
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Gregory Chang
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Michael Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Laith Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Kefala V, Ali AA, Hamilton LD, Mannen EM, Shelburne KB. Effects of Weight-Bearing on Tibiofemoral, Patellofemoral, and Patellar Tendon Kinematics in Older Adults. Front Bioeng Biotechnol 2022; 10:820196. [PMID: 35497367 PMCID: PMC9048742 DOI: 10.3389/fbioe.2022.820196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
Quantification of natural knee kinematics is essential for the assessment of joint function in the diagnosis of pathologies. Combined measurements of tibiofemoral and patellofemoral joint kinematics are necessary because knee pathologies, such as progression of osteoarthritis and patellar instability, are a frequent concern in both articulations. Combined measurement of tibiofemoral and patellofemoral kinematics also enables calculation of important quantities, specifically patellar tendon angle, which partly determines the loading vector at the tibiofemoral joint and patellar tendon moment arm. The goals of this research were to measure the differences in tibiofemoral and patellofemoral kinematics, patellar tendon angle (PTA), and patellar tendon moment arm (PTMA) that occur during non-weight-bearing and weight-bearing activities in older adults. Methods: High-speed stereo radiography was used to measure the kinematics of the tibiofemoral and patellofemoral joints in subjects as they performed seated, non-weight-bearing knee extension and two weight-bearing activities: lunge and chair rise. PTA and PTMA were extracted from the subject’s patellofemoral and tibiofemoral kinematics. Kinematics and the root mean square difference (RMSD) between non-weight-bearing and weight-bearing activities were compared across subjects and activities. Results: Internal rotation increased with weight-bearing (mean RMSD from knee extension was 4.2 ± 2.4° for lunge and 3.6 ± 1.8° for chair rise), and anterior translation was also greater (mean RMSD from knee extension was 2.2 ± 1.2 mm for lunge and 2.3 ± 1.4 mm for chair rise). Patellar tilt and medial–lateral translation changed from non-weight-bearing to weight-bearing. Changes of the patellar tendon from non-weight-bearing to weight-bearing were significant only for PTMA. Conclusions: While weight-bearing elicited changes in knee kinematics, in most degrees of freedoms, these differences were exceeded by intersubject differences. These results provide comparative kinematics for the evaluation of knee pathology and treatment in older adults.
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Affiliation(s)
- Vasiliki Kefala
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Azhar A Ali
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
- Stryker Orthopedics, Kalamazoo, MI, United States
| | - Landon D Hamilton
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Erin M Mannen
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, ID, United States
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
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KARAGÖZOĞLU COŞKUNSU D, CAN F, KUCHIMOV S, AKALAN NE, KILIÇOĞLU Ö, ÖZTÜRK N. Time Difference Between Onsets Of Lateral And Medial Hamstring Muscles During Gait In Patients With Patellofemoral Pain: A Preliminary Study. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.923264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Arthroscopic lateral retinacular release improves patello-femoral and femoro-tibial kinematics in patients with isolated lateral retinacular tightness. Knee Surg Sports Traumatol Arthrosc 2022; 30:791-799. [PMID: 33496826 PMCID: PMC8901473 DOI: 10.1007/s00167-021-06434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Arthroscopic lateral retinacular release (LRR) has long been considered the gold standard for the treatment for anterior knee pain caused by lateral retinacular tightness (LRT). However, one-third of patients experience continuous pain postoperatively, which is thought to be related to persistent maltracking of the patella and altered femoro-tibial kinematics. Therefore, the aim of the present study was to simultaneously assess femoro-tibial and patello-femoral kinematics and identify the influence of arthroscopic LRR. METHODS Sixteen healthy volunteers and 12 patients with unilateral, isolated LRT were prospectively included. Open MRI scans with and without isometric quadriceps contraction were performed in 0°, 30° and 90° of knee flexion preoperatively and at 12 months after surgery. Patellar shift, tilt angle, patello-femoral contact area and magnitude of femoro-tibial rotation were calculated by digital image processing. RESULTS Postoperatively, patellar shift was significantly reduced at 90° of knee flexion compared to preoperative values. The postoperative patellar tilt angle was found to be significantly smaller at 30° of knee flexion compared to that preoperatively. Isometric muscle contractions did not considerably influence patellar shift or tilt in either group. The patello-femoral contact area increased after LRR over the full range of motion (ROM), with significant changes at 0° and 90°. Regarding femoro-tibial kinematics, significantly increased femoral internal rotation at 0° was observed in the patient group preoperatively, whereas the magnitude of rotation at 90° of knee flexion was comparable to that of healthy individuals. The pathologically increased femoral internal rotation at 30° without muscular activity could be significantly decreased by LRR. With isometric quadriceps contraction no considerable improvement of femoral internal rotation could be achieved by LRR at 30° of knee flexion. CONCLUSIONS Patello-femoral and femoro-tibial joint kinematics could be improved, making LRR a viable surgical option in carefully selected patients with isolated LRT. However, pathologically increased femoral internal rotation during early knee flexion remained unaffected by LRR and thus potentially accounts for persistent pain. LEVEL OF EVIDENCE II.
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Lansdown DA, Christian D, Madden B, Redondo M, Farr J, Cole BJ, Yanke AB. The Sagittal Tibial Tubercle-Trochlear Groove Distance as a Measurement of Sagittal Imbalance in Patients with Symptomatic Patellofemoral Chondral Lesions. Cartilage 2021; 13:449S-455S. [PMID: 31965819 PMCID: PMC8808873 DOI: 10.1177/1947603519900802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective. To measure the sagittal alignment of the tibial tubercle through the sagittal tibial tubercle-trochlear groove (sTTTG) distance in patients with and without patellar chondral lesions. Design. Patients treated with patellofemoral cartilage restoration or repair procedures were retrospectively reviewed (group 1; N = 17). A control group of patients (group 2; N = 20) undergoing partial meniscectomy with normal patellar cartilage was included. An asymptomatic patellar chondrosis group (group 3; N = 15) was identified as patients undergoing partial meniscectomy with patellar cartilage wear. The sTTTG was measured on the preoperative axial T2 magnetic resonance imaging (MRI) sequence. The first point was the nadir of the anterior trochlear cartilage, and the second point was the anterior tibial tubercle. A line was drawn between these points, perpendicular to the posterior condylar axis. Comparisons were made between the 3 groups using analysis of variance testing with Bonferroni corrections. Significance was defined as P < 0.05. Results. The mean sTTTG was significantly more posterior in group 1 (5.9 ± 5.5 mm posterior to the trochlear groove) relative to group 2 (0.8 ± 5.3 mm posterior; P = 0.018). The mean value for group 3 (2.7 ± 5.3 mm posterior) fell between group 1 and 3 but was not significantly different from group 1 (P = 0.31) or group 2 (P = 0.89). There were no significant differences with regards to sulcus angle, Caton-Deschamps Index, TTTG, or knee flexion angle on the MRI scan. Conclusions. A more posteriorly positioned tibial tubercle was observed in patients with patellar cartilage lesions relative to those with intact patellar cartilage. Intermediate positioning was observed in patients with asymptomatic patellar chondral wear. Level of Evidence. Level 3 diagnostic study.
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Affiliation(s)
- Drew A. Lansdown
- Department of Orthopedic Surgery,
University of California, San Francisco, San Francisco, CA, USA,Drew A. Lansdown, Department of Orthopedic
Surgery, University of California, San Francisco, 1500 Owens Street, Suite 170,
San Francisco, CA 94158, USA.
| | - David Christian
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Brett Madden
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Michael Redondo
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | | | - Brian J. Cole
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Adam B. Yanke
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
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14
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Zhang L, Fan S, Ye J, Jiang X, Cai B. Gender differences in knee kinematics during weight-bearing knee flexion for patients with arthrofibrosis after anterior cruciate ligament reconstruction. J Orthop Surg Res 2021; 16:573. [PMID: 34565414 PMCID: PMC8474925 DOI: 10.1186/s13018-021-02729-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Knowledge of tibiofemoral and patellofemoral joint kinematics is important for understanding gender-related dimorphism in developing knee arthrofibrosis and advancement of related treatments. The objective of our study was to investigate gender differences existing in tibiofemoral kinematics and patellar tracking in patients with arthrofibrosis after anterior cruciate ligament (ACL) reconstruction during weight-bearing knee flexion. Methods The tibiofemoral and patellofemoral joint kinematics were measured in 30 patients (15 male and 15 female) with arthrofibrosis after ACL reconstruction during a lunge task, using computed tomography and dual fluoroscopic imaging system. These data were analyzed for gender differences. Results The range of tibial rotation, patellar inferior shift, tilt, and flexion were significantly decreased in the affected knee compared to the contralateral knee from 15° to 75° of knee flexion (P ≤ 0.04). Statistically significant difference was detected for medial tibial translation between male and female patients at 60° (P = 0.04) and 75° of knee flexion (P = 0.02). The tibial rotation was significantly decreased at 60° (P = 0.03) and 75° of knee flexion (P < 0.01) in females. The inferior patellar shift in females was significantly lower than that in males at 15° (P = 0.04) and 30° of knee flexion (P = 0.01). The patellar tilt was significantly lower at 60° (P = 0.02) and 75° of knee flexion (P < 0.01) in females compared to males. Conclusions The results indicated a significant effect of gender on knee kinematics in patients with arthrofibrosis after ACL reconstruction during weight-bearing knee flexion. These gender differences in tibiofemoral kinematics and patellar tracking may warrant further investigations to determine implications for making gender-specific surgical treatments and rehabilitation programs.
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Affiliation(s)
- Ling Zhang
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Shuai Fan
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Jiling Ye
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Xin Jiang
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Bin Cai
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China.
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15
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Kinematic and Coordination Variability in Individuals With Acute and Chronic Patellofemoral Pain. J Appl Biomech 2021; 37:463-470. [PMID: 34548419 DOI: 10.1123/jab.2020-0401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022]
Abstract
Altered gait variability occurs in those with patellofemoral pain and may be relevant to pain progression. We examined gait kinematic and coordination variability between individuals with acute and chronic patellofemoral pain and healthy controls. Eighty-three patellofemoral pain runners (37 men and 46 women) and 142 healthy controls (52 men and 90 women) ran on a treadmill while 3-dimensional lower limb kinematic data were collected. Patellofemoral pain runners were split into acute (n = 22) and chronic (n = 61) subgroups based on pain duration (< and ≥3 mo, respectively). Approximate entropy assessed continuous hip, knee, and ankle kinematic variability. Vector coding calculated coordination variability for select joint couplings. Variability measures were compared between groups using 1-way analysis of variance and post hoc comparisons with Cohen d effect sizes. The chronic patellofemoral pain subgroup displayed higher frontal plane knee kinematic variability compared with controls (P = .0004, d = 0.550). No statistically significant effects for any coordination variability couplings were identified. Minimal differences in gait variability were detected between those with acute and chronic patellofemoral pain and healthy controls.
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16
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Ellenberger L, Casutt S, Fröhlich S, Frey WO, Snedeker JG, Spörri J. Thigh muscle activation patterns and dynamic knee valgus at peak ground reaction force during drop jump landings: Reliability, youth competitive alpine skiing-specific reference values and relation to knee overuse complaints. J Sci Med Sport 2021; 24:1230-1234. [PMID: 34238661 DOI: 10.1016/j.jsams.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES (1) To evaluate the reliability of quantifying thigh muscle activation patterns and dynamic knee valgus during drop jump landings, (2) to provide reference values for female and male youth alpine skiers, and (3) to study their associations with age, anthropometrics, biological maturation and knee overuse complaints. DESIGN Cross-sectional biomechanical experiment including questionnaires. METHODS One hundred fourteen skiers of the under 16 category (main experiment) and twelve healthy participants (reliability experiment) volunteered. Quadriceps-to-hamstring-activation ratio and medial knee displacementat peak ground reaction force during drop jump landings were measured using marker-based motion analysis, force plates and electromyography. Additionally, age, anthropometrics, biological maturation and knee overuse complaints were assessed. RESULTS There were good test-retest reliabilities and moderate standardized typical errors for both quadriceps-to-hamstring-activation ratio (intraclass correlation coefficient(3,1) = 0.84 [95% confidence interval: 0.69, 0.94]; standardized typical errors = 0.43 [0.35, 0.56]) and medial knee displacement (intraclass correlation coefficient(3,1) = 0.87 [0.74, 0.95]; standardized typical errors = 0.39 [0.32, 0.50]). Male skiers had a significantly higher quadriceps-to-hamstring-activation ratio (3.9 ± 2.0 vs. 2.9 ± 1.4, p = 0.011), whilst medial knee displacement was comparable to females (12 mm ± 11 mm vs. 13 mm ± 9 mm; p = 0.419). In male skiers, medial knee displacement correlated with anthropometrics and maturity offset; in female skiers, quadriceps-to-hamstring-activation ratio and medial knee displacement were associated with knee overuse complaints (p < 0.05). CONCLUSIONS Female and male youth skiers use different thigh muscle activation strategies, but show comparable dynamic knee valgus motions during drop jump landings. In females, a combination of increased relative quadriceps activity and medial knee displacement may favour knee overuse complaints.
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Affiliation(s)
- Lynn Ellenberger
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Selina Casutt
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Jess G Snedeker
- Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Switzerland.
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; Motion Analysis Zurich, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
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17
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Ducatti MHM, Waiteman MC, Botta AFB, Lopes HDS, Glaviano NR, Azevedo FMD, Briani RV. Knee flexor strength, rate of torque development and flexibility in women and men with patellofemoral pain: Relationship with pain and the performance in the single leg bridge test. Phys Ther Sport 2021; 50:166-172. [PMID: 34038835 DOI: 10.1016/j.ptsp.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate the relationship between: (1) knee flexor strength, rate of torque development (RTD), and flexibility with pain level; (2) knee flexor strength and RTD with the performance in the single leg bridge test (SLBT) in women and men with patellofemoral pain (PFP). DESIGN Cross-sectional. SETTING Laboratory-based study. PARTICIPANTS 39 women and 36 men with PFP. MAIN OUTCOME MEASURES Knee flexor strength, RTD, and flexibility; performance in the SLBT, current, and worst pain level. RESULTS Moderate to strong significant negative relationships were identified between the current pain level with knee flexor strength (r = -0.57 to -0.34) and flexibility (r = -0.44 to -0.35); and between knee flexor strength and RTD with the performance in the SLBT (r = 0.34 to 0.57) in women and men with PFP. Knee flexor RTD was not related to any pain level and no significant relationships were identified between the worst pain level with knee flexor strength and flexibility in women and men with PFP. CONCLUSIONS Our results support the potential value of assessing knee flexor strength and flexibility in women and men with PFP. The SLBT may be a useful tool to assess knee flexor muscle capacity in individuals with PFP in a clinical setting.
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Affiliation(s)
- Matheus Henrique Maiolini Ducatti
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
| | - Marina Cabral Waiteman
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
| | - Ana Flávia Balotari Botta
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
| | - Helder Dos Santos Lopes
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
| | - Neal Robert Glaviano
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut (UCONN), Storrs, Connecticut, United States.
| | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
| | - Ronaldo Valdir Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
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18
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Huang W, Ong MTY, Man GCW, Liu Y, Lau LCM, Yung PSH. Posterior Tibial Loading Results in Significant Increase of Peak Contact Pressure in the Patellofemoral Joint During Anterior Cruciate Ligament Reconstruction: A Cadaveric Study. Am J Sports Med 2021; 49:1286-1295. [PMID: 33689503 DOI: 10.1177/0363546521995546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Inappropriate posterior tibial loading and initial graft tension during anterior cruciate ligament (ACL) reconstruction may cause altered patellofemoral joint (PFJ) contact mechanics, potentially resulting in pain and joint degeneration. HYPOTHESIS PFJ contact pressure would increase with the increases in posterior tibial loading and graft tension during ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS Nine fresh-frozen, nonpaired human cadaveric knees were tested in a customized jig from 0° to 120° of knee flexion. First, the knee was tested in the ACL-intact state. Second, reconstruction of the ACLs using different posterior tibial loadings and graft tensions were performed. The posterior tibial loading was evaluated at 2 levels: 33.5 and 67 N. Graft tension was assessed at 3 levels: low tension (20 N), medium tension (60 N), and high tension (80 N). Maximum values of peak contact pressure in the medial and lateral patellar facets were compared between ACL-intact and ACL-reconstructed knees. The PFJ kinematics between ACL-intact knees and ACL-reconstructed knees were compared during knee flexion at 30°, 60°, 90°, and 120°. RESULTS Reconstruction of ACLs with both low and high posterior tibial loading resulted in significant increases of peak contact pressure in the medial (range of differences, 0.46-0.92 MPa; P < .05) and lateral (range of differences, 0.51-0.83 MPa; P < .05) PFJ compared with the ACL-intact condition. However, no significant differences in PFJ kinematics were identified between ACL-reconstructed knees and ACL-intact knees. In ACL-reconstructed knees, it was found that a high posterior tibial loading resulted in high peak contact pressure on the medial patellar side (range of differences, 0.37-0.46 MPa; P < .05). No significant difference in peak contact pressure was observed among the differing graft tensions. CONCLUSION In this cadaveric model, ACL reconstruction resulted in significant increases of peak contact pressure in the PFJ facet when compared with the ACL-intact condition. A high posterior tibial loading can lead to high medial PFJ peak contact pressure. Graft tension was found to not significantly affect PFJ contact pressure during ACL reconstruction. CLINICAL RELEVANCE An excessive posterior tibial loading during ACL reconstruction resulted in increased PFJ contact pressures at time of surgery. These data suggest that a low posterior tibial loading might be preferred during ACL reconstruction surgery to reduce the PFJ contact pressure close to that of the ACL-intact condition.
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Affiliation(s)
- Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China.,Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Gene Chi-Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yang Liu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Lawrence Chun-Man Lau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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19
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Secondary Patellar Resurfacing in TKA: A Combined Analysis of Registry Data and Biomechanical Testing. J Clin Med 2021; 10:jcm10061227. [PMID: 33809605 PMCID: PMC8000328 DOI: 10.3390/jcm10061227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 01/07/2023] Open
Abstract
The German Arthroplasty registry (EPRD) has shown that different prosthesis systems have different rates of secondary patellar resurfacing: four years after implantation, the posterior-stabilized (PS) Vega prosthesis has a 3.2% risk of secondary patellar resurfacing compared to the cruciate-retaining (CR) Columbus prosthesis at 1.0% (both Aesculap AG, Tuttlingen, Germany). We hypothesized that PS implants have increased retropatellar pressure and a decreased retropatellar contact area compared to a CR design, which may lead to an increased likelihood of secondary patellar resurfacing. Eight fresh frozen specimens (cohort 1) were tested with an established knee rig. In addition, a possible influence of the registry-based patient collective (cohort 2) was investigated. No significant differences were found in patient data–cohort 2-(sex, age). A generally lower number of PS system cases is noteworthy. No significant increased patella pressure could be detected with the PS design, but a lower contact area was observed (cohort 1). Lower quadriceps force (100°–130° flexion), increased anterior movement of the tibia (rollback), greater external tilt of the patella, and increasing facet pressure in the Vega PS design indicate a multifactorial cause for a higher rate of secondary resurfacing which was found in the EPRD patient cohort and might be related to the PS’ principle function.
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20
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Kim HK, Mei Q, Gu Y, Mirjalili A, Fernandez J. Reduced joint reaction and muscle forces with barefoot running. Comput Methods Biomech Biomed Engin 2021; 24:1263-1273. [PMID: 33522848 DOI: 10.1080/10255842.2021.1880572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Barefoot running has been associated with lowered joint loading, but it remains unclear whether the biomechanical benefits are evident after mid-distance running. A musculoskeletal model was adopted for estimating lower limb joint loading for barefoot (n = 10) versus shod (n = 10) 5 km running. The barefoot group reduced peak joint reaction force at the hip and knee, and presented muscle force reductions compared to shod controls with significant group effects and interaction effects (p < .05). These changes were primarily group effects as time point effects were not significant. These findings should be considered when designing barefoot running shoes, running programmes, and injury prevention programmes.
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Affiliation(s)
- Hyun Kyung Kim
- Kinesiology Department, Iowa State University, Ames, Iowa, USA.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Qichang Mei
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Faculty of Sport Sciences, Ningbo University, Ningbo, China.,Research Academy of Grand Health Interdisciplinary, Ningbo University, Ningbo, China
| | - Yaodong Gu
- Faculty of Sport Sciences, Ningbo University, Ningbo, China.,Research Academy of Grand Health Interdisciplinary, Ningbo University, Ningbo, China
| | - Ali Mirjalili
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Research Academy of Grand Health Interdisciplinary, Ningbo University, Ningbo, China.,Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
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21
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Load Distribution at the Patellofemoral Joint During Walking. Ann Biomed Eng 2020; 48:2821-2835. [DOI: 10.1007/s10439-020-02672-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
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22
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Telarolli DJA, Grossi DB, Cervi ACC, Santiago PRP, Lemos TW, Resende RA. Comparison of Foot Kinematics and Foot Plantar Area and Pressure Among Five Different Closed Kinematic Tasks. J Am Podiatr Med Assoc 2020; 110:447710. [PMID: 33179066 DOI: 10.7547/17-226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Different closed kinematic tasks may present different magnitudes of knee abduction, foot pronation, and foot plantar pressure and area. Although there are plenty of studies comparing knee abduction between different tasks, the literature lacks information regarding differences in foot pronation and foot plantar pressure and area. We compared foot angular displacement in the frontal plane and foot plantar pressure and area among five closed kinematic tasks. METHODS Forefoot and rearfoot angular displacement and foot plantar pressure and area were collected in 30 participants while they performed the following tasks: stair descent, single-leg step down, single-leg squat, single-leg landing, and drop vertical jump. Repeated-measures analyses of variance were used to investigate differences between tasks with α = 0.05. RESULTS Single-leg squat and stair descent had increased foot total plantar area compared with single-leg landing (P = .005 versus .027; effect size [ES] = 0.66), drop vertical jump (P = .001 versus P = .001; ES = 0.38), and single-leg step down (P = .01 versus P = .007; ES = 0.43). Single-leg landing and single-leg step down had greater foot total plantar area compared with drop vertical jump (P = .026 versus P = .014; ES = 0.54). There were differences also in rearfoot and midfoot plantar area and pressure and forefoot plantar pressure. CONCLUSIONS Differences in foot-striking pattern, magnitude of ground reaction force, and task speed might explain these findings. Clinicians should consider these findings to improve decisions about tasks used during rehabilitation of patients with foot conditions.
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23
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Nishida K, Matsushita T, Araki D, Sasaki H, Tanaka T, Hoshino Y, Kanzaki N, Matsumoto T, Nagamune K, Niikura T, Kurosaka M, Kuroda R. Analysis of anterior tibial subluxation to the femur at maximum extension in anterior cruciate ligament-deficient knees. J Orthop Surg (Hong Kong) 2020; 27:2309499019833606. [PMID: 30836823 DOI: 10.1177/2309499019833606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The factors affecting anterior tibial subluxation (ATS) have not yet been well examined. To assess the factors affecting ATS in anterior cruciate ligament (ACL)-deficient knees. METHODS One hundred twenty-four patients with unilateral ACL injuries were included. True lateral views of the ACL-deficient knee and contralateral normal knee were obtained during maximum extension using fluoroscopy under general anesthesia, and ATS was calculated as the side-to-side difference in the tibial position relative to the femur. Patients were divided into four groups according to the time from injury to surgery. To identify the factors affecting ATS, the following possible factors were assessed: (1) the time from injury to surgery, (2) presence of a medial meniscal injury, and (3) posterior tibial slope angle. RESULTS There was a positive correlation between the ATS ratio and the time from injury to surgery ( r = 0.52). The ratio of the presence of a medial meniscus injury was significantly higher in patients who underwent anterior tibial subluxation reconstruction (ACL-R) more than 12 months after an injury than in other patients who underwent ACL-R within 12 months after an injury. The ATS ratio was significantly higher in patients with a medial meniscus injury than in those without a medial meniscus injury (5.6% vs. 4.1%). CONCLUSIONS Our results suggested that ACL-R should be performed within 6 months after injury if surgeons prefer to avoid an increase in ATS in maximum knee extension and at the latest within 12 months to avoid medial meniscal injury at the time of ACL-R.
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Affiliation(s)
- Kyohei Nishida
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Araki
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Sasaki
- 2 Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Toshikazu Tanaka
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Kanzaki
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kouki Nagamune
- 3 Department of Human and Artificial Intelligent Systems, School of Engineering, University of Fukui, Fukui, Japan
| | - Takahiro Niikura
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- 2 Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Ryosuke Kuroda
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Wada O, Gamada K, Aoyama N, Mizuno K, Iwasaki Y. A difference in rotational alignment of the tibio-femoral joint after anterior cruciate ligament reconstruction between the bone-patellar tendon-bone and semitendinosus-gracilis grafts. Clin Biomech (Bristol, Avon) 2019; 65:45-50. [PMID: 30965227 DOI: 10.1016/j.clinbiomech.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/22/2018] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A question as to the effect of the graft choice on rotational kinematics after anterior cruciate ligament reconstruction remains unclear. The purpose of this study was to determine if there were any differences in rotational alignment of the knee after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BTB) graft compared to that using semitendinosus-gracilis (STG) graft. METHODS Ten patients with BTB graft and 10 patients with STG graft were assessed at 3 months after ACL reconstruction. We compared the 6 degrees-of-freedom alignment of the tibiofemoral joint in the fully extended position between knees reconstructed with BTB graft and STG graft using the uninvolved knee as a control. FINDINGS The BTB graft group showed no difference in knee alignment between the ACL reconstructed knee and uninvolved knee, whereas the STG graft group showed greater external rotation in the ACL reconstructed knee than in the uninvolved knee (median values, 8.4° vs 5.8°; p = 0.022). INTERPRETATION ACL reconstruction with the STG graft leads to increased external tibial rotation. Our findings suggest that clinicians should make an effort to prevent increased external tibial rotation during the rehabilitation process in patients with STG graft.
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Affiliation(s)
- Osamu Wada
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kazuyoshi Gamada
- Department of Rehabilitation, Hiroshima International University, 555-36, Kurosegakuendai, Higashihiroshima City, Hiroshima, Japan.
| | - Naoki Aoyama
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kiyonori Mizuno
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Yasunobu Iwasaki
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
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Osborne JD, Luczak SB, Acker WB, Bicos J. Patellofemoral Joint Contact Pressures: Current Concepts and Use in Patellar Instability Studies. Orthopedics 2019; 42:e172-e179. [PMID: 30668882 DOI: 10.3928/01477447-20190118-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/21/2018] [Indexed: 02/03/2023]
Abstract
The patellofemoral joint is thought to be a common source for knee pain. Improper alignment and function of the patellofemoral joint can lead to abnormal contact pressures, which may explain patients' symptoms. In this review, the authors examine techniques for measuring patellofemoral joint contact pressures and summarize the relevant patellofemoral joint anatomy and contact pressures in normal knee kinematics. Finally, they discuss the results of studies investigating contact pressure changes in cases of patellar instability. This includes both reconstruction of the medial patellofemoral ligament and tibial tubercle osteotomy. [Orthopedics. 2019; 42(2):e172-e179.].
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Effects of a prophylactic knee bracing on patellofemoral loading during cycling. SPORT SCIENCES FOR HEALTH 2018. [DOI: 10.1007/s11332-018-0482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Waiteman MC, Briani RV, Pazzinatto MF, Ferreira AS, Ferrari D, de Oliveira Silva D, de Azevedo FM. Relationship between knee abduction moment with patellofemoral joint reaction force, stress and self-reported pain during stair descent in women with patellofemoral pain. Clin Biomech (Bristol, Avon) 2018; 59:110-116. [PMID: 30227276 DOI: 10.1016/j.clinbiomech.2018.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/01/2018] [Accepted: 09/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increased external knee abduction moment has been proposed as a risk factor for patellofemoral pain. This alteration is thought to be associated with elevated patellofemoral joint reaction force and stress, however these relationships remain poorly explored. Therefore, this study aimed at comparing knee abduction moment parameters (peak, rate of moment development and impulse), patellofemoral joint reaction force and stress of women with patellofemoral pain and pain-free controls during stair descent; and investigating the relationship among these variables with self-reported pain. METHODS Kinetic data was obtained by inverse-dynamics equations and a previously reported algorithmic model was used to determine patellofemoral joint reaction force and stress. Participants' worst pain in the last month and pain level during stair descent were evaluated using a visual analogue scale. FINDINGS Women with patellofemoral pain presented higher peak, rate of moment development and impulse of the external knee abduction moment, patellofemoral joint reaction force and stress (p = 0.005 to 0.04, effect size = 0.52 to 0.96) during stair descent than pain-free controls. Only knee abduction moment impulse presented positive moderate correlations with worst pain level in the last month (r = 0.53, p < 000.1), pain level during stair descent (r = 0.33, p = 0.042), patellofemoral joint reaction force (r = 0.65, p < 000.1) and stress (r = 0.58, p < 000.1). INTERPRETATION These findings indicate that strategies aimed at decreasing external knee abduction moment impulse could reduce the load over the patellofemoral joint and improve pain of women with patellofemoral pain.
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Affiliation(s)
- Marina Cabral Waiteman
- São Paulo State University, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil
| | - Ronaldo Valdir Briani
- São Paulo State University, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil
| | - Marcella Ferraz Pazzinatto
- São Paulo State University, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil; La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Amanda Schenatto Ferreira
- São Paulo State University, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil
| | - Deisi Ferrari
- Educational Faculty of Francisco Beltrão, Physical Therapy Department, Francisco Beltrão, Brazil; Cascavel Educational Center, Physical Therapy Department, Cascavel, Brazil
| | - Danilo de Oliveira Silva
- São Paulo State University, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil; La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Fábio Mícolis de Azevedo
- São Paulo State University, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil.
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Li G, Li JS, Torriani M, Hosseini A. Short-Term Contact Kinematic Changes and Longer-Term Biochemical Changes in the Cartilage After ACL Reconstruction: A Pilot Study. Ann Biomed Eng 2018; 46:1797-1805. [PMID: 29946971 DOI: 10.1007/s10439-018-2079-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 06/20/2018] [Indexed: 12/22/2022]
Abstract
Investigation of the development of cartilage degeneration after ACL reconstruction is important for improving current surgical treatment of ACL injuries to prevent long-term knee joint degeneration. This pilot study examined the relationship between the changes in weight-bearing knee contact kinematics 6 months after ACL reconstruction and the biochemical composition changes in the knee cartilage measured using T2 relaxation values 3 years after the surgery in seven patients. The analysis indicated that the change of the knee contact kinematics in short-term after ACL reconstruction is associated with an increase of T2 values of the cartilage in longer follow up times. The data of this study could provide preliminary data to power future studies that use prospective, longitudinal research and large patient populations to establish prognostic biomechanical markers for determination of long-term cartilage degeneration after ACL reconstruction.
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Affiliation(s)
- Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital and Harvard Medical School, Newton, MA, 02462, USA.
| | - Jing-Sheng Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital and Harvard Medical School, Newton, MA, 02462, USA.,College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - Ali Hosseini
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital and Harvard Medical School, Newton, MA, 02462, USA
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Luz BC, Dos Santos AF, de Souza MC, de Oliveira Sato T, Nawoczenski DA, Serrão FV. Relationship between rearfoot, tibia and femur kinematics in runners with and without patellofemoral pain. Gait Posture 2018; 61:416-422. [PMID: 29475152 DOI: 10.1016/j.gaitpost.2018.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is the most common running overuse injury. Excessive rearfoot eversion is commonly considered as a PFP risk factor and the relationship between ankle-foot complex movement and lower limb may be involved with this dysfunction. The purpose of this study was to evaluate the correlation between rearfoot eversion with tibia and femur kinematics in frontal and transverse planes during running in individuals with and without PFP. The secondary purpose was to compare the lower limb kinematics between runners with and without PFP. METHODS Fifty-four recreational runners were divided into 2 groups: healthy runners (CG, n = 27) and runners with patellofemoral pain (PFPG, n = 27). Kinematics during running were assessed using three-dimensional motion analysis system. Pearson's correlation coefficients (r) were calculated to establish the correlation of rearfoot eversion with tibial and femur movements. FINDINGS Greater peak rearfoot eversion was correlated with greater peak femur adduction in PFP runners. Greater peak rearfoot eversion was correlated with greater peak tibial internal rotation and tibial adduction in the PFPG and CG. Additionally, greater peak rearfoot eversion was correlated with greater tibial internal rotation range of motion in the PFPG and CG. No significant differences were found between the PFPG and CG for all kinematics variables. INTERPRETATION Correlation between greater rearfoot eversion and greater peak hip adduction in the PFPG might be related to PFP persistence in runners with excessive rearfoot eversion, and indicates that treatment strategies aimed at controlling the movement of the rearfoot could help modify the symptoms.
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Affiliation(s)
- Bruna Calazans Luz
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Ana Flávia Dos Santos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Deborah A Nawoczenski
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
| | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
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Deehan DJ, Ghosh KM, Blain A, Longstaff L, Rushton S. Sagittal flexion arc evaluation for a modern generation single-radius femoral component design. Proc Inst Mech Eng H 2018; 232:412-417. [PMID: 29473455 DOI: 10.1177/0954411918759136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Single-radius femoral total knee design aims to deliver improved kinematic behaviour when compared to the standard two-radii geometry. This study has evaluated the behaviour, through a functional range of motion in the sagittal plane, of a single-radius femoral component compared to a dual-radius standard knee construct. Particular focus was placed on how the flexion axes of the native and replaced knee approximated to the transepicondylar axis through a loaded navigated knee design. Significant differences in flexion arcs were noted between the native and total knee arthroplasty state. These arcs were not uniform in all knees and did not display single-radius behaviour. There were no significant differences in the location of flexion axes in the native and total knee arthroplasty knee. Both exhibited similar posterior and inferior transverse axes of motion with respect to the anatomical epicondylar axis. This work has cast doubt on the reliability under loaded conditions of the single-radius concept, but the close proximity of the flexion axes of each replaced knee in relation to the functional flexion axis of the native knee may be the true basis of this purported improved kinematic performance.
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Affiliation(s)
- David John Deehan
- 1 Freeman Hospital, Newcastle upon Tyne, UK
- 2 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - Alasdair Blain
- 3 School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | | | - Steven Rushton
- 3 School of Biology, Newcastle University, Newcastle upon Tyne, UK
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Squatting Re-education With Lumbo-Pelvic-Thigh Muscle Cocontraction Improves Functional Performance in Patellofemoral Pain Syndrome: A Case Presentation. PM R 2017; 10:779-783. [DOI: 10.1016/j.pmrj.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 10/21/2017] [Accepted: 11/05/2017] [Indexed: 11/18/2022]
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Fox A, Ferber R, Saunders N, Osis S, Bonacci J. Gait Kinematics in Individuals with Acute and Chronic Patellofemoral Pain. Med Sci Sports Exerc 2017; 50:502-509. [PMID: 29077638 DOI: 10.1249/mss.0000000000001465] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to identify the discriminating kinematic gait characteristics between individuals with acute and chronic patellofemoral pain (PFP) and healthy controls. METHODS Ninety-eight runners with PFP (39 male, 59 female) and 98 healthy control runners (38 male, 60 female) ran on a treadmill at a self-selected speed while three-dimensional lower limb kinematic data were collected. Runners with PFP were split into acute (n = 25) and chronic (n = 73) subgroups on the basis of whether they had been experiencing pain for less or greater than 3 months, respectively. Principal component analysis and linear discriminant analysis were used to determine the combination of kinematic gait characteristics that optimally separated individuals with acute PFP and chronic PFP and healthy controls. RESULTS Compared with controls, both the acute and chronic PFP subgroups exhibited greater knee flexion across stance and greater ankle dorsiflexion during early stance. The acute PFP subgroup demonstrated greater transverse plane hip motion across stance compared with healthy controls. In contrast, the chronic PFP subgroup demonstrated greater frontal plane hip motion, greater knee abduction, and reduced ankle eversion/greater ankle inversion across stance when compared with healthy controls. CONCLUSIONS This study identified characteristics that discriminated between individuals with acute and chronic PFP when compared with healthy controls. Certain discriminating characteristics were shared between both the acute and chronic subgroups when compared with healthy controls, whereas others were specific to the duration of PFP.
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Affiliation(s)
- Aaron Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Reed Ferber
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA.,Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA.,Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Natalie Saunders
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Sean Osis
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA.,Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
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Welch T, Keller T, Maldonado R, Metzger M, Mohr K, Kvitne R. The effect of a dynamic PCL brace on patellofemoral compartment pressures in PCL-and PCL/PLC-deficient knees. J Exp Orthop 2017; 4:10. [PMID: 28361277 PMCID: PMC5374082 DOI: 10.1186/s40634-017-0085-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/17/2017] [Indexed: 11/26/2022] Open
Abstract
Background The natural history of posterior cruciate ligament (PCL) deficiency includes the development of arthrosis in the patellofemoral joint (PFJ). The purpose of this biomechanical study was to evaluate the hypothesis that dynamic bracing reduces PFJ pressures in PCL- and combined PCL/posterolateral corner (PLC)-deficient knees. Study Design: Controlled Laboratory Study. Methods Eight fresh frozen cadaveric knees with intact cruciate and collateral ligaments were included. PFJ pressures and force were measured using a pressure mapping system via a lateral arthrotomy at knee flexion angles of 30°, 60°, 90°, and 120° in intact, PCL-deficient, and PCL/PLC-deficient knees under a combined quadriceps/hamstrings load of 400 N/200 N. Testing was then repeated in PCL- and PCL/PLC-deficient knees after application of a dynamic PCL brace. Results Application of a dynamic PCL brace led to a reduction in peak PFJ pressures in PCL-deficient knees. In addition, the brace led to a significant reduction in peak pressures in PCL/PLC-deficient knees at 60°, 90°, and 120° of flexion. Application of the dynamic brace also led to a reduction in total PFJ force across all flexion angles for both PCL- and PCL/PLC-deficient knees. Conclusion Dynamic bracing reduces PFJ pressures in PCL- and combined PCL/PLC-deficient knees, particularly at high degrees of knee flexion.
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Affiliation(s)
- Tyler Welch
- Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA, USA.
| | - Thomas Keller
- Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA, USA
| | | | | | - Karen Mohr
- Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA, USA
| | - Ronald Kvitne
- Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA, USA
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Debski RE, Yamakawa S, Musahl V, Fujie H. Use of Robotic Manipulators to Study Diarthrodial Joint Function. J Biomech Eng 2017; 139:2597610. [PMID: 28056127 DOI: 10.1115/1.4035644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Indexed: 01/13/2023]
Abstract
Diarthrodial joint function is mediated by a complex interaction between bones, ligaments, capsules, articular cartilage, and muscles. To gain a better understanding of injury mechanisms and to improve surgical procedures, an improved understanding of the structure and function of diarthrodial joints needs to be obtained. Thus, robotic testing systems have been developed to measure the resulting kinematics of diarthrodial joints as well as the in situ forces in ligaments and their replacement grafts in response to external loading conditions. These six degrees-of-freedom (DOF) testing systems can be controlled in either position or force modes to simulate physiological loading conditions or clinical exams. Recent advances allow kinematic, in situ force, and strain data to be measured continuously throughout the range of joint motion using velocity-impedance control, and in vivo kinematic data to be reproduced on cadaveric specimens to determine in situ forces during physiologic motions. The principle of superposition can also be used to determine the in situ forces carried by capsular tissue in the longitudinal direction after separation from the rest of the capsule as well as the interaction forces with the surrounding tissue. Finally, robotic testing systems can be used to simulate soft tissue injury mechanisms, and computational models can be validated using the kinematic and force data to help predict in vivo stresses and strains present in these tissues. The goal of these analyses is to help improve surgical repair procedures and postoperative rehabilitation protocols. In the future, more information is needed regarding the complex in vivo loads applied to diarthrodial joints during clinical exams and activities of daily living to serve as input to the robotic testing systems. Improving the capability to accurately reproduce in vivo kinematics with robotic testing systems should also be examined.
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Affiliation(s)
- Richard E Debski
- Orthopaedic Robotics Laboratory, Departments of Bioengineering and Orthopaedic Surgery, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219 e-mail:
| | - Satoshi Yamakawa
- Tokyo Metropolitan University, 6-6 Asahigaoka, Hino, Tokyo 191-0065, Japan
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219
| | - Hiromichi Fujie
- Tokyo Metropolitan University, 6-6 Asahigaoka, Hino, Tokyo 191-0065, Japan
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Feasibility of using MRIs to create subject-specific parallel-mechanism joint models. J Biomech 2017; 53:45-55. [DOI: 10.1016/j.jbiomech.2016.12.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/10/2016] [Accepted: 12/19/2016] [Indexed: 11/21/2022]
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Matthews M, Rathleff MS, Claus A, McPoil T, Nee R, Crossley K, Kasza J, Paul S, Mellor R, Vicenzino B. The Foot Orthoses versus Hip eXercises (FOHX) trial for patellofemoral pain: a protocol for a randomized clinical trial to determine if foot mobility is associated with better outcomes from foot orthoses. J Foot Ankle Res 2017; 10:5. [PMID: 28138341 PMCID: PMC5264284 DOI: 10.1186/s13047-017-0186-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/10/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent, often recalcitrant and multifactorial knee pain condition. One method to optimize treatment outcome is to tailor treatments to the patient's presenting characteristics. Foot orthoses and hip exercises are two such treatments for PFP with proven efficacy yet target different ends of the lower limb with different proposed mechanisms of effect. These treatments have not been compared head-to-head, so there is a dearth of evidence for which to use clinically. Only foot orthoses have been explored for identifying patient characteristics that might predict a beneficial effect with either of these two treatments. Preliminary evidence suggests patients will do well with foot orthoses if they have a midfoot width in weight bearing that is ≥ 11 mm more than in non-weight bearing, but this has yet to be verified in a study that includes a comparator treatment and an adequate sample size. This trial will determine if: (i) hip exercises are more efficacious than foot orthoses, and (ii) greater midfoot width mobility will be associated with success with foot orthoses, when compared to hip exercises. METHODS Two hundred and twenty participants, aged 18-40 years, with a clinical diagnosis of PFP will be randomly allocated with a 1:1 ratio to receive foot orthoses or progressive resisted hip exercises, and stratified into two subgroups based on their presenting midfoot width mobility (high mobility defined as ≥11 mm). The primary outcome will be a 7-point Likert scale for global rating of change. All analyses will be conducted on an intention-to-treat basis using regression models. DISCUSSION This trial is designed to compare the efficacy of foot orthoses versus hip exercise, as well as to determine if high midfoot width mobility is associated with better outcomes with foot orthoses when compared to hip exercises. Results of this trial will assist clinicians in optimising the management of those with PFP by testing whether a simple measure of midfoot width mobility can help to determine which patients are most likely to benefit from foot orthoses. TRIAL REGISTRATION This trial is registered on the Australian New Zealand Clinical Trials Register (ACTRN12614000260628).
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Affiliation(s)
- Mark Matthews
- The University of Queensland, School of Health and Rehabilitation Sciences, Sports Injuries Rehabilitation and Prevention for Health research unit, CCRE Spine, Brisbane, Australia
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg and Department of Clinical Medicine, Aalborg, Denmark
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Andrew Claus
- The University of Queensland, School of Health and Rehabilitation Sciences, Sports Injuries Rehabilitation and Prevention for Health research unit, CCRE Spine, Brisbane, Australia
| | - Tom McPoil
- School of Physical Therapy, Rueckert-Hartman College for Health Professions, Regis University, Denver, USA
| | - Robert Nee
- School of Physical Therapy, Pacific University, Hillsboro, USA
| | - Kay Crossley
- La Trobe University, School of Allied Health, College of Science, Health and Engineering, Melbourne, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Sanjoy Paul
- Clinical Trials and Biostatistics Centre, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Rebecca Mellor
- The University of Queensland, School of Health and Rehabilitation Sciences, Sports Injuries Rehabilitation and Prevention for Health research unit, CCRE Spine, Brisbane, Australia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Sports Injuries Rehabilitation and Prevention for Health research unit, CCRE Spine, Brisbane, Australia
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Thomson C, Krouwel O, Kuisma R, Hebron C. The outcome of hip exercise in patellofemoral pain: A systematic review. ACTA ACUST UNITED AC 2016; 26:1-30. [DOI: 10.1016/j.math.2016.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/10/2016] [Accepted: 06/06/2016] [Indexed: 12/31/2022]
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Rabin A, Portnoy S, Kozol Z. The Association Between Visual Assessment of Quality of Movement and Three-Dimensional Analysis of Pelvis, Hip, and Knee Kinematics During a Lateral Step Down Test. J Strength Cond Res 2016; 30:3204-3211. [DOI: 10.1519/jsc.0000000000001420] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The Association of Ankle Dorsiflexion Range of Motion With Hip and Knee Kinematics During the Lateral Step-down Test. J Orthop Sports Phys Ther 2016; 46:1002-1009. [PMID: 27686412 DOI: 10.2519/jospt.2016.6621] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study. Background Altered hip and knee kinematics have been associated with several knee disorders, including anterior cruciate ligament tear, patellofemoral pain, and iliotibial band syndrome. Limited ankle dorsiflexion (DF) range of motion (ROM), which has been linked with some of these disorders, has also been associated with altered knee kinematics. Objective To explore the association of ankle DF ROM with hip and knee kinematics during a step-down task. Methods Thirty healthy participants underwent a 3-D analysis of hip and knee kinematics during a lateral step-down test, followed by measurement of ankle DF ROM in weight bearing (WB) and non-weight bearing (NWB). Participants were dichotomized using the median values into low- and high-DF subgroups within both WB and NWB. Hip and knee kinematics were compared between the low- and high-DF subgroups. Results Participants in the low-DF subgroups exhibited greater peak hip adduction (WB, P = .02; NWB, P<.01) and greater peak knee external rotation (WB, P = .02; NWB, P<.01) compared with participants in the high-DF subgroups. In addition, participants in the low-DF WB subgroup exhibited decreased peak knee flexion compared with participants in the high-DF WB subgroup (P<.01). Conclusion Individuals with lower ankle DF ROM exhibited hip and knee kinematics previously associated with several knee disorders, suggesting that this impairment may be involved in the pathogenesis of the same disorders. Assessment of ankle DF ROM may be useful as part of a preparticipation screening. Furthermore, deficits in ankle DF ROM may need to be addressed in individuals with altered movement patterns. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6621.
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Culvenor AG, Perraton L, Guermazi A, Bryant AL, Whitehead TS, Morris HG, Crossley KM. Knee kinematics and kinetics are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction. Osteoarthritis Cartilage 2016; 24:1548-53. [PMID: 27188685 DOI: 10.1016/j.joca.2016.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patellofemoral osteoarthritis (PFOA) commonly occurs following anterior cruciate ligament reconstruction (ACLR). Our study aimed to compare knee kinematics and kinetics during a hop-landing task between individuals with and without early PFOA post-ACLR. DESIGN Forty-five individuals (mean ± SD 26 ± 5 years) 1-2 years post-ACLR underwent 3T isotropic MRI scans and 3D biomechanical assessment of a standardised forward hop task. Knee kinematics (initial contact, peak, excursion) in all three planes and sagittal plane kinetics (peak) were compared between 15 participants with early PFOA (MRI-defined patellofemoral cartilage lesion) and 30 participants with no PFOA (absence of patellofemoral cartilage lesion on MRI) using analysis of covariance (ANCOVA), adjusted for age, BMI, sex and the presence of early tibiofemoral OA. RESULTS Compared to participants without PFOA, those with early PFOA exhibited smaller peak knee flexion angles (mean difference, 95% confidence interval [CI]: -5.2°, -9.9 to -0.4; P = 0.035) and moments (-4.2 Nm/kg.m, -7.8 to -0.6; P = 0.024), and greater knee internal rotation excursion (5.3°, 2.0 to 8.6; P = 0.002). CONCLUSIONS Individuals with early PFOA within the first 2-years following ACLR exhibit distinct kinematic and kinetic features during a high-load landing task. These findings provide new information regarding common post-ACLR biomechanical patterns and PFOA. Since management strategies, such as altering knee load, are more effective during the early stages of disease, this knowledge will help to inform clinical management of early PFOA post-ACLR.
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Affiliation(s)
- A G Culvenor
- Paracelsus Medical University, Institute of Anatomy Salzburg & Nuremberg, Salzburg, Austria; La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Bundoora, Australia; Australian Hip and Knee Institute, Melbourne, Australia.
| | - L Perraton
- The University of Melbourne, Department of Physiotherapy, School of Medicine, Dentistry and Health Sciences, Parkville, Australia.
| | - A Guermazi
- Boston University School of Medicine, Department of Radiology, Boston, USA.
| | - A L Bryant
- The University of Melbourne, Department of Physiotherapy, School of Medicine, Dentistry and Health Sciences, Parkville, Australia.
| | - T S Whitehead
- OrthoSport Victoria, Epworth Richmond, Melbourne, Australia.
| | - H G Morris
- The Park Clinic, St Vincent's Private Hospital, Melbourne, Australia.
| | - K M Crossley
- La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Bundoora, Australia.
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Wang X, Malik A, Bartel DL, Wright TM, Padgett DE. Load Sharing Among Collateral Ligaments, Articular Surfaces, and the Tibial Post in Constrained Condylar Knee Arthroplasty. J Biomech Eng 2016; 138:2526201. [PMID: 27223672 DOI: 10.1115/1.4033678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Indexed: 11/08/2022]
Abstract
The normal knee joint maintains stable motion during activities of daily living. After total knee arthroplasty (TKA), stability is achieved by the conformity of the bearing surfaces of the implant components, ligaments, and constraint structures incorporated in the implant design. The large, rectangular tibial post in constrained condylar knee (CCK) arthroplasty, often used in revision surgery, provides added stability, but increases susceptibility to polyethylene wear as it contacts the intercondylar box on the femoral component. We examined coronal plane stability to understand the relative contributions of the mechanisms that act to stabilize the CCK knee under varus-valgus loading, namely, load distribution between the medial and lateral condyles, contact of the tibial post with the femoral intercondylar box, and elongation of the collateral ligaments. A robot testing system was used to determine the joint stability in human cadaveric knees as described by the moment versus angular rotation behavior under varus-valgus moments at 0 deg, 30 deg, and 90 deg of flexion. The angular rotation of the CCK knee in response to the physiological moments was limited to ≤1.5 deg. The primary stabilizing mechanism was the redistribution of the contact force on the bearing surfaces. Contact between the tibial post and the femoral box provided a secondary stabilizing mechanism after lift-off of a condyle had occurred. Collateral ligaments provide limited stability because little ligament elongation occurred under such small angular rotations. Compressive loads applied across the knee joint, such as would occur with the application of muscle forces, enhanced the ability of the bearing surfaces to provide resisting internal varus-valgus moment and, thus, reduced the exposure of the tibial post to the external varus-valgus loads. Our results suggest that the CCK stability can be refined by considering both the geometry of the bearing surfaces and the contacting geometry between the tibial post and femoral box.
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Engel K, Hartmann U, Potthast W, Brüggemann GP. Influence of calibration method and material on the accuracy of stress distribution measurement systems. BIOMED ENG-BIOMED TE 2016; 61:317-22. [PMID: 26146092 DOI: 10.1515/bmt-2014-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 06/10/2015] [Indexed: 11/15/2022]
Abstract
Biomechanical analyses of the stress distribution and the force transfer in the human knee are essential to better understand the aetiology of joint diseases. Accuracy studies of commonly used capacitive or resistive-based stress distribution measurement systems have led to severe problems caused by an inaccurate experimental setup. For instance, in one study, overestimations of the measured forces in the sensor's centre were reported. Therefore, the primary aim of this study was to investigate the ability of capacitive and resistive-based sensors to measure forces in a homogenous pressure environment and the secondary goal was to analyse the influence of different calibration materials on the measurement accuracy. A Novel pressure vessel and metal indenters covered with different rubber materials were used in combination with a material testing machine to load the sensors. Four different linearly increasing nominal forces (925-3670 N) were applied and the deviations between the nominal and the measured forces were calculated. The capacitive measurement system showed errors between 1% and 7% in the homogenous pressure environment, whereas the errors of the resistive system were found to vary between 4% and 17%. The influence of the calibration material was observed to be greater for the resistive sensors (1-179%) than for the capacitive sensors (0.5-25%). In conclusion, it can be stated that - for the pressure measurement systems compared in this article - the capacitive one is less sensitive to the calibration method and the calibration material than the resistive system.
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Ali AA, Shalhoub SS, Cyr AJ, Fitzpatrick CK, Maletsky LP, Rullkoetter PJ, Shelburne KB. Validation of predicted patellofemoral mechanics in a finite element model of the healthy and cruciate-deficient knee. J Biomech 2016; 49:302-9. [PMID: 26742720 PMCID: PMC4761469 DOI: 10.1016/j.jbiomech.2015.12.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/05/2015] [Accepted: 12/14/2015] [Indexed: 11/16/2022]
Abstract
Healthy patellofemoral (PF) joint mechanics are critical to optimal function of the knee joint. Patellar maltracking may lead to large joint reaction loads and high stresses on the articular cartilage, increasing the risk of cartilage wear and the onset of osteoarthritis. While the mechanical sources of PF joint dysfunction are not well understood, links have been established between PF tracking and abnormal kinematics of the tibiofemoral (TF) joint, specifically following cruciate ligament injury and repair. The objective of this study was to create a validated finite element (FE) representation of the PF joint in order to predict PF kinematics and quadriceps force across healthy and pathological specimens. Measurements from a series of dynamic in-vitro cadaveric experiments were used to develop finite element models of the knee for three specimens. Specimens were loaded under intact, ACL-resected and both ACL and PCL-resected conditions. Finite element models of each specimen were constructed and calibrated to the outputs of the intact knee condition, and subsequently used to predict PF kinematics, contact mechanics, quadriceps force, patellar tendon moment arm and patellar tendon angle of the cruciate resected conditions. Model results for the intact and cruciate resected trials successfully matched experimental kinematics (avg. RMSE 4.0°, 3.1mm) and peak quadriceps forces (avg. difference 5.6%). Cruciate resections demonstrated either increased patellar tendon loads or increased joint reaction forces. The current study advances the standard for evaluation of PF mechanics through direct validation of cruciate-resected conditions including specimen-specific representations of PF anatomy.
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Affiliation(s)
- Azhar A Ali
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Sami S Shalhoub
- Department of Mechanical Engineering, University of Kansas, Lawrence, KS, USA
| | - Adam J Cyr
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA; Department of Mechanical Engineering, University of Kansas, Lawrence, KS, USA
| | | | - Lorin P Maletsky
- Department of Mechanical Engineering, University of Kansas, Lawrence, KS, USA
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Kevin B Shelburne
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
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No difference in patellar kinematics between fixed-bearing cruciate-retaining and cruciate-substituting total knee arthroplasty: a cadaveric investigation. INTERNATIONAL ORTHOPAEDICS 2015; 40:731-5. [PMID: 26563169 DOI: 10.1007/s00264-015-3041-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The influence of cruciate-ligament-retaining (CR-TKA) and cruciate-ligament-substituting (CS-TKA) TKA on tibiofemoral kinematics was analysed in many investigations. However, the influence on patellar kinematics is unclear so far. The aim of this study was to compare patellar kinematics of the natural knee with those after CR- and CS-TKA. METHODS Patellar kinematics of nine healthy whole-body cadaveric knees before and after CR- and CS-TKA was investigated using a commercial optical computer navigation system. Patellar kinematics of the healthy knee was compared with those after CR- and CS-TKA. RESULTS No significant difference between the natural knee and the knee after TKA or between both types of TKA for patellar kinematics could be found. Interestingly, both types of TKA resulted in a more medial patellar shift and a contrary patellar tilt and rotation behaviour. CR- and CS-TKA resulted in smaller values for patellar epicondylar distance at all flexion angles. CONCLUSIONS Our study found no influence of prosthesis type on patellar kinematics. Factors like component alignment and prosthesis design seem to be more important in terms of adequate restoration of patellar kinematics in TKA than whether choosing CR- or CS-TKA.
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Lee YS. The Effect of Genu Valgum on the Body Mass Index, Moment of Lower Limb Joints, Ground Reaction Force. ACTA ACUST UNITED AC 2015. [DOI: 10.5103/kjsb.2015.25.3.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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46
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Knee alignment in the transverse plane during weight-bearing activity and its implication for the tibial rotational alignment in total knee arthroplasty. Clin Biomech (Bristol, Avon) 2015; 30:565-71. [PMID: 25936578 DOI: 10.1016/j.clinbiomech.2015.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/04/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The alignment of the knee in the transverse plane is important to the biomechanical functions of the lower limb, and is also associated with the outcomes of the total knee arthroplasty. This study aimed to evaluate the dynamic tibiofemoral alignment in the transverse plane during a weight-bearing activity. METHODS Knee kinematics of weight-bearing flexion from 0° to 120° was obtained in 16 healthy subjects utilizing biplanar radiography and 3D-2D registration techniques. The anteroposterior axes of the femur at multiple flexion angles in the range of knee motion were used to calculate the anteroposterior axis of motion using the least square method. The latter was compared to six surface-derived anatomical axes in the proximal tibia which were most commonly reported in the literature. The relationship between the anteroposterior axis of motion and the tibial tubercle was also quantified. FINDINGS The anteroposterior axis of motion did not coincide with any of the six anatomical axes tested. Their orientations varied from 10.3° of external rotation to 9.9° of internal rotation in relation to the former. The anteroposterior axis of motion tended to intersect the tibial tubercle between the medial border and the medial 1/3 point. INTERPRETATION Instead of any of the tested anatomical axes, the transverse knee alignment during functional movements is associated with the medial 1/3 portion of the tibial tubercle. This region may be helpful for the rotational alignment of the tibial components in total knee arthroplasty.
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Segal NA, Nevitt MC, Welborn RD, Nguyen USDT, Niu J, Lewis CE, Felson DT, Frey-Law L. The association between antagonist hamstring coactivation and episodes of knee joint shifting and buckling. Osteoarthritis Cartilage 2015; 23:1112-21. [PMID: 25765501 PMCID: PMC4744470 DOI: 10.1016/j.joca.2015.02.773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/19/2015] [Accepted: 02/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Hamstring coactivation during quadriceps activation is necessary to counteract the quadriceps pull on the tibia, but coactivation can be elevated with symptomatic knee osteoarthritis (OA). To guide rehabilitation to attenuate risk for mobility limitations and falls, this study evaluated whether higher antagonistic open kinetic chain hamstring coactivation is associated with knee joint buckling (sudden loss of support) and shifting (a sensation that the knee might give way). DESIGN At baseline, median hamstring coactivation was assessed during maximal isokinetic knee extensor strength testing and at baseline and 24-month follow-up, knee buckling and shifting was self-reported. Associations between tertiles of co-activation and knee (1) buckling, (2) shifting and (3) either buckling or shifting were assessed using logistic regression, adjusted for age, sex, knee OA and pain. RESULTS 1826 participants (1089 women) were included. Mean ± SD age was 61.7 ± 7.7 years, BMI was 30.3 ± 5.5 kg/m(2) and 38.2% of knees had OA. There were no consistent statistically significant associations between hamstring coactivation and ipsilateral prevalent or incident buckling or the combination of buckling and shifting. The odds ratios for incident shifting in the highest in comparison with the lowest tertile of coactivation had similar magnitudes in the combined and medial hamstrings, but only reached statistical significance for lateral hamstring coactivation, OR(95%CI) 1.53 (0.99, 2.36). CONCLUSIONS Hamstring coactivation during an open kinetic chain quadriceps exercise was not consistently associated with prevalent or incident self-reported knee buckling or shifting in older adults with or at risk for knee OA.
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Affiliation(s)
- N A Segal
- The University of Kansas, Kansas City, KS, United States.
| | - M C Nevitt
- University of California San Francisco, San Francisco, CA, United States.
| | - R D Welborn
- The University of Iowa, Iowa City, IA, United States.
| | - U-S D T Nguyen
- Boston University School of Medicine, Boston, MA, United States; University of Massachusetts Medical School, Worcester, MA, United States.
| | - J Niu
- Boston University School of Medicine, Boston, MA, United States.
| | - C E Lewis
- University of Alabama at Birmingham, Birmingham, AL, United States.
| | - D T Felson
- Boston University School of Medicine, Boston, MA, United States.
| | - L Frey-Law
- The University of Iowa, Iowa City, IA, United States.
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48
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Ghosh KM, Hunt N, Blain A, Athwal KK, Longstaff L, Amis AA, Rushton S, Deehan DJ. Isolated popliteus tendon injury does not lead to abnormal laxity in posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:1763-9. [PMID: 25552404 DOI: 10.1007/s00167-014-3488-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 12/12/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE The popliteus tendon is crucial to postero-lateral stability and prone to iatrogenic injury intra-operatively. Its role in the stability of the replaced knee remains contentious. The aim of this study was to use computer navigation to quantify the effect of popliteus sectioning on the 'envelope of laxity' (EoL) offered by a posterior-stabilised (PS) total knee arthroplasty (TKA) and compare with that of the native knee. METHODS Loaded cadaveric legs were mounted on a purpose built rig. EoL was measured in 3 degrees of freedom using computer navigation. Knees were subjectively stressed in varus/valgus, internal/external rotation and anterior draw. This was performed preoperatively, during TKA and after sectioning of the popliteus tendon. Real-time data were recorded at 0°, 30°, 60° and 90° of flexion as the operating surgeon stressed the knee in 3 degrees of freedom to its subjective endpoint. Mixed-effect modelling was used to quantify the effects of intervention on degree of laxity. RESULTS In all conditions, there was an increase in laxity with knee flexion. Insertion of a PS TKA resulted in increased constraint, particularly in rotation. Sectioning of the popliteus did not result in a significant increase in knee laxity to 90º of knee flexion. However, at deeper flexion angles, tendon sectioning overcame the constraints of the implant resulting in a significant increase in rotatory and varus/valgus laxity towards the native condition. CONCLUSION These findings support the view that certain current designs of PS knee replacement can constrain the knee in flexion in the absence of postero-lateral deficiency. For this implant, isolated sectioning of the popliteus tendon did not substantially generate abnormal knee laxity.
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Affiliation(s)
- K M Ghosh
- Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK,
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49
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Gadikota HR, Hosseini A, Asnis P, Li G. Kinematic Analysis of Five Different Anterior Cruciate Ligament Reconstruction Techniques. Knee Surg Relat Res 2015; 27:69-75. [PMID: 26060604 PMCID: PMC4458485 DOI: 10.5792/ksrr.2015.27.2.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/05/2015] [Accepted: 04/16/2015] [Indexed: 02/07/2023] Open
Abstract
Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed. The knee kinematics were determined under anterior tibial load (134 N) and simulated quadriceps load (400 N) at 0°, 15°, 30°, 60°, and 90° of flexion using a robotic testing system. Anterior joint stability under anterior tibial load was qualified as normal for ASTR-HST and DBR-HST and nearly normal for SBR-BPTB, SBR-HST, and STDBR-HST as per the International Knee Documentation Committee knee examination form categorization. The analysis of this study also demonstrated that SBR-BPTB, STDBR-HST, ASTR-HST, and DBR-HST restored the anterior joint stability to normal condition while the SBR-HST resulted in a nearly normal anterior joint stability under the action of simulated quadriceps load. The medial-lateral translations were restored to normal level by all the reconstructions. The internal tibial rotations under the simulated muscle load were over-constrained by all the reconstruction techniques, and more so by the DBR-HST. All five ACL reconstruction techniques could provide either normal or nearly normal anterior joint stability; however, the techniques over-constrained internal tibial rotation under the simulated quadriceps load.
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Affiliation(s)
- Hemanth R Gadikota
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ali Hosseini
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter Asnis
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Schwane BG, Goerger BM, Goto S, Blackburn JT, Aguilar AJ, Padua DA. Trunk and Lower Extremity Kinematics During Stair Descent in Women With or Without Patellofemoral Pain. J Athl Train 2015; 50:704-12. [PMID: 25898109 DOI: 10.4085/1062-6050-49.3.100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT There is limited evidence indicating the contribution of trunk kinematics to patellofemoral pain (PFP). A better understanding of the interaction between trunk and lower extremity kinematics in this population may provide new avenues for interventions to treat PFP. OBJECTIVE To compare trunk and lower extremity kinematics between participants with PFP and healthy controls during a stair-descent task. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty women with PFP (age = 22.2 ± 3.1 years, height = 164.5 ± 9.2 cm, mass = 63.5 ± 13.6 kg) and 20 healthy women (age = 21.0 ± 2.6 years, height = 164.5 ± 7.1 cm, mass = 63.8 ± 12.7 kg). INTERVENTION(S) Kinematics were recorded as participants performed stair descent at a controlled velocity. MAIN OUTCOME MEASURE(S) Three-dimensional joint displacement of the trunk, hip, and knee during the stance phase of stair descent for the affected leg was measured using a 7-camera infrared optical motion-capture system. Pretest and posttest pain were assessed using a visual analogue scale. Kinematic differences between groups were determined using independent-samples t tests. A 2 × 2 mixed-model analysis of variance (group = PFP, control; time = pretest, posttest) was used to compare knee pain. RESULTS We observed greater knee internal-rotation displacement for the PFP group (12.8° ± 7.2°) as compared with the control group (8.9° ± 4.4°). No other between-groups differences were observed for the trunk, hip, or other knee variables. CONCLUSIONS We observed no difference in trunk kinematics between groups but did note differences in knee internal-rotation displacement. These findings contribute to the current knowledge of altered movement in those with PFP and provide direction for exercise interventions.
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Affiliation(s)
| | | | | | | | - Alain J Aguilar
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill
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