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Braun L, Mai P, Hipper M, Denis Y, Helwig J, Anedda B, Utku B, Gehring D, Willwacher S. Managing lower extremity loading in distance running by altering sagittal plane trunk leaning. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:100985. [PMID: 39251186 DOI: 10.1016/j.jshs.2024.100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/02/2024] [Accepted: 06/14/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Trunk lean angle is an underrepresented biomechanical variable for modulating and redistributing lower extremity joint loading and potentially reducing the risk of running-related overuse injuries. The purpose of this study was to systematically alter the trunk lean angle in distance running using an auditory real-time feedback approach and to derive dose-response relationships between sagittal plane trunk lean angle and lower extremity (cumulative) joint loading to guide overuse load management in clinical practice. METHODS Thirty recreational runners (15 males and 15 females) ran at a constant speed of 2.5 m/s at 5 systematically varied trunk lean conditions on a force-instrumented treadmill while kinematic and kinetic data were captured. RESULTS A change in trunk lean angle from -2° (extension) to 28° (flexion) resulted in a systematic increase in stance phase angular impulse, cumulative impulse, and peak moment at the hip joint in the sagittal and transversal plane. In contrast, a systematic decrease in these parameters at the knee joint in the sagittal plane and the hip joint in the frontal plane was found (p < 0.001). Linear fitting revealed that with every degree of anterior trunk leaning, the cumulative hip joint extension loading increases by 3.26 Nm·s/kg/1000 m, while simultaneously decreasing knee joint extension loading by 1.08 Nm·s/kg/1000 m. CONCLUSION Trunk leaning can reduce knee joint loading and hip joint abduction loading, at the cost of hip joint loading in the sagittal and transversal planes during distance running. Modulating lower extremity joint loading by altering trunk lean angle is an effective strategy to redistribute joint load between/within the knee and hip joints. When implementing anterior trunk leaning in clinical practice, the increased demands on the hip musculature, dynamic stability, and the potential trade-off with running economy should be considered.
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Affiliation(s)
- Luca Braun
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg 77652, Germany.
| | - Patrick Mai
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo 0863, Norway
| | - Markus Hipper
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg 77652, Germany
| | - Yannick Denis
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg 77652, Germany
| | - Janina Helwig
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg 77652, Germany
| | - Bastian Anedda
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg 77652, Germany
| | - Burkay Utku
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg 77652, Germany
| | - Dominic Gehring
- Department of Sport and Sport Science, University of Freiburg, Freiburg 79102, Germany
| | - Steffen Willwacher
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg 77652, Germany
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Yalfani A, Ahadi F, Ahmadi M. Effects of pain exacerbation on postural control in women with patellofemoral pain during single leg squat: a cross-sectional study. J Orthop Surg Res 2024; 19:462. [PMID: 39107811 PMCID: PMC11302083 DOI: 10.1186/s13018-024-04911-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The center of pressure (COP) excursion parameters are recognized as risk factors for the etiology and development of patellofemoral pain (PFP). The purpose of the present study measures the effect of pain exacerbation on COP excursion, and the correlation between pain intensity and COP excursion in women with PFP during single leg squat (SLS). METHODS Sixty patients with PFP participated in this cross-sectional study. The outcome measures were included pain intensity and COP excursion which evaluated in pre and post pain exacerbation during SLS. The COP parameters were evaluated during single leg squat in 60° of knee flexion. A paired t-test and MANOVA was used to compare pain intensity and COP excursion between the two conditions, respectively. Furthermore, A Pearson's correlation matrix was used to examine the relationship between pain intensity with COP excursion. RESULTS Statistical analysis showed that pain intensity (t = - 16.655, p < 0.001) and COP excursion (Wilks' Lambda = 0.225, p < 0.001) with medium effect size increased after PFJ loading. In addition, an excellent positive correlation was observed between increased in pain intensity and COP excursion (P < 0.001, r > 0.80). CONCLUSION After PFJ loading, women with PFP presented increases in the pain intensity, COP excursions, and sway velocity. In addition, there was an association between the increase in pain intensity and COP excursions. Clinicians aiming to improve postural control of patients with PFP could use kinesio taping as a short-term intervention and balance training to improvements in postural control at medium and long-term. Furthermore, emphasizing psychological factors to reducing kinesiophobia can be useful to restoring proper movement pattern, reducing pain and improving symptoms.
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Affiliation(s)
- Ali Yalfani
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran.
| | - Fatemeh Ahadi
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Mohamadreza Ahmadi
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
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Lee JH, Schwarzkopf R, Fraipont G, Bouzarif G, McGarry MH, Lee TQ. Load-Dependent Characteristics of Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Biomechanical Study. Clin Orthop Surg 2024; 16:570-577. [PMID: 39092300 PMCID: PMC11262949 DOI: 10.4055/cios23356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 08/04/2024] Open
Abstract
Background Increased load bearing across the patellofemoral and tibiofemoral articulations has been associated with total knee arthroplasty (TKA) complications. Therefore, the purpose of this study was to quantify the biomechanical characteristics of the patellofemoral and tibiofemoral joints and simulate varying weight-bearing demands after posterior cruciate ligament-retaining (CR) and posterior-stabilized (PS) TKAs. Methods Eight fresh-frozen cadaveric knees (average age, 68.4 years; range, 40-86 years) were tested using a custom knee system with muscle-loading capabilities. The TKA knees were tested with a CR and then a PS TKA implant and were loaded at 6 different flexion angles from 15° to 90° with progressively increasing loads. The independent variables were the implant types (CR and PS TKA), progressively increased loading, and knee flexion angle (KFA). The dependent variables were the patellofemoral and tibiofemoral kinematics and contact characteristics. Results The results showed that at higher KFAs, the position of the femur translated significantly more posterior in CR implants than in PS implants (36.6 ± 5.2 mm and 32.5 ± 5.7 mm, respectively). The patellofemoral contact force and contact area were significantly greater in PS than in CR implants at higher KFAs and loads (102.4 ± 12.5 N and 88.1 ± 10.9 N, respectively). Lastly, the tibiofemoral contact force was significantly greater in the CR than the PS implant at flexion angles of 45°, 60°, 75°, and 90° KFA, the average at these flexion angles for all loads tested being 246.1 ± 42.1 N and 192.8 ± 54.8 N for CR and PS implants, respectively. Conclusions In this biomechanical study, CR TKAs showed less patellofemoral contact force, but more tibiofemoral contact force than PS TKAs. For higher loads across the joint and at increased flexion angles, there was significantly more posterior femur translation in the CR design with a preserved posterior cruciate ligament and therefore significantly less patellofemoral contact area and force than in the PS design. The different effects of loading on implants are an important consideration for physicians as patients with higher load demands should consider the significantly greater patellofemoral contact force and area of the PS over the CR design.
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Affiliation(s)
- Jason H. Lee
- Southern California Permanente Medical Group, Department of Orthopaedics, Fontana Medical Center, Los Angeles, CA, USA
| | - Ran Schwarzkopf
- New York University Langone Orthopedic Hospital, New York, NY, USA
| | - Genevieve Fraipont
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Ghita Bouzarif
- Department of Internal Medicine, Highland Hospital, Oakland, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
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Garner MR, Homcha B, Cowman T, Goss M, Reid JS, Lewis GS. Transverse patella fracture fixation: A cadaveric biomechanical comparison of cannulated screws and anterior tension band versus low-profile, multiplanar mesh plating. Injury 2024; 55:111574. [PMID: 38669892 PMCID: PMC11111345 DOI: 10.1016/j.injury.2024.111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Multiplanar mesh plating of patella fractures has become more popular in recent years. It was the goal of this study to compare the biomechanical stability of cannulated screw with anterior tension band to multiplanar mesh plating for fixation of transverse patella fractures in cadaver specimens. MATERIALS AND METHODS Eight matched pairs of fresh frozen cadaveric knees were obtained and soft tissues dissected leaving the extensor mechanism, joint capsule, and retinaculum intact. Transverse fractures were created at the mid-portion of the patella. For each pair, one specimen was repaired using cannulated screws with anterior tension band, and the second was repaired using multiplanar mesh plating. Each specimen underwent cyclic extension loading with loads increasing by 1.1 kg after every 50 cycles. Interfragmentary displacement was measured at the end of each interval at both 5° and 45° of knee flexion angle, with fixation failure defined by >2 mm displacement. RESULTS The specimens fixed with multiplanar mesh plating survived more cycles and higher loads than the specimens fixed with cannulated screws with anterior tension band (p = 0.011 comparing survival plots). After 150 cycles of extension loading, 3 of 8 of the specimens fixed with screws/tension band had failed, whereas none of the mesh plated specimens had failed. After 400 cycles, 7 of 8 of the screws/tension band had failed, whereas half of the mesh plated specimens had failed. CONCLUSIONS While a more technically challenging and expensive technique, mesh plating for patella fractures appears to offer greater durability than traditional cannulated screw with tension banding.
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Affiliation(s)
- Matthew R Garner
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA.
| | - Brittany Homcha
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - Trevin Cowman
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - Madison Goss
- Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - J Spence Reid
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - Gregory S Lewis
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
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León-Morillas F, García-Marín M, Corujo-Hernández C, Martín Alemán M, Castellote-Caballero Y, Cahalin LP, Infante-Guedes A, Cruz-Díaz D. Evaluating the Impact of Flossing Band Integration in Conventional Physiotherapy for Patellofemoral Pain Syndrome. J Clin Med 2024; 13:2958. [PMID: 38792499 PMCID: PMC11122419 DOI: 10.3390/jcm13102958] [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: 03/30/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Patellofemoral Pain Syndrome (PFPS) is prevalent among physically active individuals, highlighting the need for innovative treatment strategies beyond conventional physiotherapy. This study investigates the effectiveness of integrating flossing band therapy with standard physiotherapy, anticipating improved outcomes in pain reduction, functional ability, and patient satisfaction. Methods: A double-blinded randomized controlled trial involved 50 PFPS-diagnosed participants. They were divided into two groups: Standard Physiotherapy Group (SPG) and Flossing Band and Physiotherapy Group (FBPG), each undergoing an 8-week intervention focusing on resistance training supplemented by respective therapies. Assessment metrics included pain (VAS), strength (Dynamometry), lower limb function (LEFS), and PFPS function (AKPS) measured before and after the intervention. Results: Significant enhancements in all outcome measures were noted for both groups, yet the FBPG exhibited notably superior improvements in pain, knee functionality, muscle strength, and lower extremity function. The FBPG demonstrated statistically significant greater efficacy in pain alleviation and strength enhancement. Conclusions: The addition of flossing band therapy to conventional physiotherapy presents a more effective treatment modality for PFPS, suggesting its potential to redefine therapeutic standards. Future studies should delve into the long-term impacts and mechanistic underpinnings of floss band therapy in PFPS management.
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Affiliation(s)
- Felipe León-Morillas
- Department of Physiotherapy, Faculty of Physiotherapy, Podiatry and Therapy Occupational, Catholic University of Murcia (UCAM), Guadalupe, 30107 Murcia, Spain;
| | - Manuel García-Marín
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (M.G.-M.); (D.C.-D.)
| | | | | | - Yolanda Castellote-Caballero
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (M.G.-M.); (D.C.-D.)
| | - Lawrence P. Cahalin
- Department of Physical Therapy, University of Miami, Miller School of Medicine, Coral Gables, FL 33146, USA;
| | - Aday Infante-Guedes
- Faculty of Health Sciences, University of Atlántico Medio, 35017 Las Palmas de Gran Canaria, Spain;
| | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (M.G.-M.); (D.C.-D.)
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Doyle EW, Doyle TLA, Bonacci J, Fuller JT. Sensor location influences the associations between IMU and motion capture measurements of impact landing in healthy male and female runners at multiple running speeds. Sports Biomech 2024:1-15. [PMID: 38190247 DOI: 10.1080/14763141.2023.2298954] [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: 06/09/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024]
Abstract
This study investigated the relationships between inertial measurement unit (IMU) acceleration at multiple body locations and 3D motion capture impact landing measures in runners. Thirty healthy runners ran on an instrumented treadmill at five running speeds (9-17 km/h) during 3D motion capture. Axial and resultant acceleration were collected from IMUs at the distal and proximal tibia, distal femur and sacrum. Relationships between peak acceleration from each IMU location and patellofemoral joint (PFJ) peak force and loading rate, impact peak and instantaneous vertical loading rate (IVLR) were investigated using linear mixed models. Acceleration was positively related to IVLR at all lower limb locations (p < 0.01). Models predicted a 1.9-3.2 g peak acceleration change at the tibia and distal femur, corresponding with a 10% IVLR change. Impact peak was positively related to acceleration at the distal femur only (p < 0.01). PFJ peak force was positively related to acceleration at the distal (p = 0.03) and proximal tibia (p = 0.03). PFJ loading rate was positively related to the tibia and femur acceleration in males only (p < 0.01). These findings suggest multiple IMU lower limb locations are viable for measuring peak acceleration during running as a meaningful indicator of IVLR.
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Affiliation(s)
- Eoin W Doyle
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Tim L A Doyle
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Joel T Fuller
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
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Ashall M, Wheatley MGA, Saliba C, Deluzio KJ, Rainbow MJ. Prediction of Model Generated Patellofemoral Joint Contact Forces Using Principal Component Prediction and Reconstruction. J Appl Biomech 2023; 39:388-394. [PMID: 37633654 DOI: 10.1123/jab.2022-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/30/2023] [Accepted: 07/03/2023] [Indexed: 08/28/2023]
Abstract
It is not currently possible to directly and noninvasively measure in vivo patellofemoral joint contact force during dynamic movement; therefore, indirect methods are required. Simple models may be inaccurate because patellofemoral contact forces vary for the same knee flexion angle, and the patellofemoral joint has substantial out-of-plane motion. More sophisticated models use 3-dimensional kinematics and kinetics coupled to a subject-specific anatomical model to predict contact forces; however, these models are time consuming and expensive. We applied a principal component analysis prediction and regression method to predict patellofemoral joint contact forces derived from a robust musculoskeletal model using exclusively optical motion capture kinematics (external approach), and with both patellofemoral and optical motion capture kinematics (internal approach). We tested this on a heterogeneous population of asymptomatic subjects (n = 8) during ground-level walking (n = 12). We developed equations that successfully capture subject-specific gait characteristics with the internal approach outperforming the external. These approaches were compared with a knee-flexion based model in literature (Brechter model). Both outperformed the Brechter model in interquartile range, limits of agreement, and the coefficient of determination. The equations generated by these approaches are less computationally demanding than a musculoskeletal model and may act as an effective tool in future rapid gait analysis and biofeedback applications.
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Affiliation(s)
- Myles Ashall
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON,Canada
| | - Mitchell G A Wheatley
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON,Canada
| | | | - Kevin J Deluzio
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON,Canada
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON,Canada
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Rosario R, Arruda EM, Grant JA, Coleman RM. Cartilage thickness mismatches in patellar osteochondral allograft transplants affect local cartilage stresses. J Orthop Res 2023; 41:2372-2383. [PMID: 37031360 PMCID: PMC10560315 DOI: 10.1002/jor.25569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 01/27/2023] [Accepted: 03/29/2023] [Indexed: 04/10/2023]
Abstract
Osteochondral allograft implantation is a form of cartilage transplant in which a cylindrical graft of cartilage and subchondral bone from a donor is implanted into a patient's prepared articular defect site. No standard exists for matching the cartilage thickness of the donor and recipient. The goal of this study was to use finite element (FE) analysis to identify the effect of cartilage thickness mismatches between donor and recipient cartilage on cartilage stresses in patellar transplants. Two types of FE models were used: patient-specific 3D models and simplified 2D models. 3D models highlighted which geometric features produced high-stress regions in the patellar cartilage and provided ranges for the parameter sweeps that were conducted with 2D models. 2D models revealed that larger thickness mismatches, thicker recipient cartilage, and a donor-to-recipient cartilage thickness ratio (DRCR) < 1 led to higher stresses at the interface between the donor and recipient cartilage. A surface angle between the donor-recipient cartilage interface and cartilage surface normal near the graft boundary increased stresses when DRCR > 1, with the largest increase observed for an angle of 15°. A surface angle decreased stresses when DRCR < 1. Clinical Significance: This study highlights a potential mechanism to explain the high rates of failure of patellar OCAs. Additionally, the relationship between geometric features and stresses explored in this study led to a hypothetical scoring system that indicates which transplanted patellar grafts may have a higher risk of failure.
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Affiliation(s)
- Ryan Rosario
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI
- Department of Mechanical Engineering, Lafayette College, Easton, PA
| | - Ellen M. Arruda
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
- Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI
| | - John A. Grant
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Rhima M. Coleman
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
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Coburn SL, Crossley KM, Kemp JL, Warden SJ, West TJ, Bruder AM, Mentiplay BF, Culvenor AG. Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2023; 9:56. [PMID: 37450202 PMCID: PMC10348990 DOI: 10.1186/s40798-023-00602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The impact of activity-related joint loading on cartilage is not clear. Abnormal loading is considered to be a mechanical driver of osteoarthritis (OA), yet moderate amounts of physical activity and rehabilitation exercise can have positive effects on articular cartilage. Our aim was to investigate the immediate effects of joint loading activities on knee and hip cartilage in healthy adults, as assessed using magnetic resonance imaging. We also investigated delayed effects of activities on healthy cartilage and the effects of activities on cartilage in adults with, or at risk of, OA. We explored the association of sex, age and loading duration with cartilage changes. METHODS A systematic review of six databases identified studies assessing change in adult hip and knee cartilage using MRI within 48 h before and after application of a joint loading intervention/activity. Studies included adults with healthy cartilage or those with, or at risk of, OA. Joint loading activities included walking, hopping, cycling, weightbearing knee bends and simulated standing within the scanner. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis estimated the percentage change in compartment-specific cartilage thickness or volume and composition (T2 relaxation time) outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system evaluated certainty of evidence. RESULTS Forty studies of 653 participants were included after screening 5159 retrieved studies. Knee cartilage thickness or volume decreased immediately following all loading activities investigating healthy adults; however, GRADE assessment indicated very low certainty evidence. Patellar cartilage thickness and volume reduced 5.0% (95% CI 3.5, 6.4, I2 = 89.3%) after body weight knee bends, and tibial cartilage composition (T2 relaxation time) decreased 5.1% (95% CI 3.7, 6.5, I2 = 0.0%) after simulated standing within the scanner. Hip cartilage data were insufficient for pooling. Secondary outcomes synthesised narratively suggest knee cartilage recovers within 30 min of walking and 90 min of 100 knee bends. We found contrasting effects of simulated standing and walking in adults with, or at risk of, OA. An increase of 10 knee bend repetitions was associated with 2% greater reduction in patellar thickness or volume. CONCLUSION There is very low certainty evidence that minimal knee cartilage thickness and volume and composition (T2 relaxation time) reductions (0-5%) occur after weightbearing knee bends, simulated standing, walking, hopping/jumping and cycling, and the impact of knee bends may be dose dependent. Our findings provide a framework of cartilage responses to loading in healthy adults which may have utility for clinicians when designing and prescribing rehabilitation programs and providing exercise advice.
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Affiliation(s)
- Sally L. Coburn
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Joanne L. Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Stuart J. Warden
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
- Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN USA
| | - Tom J. West
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Andrea M. Bruder
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Benjamin F. Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Adam G. Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
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Doyle EW, Doyle TLA, Bonacci J, Beach AJ, Fuller JT. Cumulative patellofemoral force and stress are lower during faster running compared to slower running in recreational runners. Sports Biomech 2023:1-13. [PMID: 37364918 DOI: 10.1080/14763141.2023.2226111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Management strategies for patellofemoral pain often involve modifying running distance or speed. However, the optimal modification strategy to manage patellofemoral joint (PFJ) force and stress accumulated during running warrants further investigation. This study investigated the effect of running speed on peak and cumulative PFJ force and stress in recreational runners. Twenty recreational runners ran on an instrumented treadmill at four speeds (2.5-4.2 m/s). A musculoskeletal model derived peak and cumulative (per 1 km of continuous running) PFJ force and stress for each speed. Cumulative PFJ force and stress decreased with faster speeds (9.3-33.6% reduction for 3.1-4.2 m/s vs. 2.5 m/s). Peak PFJ force and stress significantly increased with faster speeds (9.3-35.6% increase for 3.1-4.2 m/s vs. 2.5 m/s). The largest cumulative PFJ kinetics reductions occurred when speeds increased from 2.5 to 3.1 m/s (13.7-14.2%). Running at faster speeds increases the magnitude of peak PFJ kinetics but conversely results in less accumulated force over a set distance. Selecting moderate running speeds (~3.1 m/s) with reduced training duration or an interval-based approach may be more effective for managing cumulative PFJ kinetics compared to running at slow speeds.
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Affiliation(s)
- Eoin W Doyle
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Biomechanics, Physical Performance, and Exercise Research Group, Macquarie University, Sydney, New South Wales, Australia
| | - Tim L A Doyle
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Biomechanics, Physical Performance, and Exercise Research Group, Macquarie University, Sydney, New South Wales, Australia
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Aaron J Beach
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joel T Fuller
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Biomechanics, Physical Performance, and Exercise Research Group, Macquarie University, Sydney, New South Wales, Australia
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San Jose AJ, Maniar N, Whiteley R, Opar DA, Timmins RG, Kotsifaki R. Lower Patellofemoral Joint Contact Force During Side-Step Cutting After Return-to-Sports Clearance Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023:3635465231166104. [PMID: 37184026 DOI: 10.1177/03635465231166104] [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] [Indexed: 05/16/2023]
Abstract
BACKGROUND Low patellofemoral joint (PFJ) contact force has been associated with PFJ osteoarthritis. Quadriceps force and knee flexion angles, which are typically altered after an anterior cruciate ligament reconstruction (ACLR), primarily influence PFJ contact forces. It is still inconclusive whether differences in PFJ contact forces are present during high knee flexion tasks such as side-step cutting after clearance to return to sports (RTS) after ACLR. PURPOSE To explore PFJ contact forces in the ACLR limb and compare them with those of the contralateral and control limbs during side-step cutting tasks after clearance to RTS. STUDY DESIGN Controlled laboratory study. METHODS A total of 26 male athletes with ACLR who were previously cleared to RTS were matched with 23 healthy men serving as the control group. Three-dimensional motion capture and force plate data were collected while both groups performed anticipated side-step cutting tasks. Joint kinematics, kinetics, muscle forces, and PFJ contact forces were calculated using musculoskeletal modeling. RESULTS Peak PFJ force was lower in the ACLR limbs compared with the contralateral limbs (mean difference [MD], 5.89 body weight [BW]; 95% CI, 4.7-7.1 BW; P < .001) and the control limbs (MD, 4.44 BW; 95% CI, 2.1-6.8 BW; P < .001). During peak PFJ force, knee flexion angle was lower in ACLR limbs compared with the contralateral (MD, 4.88°; 95% CI, 3.0°-6.7°; P < .001) and control (MD, 6.01°; 95% CI, 2.0°-10.0°; P < .002) limbs. A lower quadriceps force compared with the contralateral (MD, 4.14 BW; 95% CI, 3.4-4.9 BW; P < .001) and control (MD, 2.83 BW; 95% CI, 1.4-4.3 BW; P < .001) limbs was also found. CONCLUSION Lower PFJ contact forces and a combination of quadriceps force deficits and smaller knee flexion angle were found in the ACLR compared with the contralateral and control limbs even after clearance to RTS. CLINICAL RELEVANCE Despite rehabilitation and subsequent clearance to RTS, differences in PFJ contact forces are present after ACLR. Current rehabilitation and RTS battery may not be effective and sensitive enough to identify and address these differences.
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Affiliation(s)
- Argell J San Jose
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Melbourne, Victoria, Australia
- OrthoSport Victoria Institute (OSVi), Richmond, Victoria, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Melbourne, Victoria, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Rodney Whiteley
- Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- School of Human Movement & Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Melbourne, Victoria, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Melbourne, Victoria, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Roula Kotsifaki
- Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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12
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Kayll SA, Hinman RS, Bryant AL, Bennell KL, Rowe PL, Paterson KL. Do biomechanical foot-based interventions reduce patellofemoral joint loads in adults with and without patellofemoral pain or osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2023:bjsports-2022-106542. [PMID: 36898768 DOI: 10.1136/bjsports-2022-106542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To evaluate the effects of biomechanical foot-based interventions (eg, footwear, insoles, taping and bracing on the foot) on patellofemoral loads during walking, running or walking and running combined in adults with and without patellofemoral pain or osteoarthritis. DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, CINAHL, SPORTdiscus, Embase and CENTRAL. ELIGIBILITY CRITERIA FOR SELECTING STUDIES English-language studies that assessed effects of biomechanical foot-based interventions on peak patellofemoral joint loads, quantified by patellofemoral joint pressure, reaction force or knee flexion moment during gait, in people with or without patellofemoral pain or osteoarthritis. RESULTS We identified 22 footwear and 11 insole studies (participant n=578). Pooled analyses indicated low-certainty evidence that minimalist footwear leads to a small reduction in peak patellofemoral joint loads compared with conventional footwear during running only (standardised mean difference (SMD) (95% CI) = -0.40 (-0.68 to -0.11)). Low-certainty evidence indicated that medial support insoles do not alter patellofemoral joint loads during walking (SMD (95% CI) = -0.08 (-0.42 to 0.27)) or running (SMD (95% CI) = 0.11 (-0.17 to 0.39)). Very low-certainty evidence indicated rocker-soled shoes have no effect on patellofemoral joint loads during walking and running combined (SMD (95% CI) = 0.37) (-0.06 to 0.79)). CONCLUSION Minimalist footwear may reduce peak patellofemoral joint loads slightly compared with conventional footwear during running only. Medial support insoles may not alter patellofemoral joint loads during walking or running and the evidence is very uncertain about the effect of rocker-soled shoes during walking and running combined. Clinicians aiming to reduce patellofemoral joint loads during running in people with patellofemoral pain or osteoarthritis may consider minimalist footwear.
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Affiliation(s)
- Samual A Kayll
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adam L Bryant
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick L Rowe
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kade L Paterson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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13
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De Oliveira Silva D, Johnston RTR, Mentiplay BF, Haberfield MJ, Culvenor AG, Bruder AM, Semciw AI, Girdwood M, Pappalardo PJ, Briggs C, West TJ, Hill JP, Patterson BE, Barton CJ, Sritharan P, Alexander JL, Carey DL, Schache AG, Souza RB, Pedoia V, Oei EH, Warden SJ, Telles GF, King MG, Hedger MP, Hulett M, Crossley KM. Trajectory of knee health in runners with and without heightened osteoarthritis risk: the TRAIL prospective cohort study protocol. BMJ Open 2023; 13:e068040. [PMID: 36759025 PMCID: PMC9923264 DOI: 10.1136/bmjopen-2022-068040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Running is one of the most popular recreational activities worldwide, due to its low cost and accessibility. However, little is known about the impact of running on knee joint health in runners with and without a history of knee surgery. The primary aim of this longitudinal cohort study is to compare knee joint structural features on MRI and knee symptoms at baseline and 4-year follow-up in runners with and without a history of knee surgery. Secondary aims are to explore the relationships between training load exposures (volume and/or intensity) and changes in knee joint structure and symptoms over 4 years; explore the relationship between baseline running biomechanics, and changes in knee joint structure and symptoms over 4 years. In addition, we will explore whether additional variables confound, modify or mediate these associations, including sex, baseline lower-limb functional performance, knee muscle strength, psychological and sociodemographic factors. METHODS AND ANALYSIS A convenience sample of at least 200 runners (sex/gender balanced) with (n=100) and without (n=100) a history of knee surgery will be recruited. Primary outcomes will be knee joint health (MRI) and knee symptoms (baseline; 4 years). Exposure variables for secondary outcomes include training load exposure, obtained daily throughout the study from wearable devices and three-dimensional running biomechanics (baseline). Additional variables include lower limb functional performance, knee extensor and flexor muscle strength, biomarkers, psychological and sociodemographic factors (baseline). Knowledge and beliefs about osteoarthritis will be obtained through predefined questions and semi-structured interviews with a subset of participants. Multivariable logistic and linear regression models, adjusting for potential confounding factors, will explore changes in knee joint structural features and symptoms, and the influence of potential modifiers and mediators. ETHICS AND DISSEMINATION Approved by the La Trobe University Ethics Committee (HEC-19524). Findings will be disseminated to stakeholders, peer-review journals and conferences.
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Affiliation(s)
- Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Richard T R Johnston
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Melissa J Haberfield
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Andrea M Bruder
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Michael Girdwood
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Paula J Pappalardo
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Connie Briggs
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Thomas J West
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Joshua P Hill
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Prasanna Sritharan
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - James L Alexander
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - David L Carey
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Richard B Souza
- Department of Radiology and Biomedical Imagining, University of California San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imagining, University of California San Francisco, San Francisco, California, USA
| | - Edwin H Oei
- Department of Radiology & Nuclear Medicine, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University, Indianapolis, Indiana, USA
| | - Gustavo F Telles
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Michael P Hedger
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Mark Hulett
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
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14
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Coburn SL, Crossley KM, Kemp JL, Warden SJ, West TJ, Bruder AM, Mentiplay BF, Culvenor AG. Is running good or bad for your knees? A systematic review and meta-analysis of cartilage morphology and composition changes in the tibiofemoral and patellofemoral joints. Osteoarthritis Cartilage 2023; 31:144-157. [PMID: 36402349 DOI: 10.1016/j.joca.2022.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The general health benefits of running are well-established, yet concern exists regarding the development and progression of osteoarthritis. AIM To systematically review the immediate (within 20 min) and delayed (20 min-48 h) effect of running on hip and knee cartilage, as assessed using magnetic resonance imaging (MRI). METHOD Studies using MRI to measure change in hip or knee cartilage within 48 h pre- and post-running were identified. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Percentage change in cartilage outcomes were estimated using random-effects meta-analysis. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS Twenty-four studies were included, evaluating 446 knees only. One third of studies were low risk of bias. Knee cartilage thickness and volume decreased immediately after running, with declines ranging from 3.3% (95% confidence interval [CI]: 2.6%, 4.1%) for weight-bearing femoral cartilage volume to 4.9% (95% CI: 4.43.6%, 6.2%) for patellar cartilage volume. T1ρ and T2 relaxation times were also reduced immediately after running, with the largest decline being 13.1% (95% CI: -14.4%, -11.7%) in femoral trochlear cartilage. Tibiofemoral cartilage T2 relaxation times recovered to baseline levels within 91 min. Existing cartilage defects were unchanged within 48 h post-run. CONCLUSIONS There is very low certainty evidence that running immediately decreases the thickness, volume, and relaxation times of patellofemoral and tibiofemoral cartilage. Hip cartilage changes are unknown, but knee changes are small and appear transient suggesting that a single bout of running is not detrimental to knee cartilage.
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Affiliation(s)
- S L Coburn
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - K M Crossley
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - J L Kemp
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - S J Warden
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia; Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN, USA.
| | - T J West
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - A M Bruder
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - B F Mentiplay
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - A G Culvenor
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
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15
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Bazett-Jones DM, Neal BS, Legg C, Hart HF, Collins NJ, Barton CJ. Kinematic and Kinetic Gait Characteristics in People with Patellofemoral Pain: A Systematic Review and Meta-analysis. Sports Med 2023; 53:519-547. [PMID: 36334239 DOI: 10.1007/s40279-022-01781-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent knee condition with many proposed biomechanically orientated etiological factors and treatments. OBJECTIVE We aimed to systematically review and synthesize the evidence for biomechanical variables (spatiotemporal, kinematic, kinetic) during walking and running in people with PFP compared with pain-free controls, and determine if biomechanical variables contribute to the development of PFP. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched Medline, CINAHL, SPORTDiscus, Embase, and Web of Science from inception to October 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All study designs (prospective, case-control [± interventional component, provided pre-intervention data were reported for both groups], cross-sectional) comparing spatiotemporal, kinematic, and/or kinetic variables during walking and/or running between people with and without PFP. RESULTS We identified 55 studies involving 1300 people with PFP and 1393 pain-free controls. Overall pooled analysis identified that people with PFP had slower gait velocity [moderate evidence, standardized mean difference (SMD) - 0.50, 95% confidence interval (CI) - 0.72, - 0.27], lower cadence (limited evidence, SMD - 0.43, 95% CI - 0.74, - 0.12), and shorter stride length (limited evidence, SMD - 0.46, 95% CI - 0.80, - 0.12). People with PFP also had greater peak contralateral pelvic drop (moderate evidence, SMD - 0.46, 95% CI - 0.90, - 0.03), smaller peak knee flexion angles (moderate evidence, SMD - 0.30, 95% CI - 0.52, - 0.08), and smaller peak knee extension moments (limited evidence, SMD - 0.41, 95% CI - 0.75, - 0.07) compared with controls. Females with PFP had greater peak hip flexion (moderate evidence, SMD 0.83, 95% CI 0.30, 1.36) and rearfoot eversion (limited evidence, SMD 0.59, 95% CI 0.03, 1.14) angles compared to pain-free females. No significant between-group differences were identified for all other biomechanical variables. Data pooling was not possible for prospective studies. CONCLUSION A limited number of biomechanical differences exist when comparing people with and without PFP, mostly characterized by small-to-moderate effect sizes. People with PFP ambulate slower, with lower cadence and a shortened stride length, greater contralateral pelvic drop, and lower knee flexion angles and knee extension moments. It is unclear whether these features are present prior to PFP onset or occur as pain-compensatory movement strategies given the lack of prospective data. TRIAL REGISTRATION PROSPERO # CRD42019080241.
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Affiliation(s)
- David M Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, The University of Toledo, Toledo, OH, USA.
| | - Bradley S Neal
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, Essex, UK.,Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Christopher Legg
- Physiotherapy Department, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Harvi F Hart
- School of Physical Therapy and Bone and Joint Institute, Western University, London, ON, Canada
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, VIC, Australia.,Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
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16
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Kayll SA, Hinman RS, Bennell KL, Bryant AL, Rowe PL, Paterson KL. The effect of biomechanical foot-based interventions on patellofemoral joint loads during gait in adults with and without patellofemoral pain or osteoarthritis: a systematic review protocol. J Foot Ankle Res 2022; 15:91. [PMID: 36514101 PMCID: PMC9746129 DOI: 10.1186/s13047-022-00596-7] [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: 09/12/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patellofemoral pain is highly prevalent across the lifespan, and a significant proportion of people report unfavourable outcomes years after diagnosis. Previous research has implicated patellofemoral joint loading during gait in patellofemoral pain and its sequelae, patellofemoral osteoarthritis. Biomechanical foot-based interventions (e.g., footwear, insoles, orthotics, taping or bracing) can alter patellofemoral joint loads by reducing motions at the foot that increase compression between the patella and underlying femur via coupling mechanisms, making them a promising treatment option. This systematic review will summarise the evidence about the effect of biomechanical foot-based interventions on patellofemoral joint loads during gait in adults with and without patellofemoral pain and osteoarthritis. METHODS MEDLINE (Ovid), the Cumulative Index to Nursing and Allied Health Literature CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), SPORTdiscus (EBSCO) and Embase (Ovid) will be searched. Our search strategy will include terms related to 'patellofemoral joint', 'loads' and 'biomechanical foot-based interventions'. We will include studies published in the English language that assess the effect of biomechanical foot-based interventions on patellofemoral joint loads, quantified by patellofemoral joint pressure, patellofemoral joint reaction force and/or knee flexion moment. Two reviewers will independently screen titles and abstracts, complete full-text reviews, and extract data from included studies. Two reviewers will assess study quality using the Revised Cochrane Risk of Bias (RoB 2) tool or the Cochrane Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tool. We will provide a synthesis of the included studies' characteristics and results. If three or more studies are sufficiently similar in population and intervention, we will pool the data to conduct a meta-analysis and report findings as standardised mean differences with 95% confidence intervals. If a meta-analysis cannot be performed, we will conduct a narrative synthesis of the results and produce forest plots for individual studies. DISCUSSION This protocol outlines the methods of a systematic review that will determine the effect of biomechanical foot-based interventions on patellofemoral joint loads. Our findings will inform clinical practice by identifying biomechanical foot-based interventions that reduce or increase patellofemoral joint loads, which may aid the treatment of adults with patellofemoral pain and osteoarthritis. TRIAL REGISTRATION Registered with PROSPERO on the 4th of May 2022 (CRD42022315207).
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Affiliation(s)
- Samual A. Kayll
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 3010, Level 7, Alan Gilbert Building, 161 Barry Street, Parkville, Australia
| | - Rana S. Hinman
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 3010, Level 7, Alan Gilbert Building, 161 Barry Street, Parkville, Australia
| | - Kim L. Bennell
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 3010, Level 7, Alan Gilbert Building, 161 Barry Street, Parkville, Australia
| | - Adam L. Bryant
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 3010, Level 7, Alan Gilbert Building, 161 Barry Street, Parkville, Australia
| | - Patrick L. Rowe
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 3010, Level 7, Alan Gilbert Building, 161 Barry Street, Parkville, Australia
| | - Kade L. Paterson
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 3010, Level 7, Alan Gilbert Building, 161 Barry Street, Parkville, Australia
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