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Oehme S, Moewis P, Boeth H, Bartek B, von Tycowicz C, Ehrig R, Duda GN, Jung T. Altered knee kinematics after posterior cruciate ligament single-bundle reconstruction-a comprehensive prospective biomechanical in vivo analysis. Front Bioeng Biotechnol 2024; 12:1322136. [PMID: 38352697 PMCID: PMC10863728 DOI: 10.3389/fbioe.2024.1322136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Purpose: Passive tibiofemoral anterior-posterior (AP) laxity has been extensively investigated after posterior cruciate ligament (PCL) single-bundle reconstruction. However, the PCL also plays an important role in providing rotational stability in the knee. Little is known in relation to the effects of PCL single-bundle reconstruction on passive tibiofemoral rotational laxity. Gait biomechanics after PCL reconstruction are even less understood. The aim of this study was a comprehensive prospective biomechanical in vivo analysis of the effect of PCL single-bundle reconstruction on passive tibiofemoral rotational laxity, passive anterior-posterior laxity, and gait pattern. Methods: Eight patients undergoing PCL single-bundle reconstruction (seven male, one female, mean age 35.6 ± 6.6 years, BMI 28.0 ± 3.6 kg/m2) were analyzed preoperatively and 6 months postoperatively. Three of the eight patients received additional posterolateral corner (PLC) reconstruction. Conventional stress radiography was used to evaluate passive translational tibiofemoral laxity. A previously established rotometer device with a C-arm fluoroscope was used to assess passive tibiofemoral rotational laxity. Functional gait analysis was used to examine knee kinematics during level walking. Results: The mean side-to-side difference (SSD) in passive posterior translation was significantly reduced postoperatively (12.1 ± 4.4 mm vs. 4.3 ± 1.8 mm; p < 0.01). A significant reduction in passive tibiofemoral rotational laxity at 90° knee flexion was observed postoperatively (27.8° ± 7.0° vs. 19.9° ± 7.5°; p = 0.02). The range of AP tibiofemoral motion during level walking was significantly reduced in the reconstructed knees when compared to the contralateral knees at 6-month follow-up (16.6 ± 2.4 mm vs. 13.5 ± 1.6 mm; p < 0.01). Conclusion: PCL single-bundle reconstruction with optional PLC reconstruction reduces increased passive tibiofemoral translational and rotational laxity in PCL insufficient knees. However, increased passive tibiofemoral translational laxity could not be fully restored and patients showed altered knee kinematics with a significantly reduced range of tibiofemoral AP translation during level walking at 6-month follow-up. The findings of this study indicate a remaining lack of restoration of biomechanics after PCL single-bundle reconstruction in the active and passive state, which could be a possible cause for joint degeneration after PCL single-bundle reconstruction.
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Affiliation(s)
- Stephan Oehme
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Philippe Moewis
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute Berlin, Berlin, Germany
| | - Heide Boeth
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute Berlin, Berlin, Germany
| | - Benjamin Bartek
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | - Rainald Ehrig
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute Berlin, Berlin, Germany
- Zuse Institute Berlin, Berlin, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute Berlin, Berlin, Germany
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Febrer-Nafría M, Dreyer MJ, Maas A, Taylor WR, Smith CR, Hosseini Nasab SH. Knee kinematics are primarily determined by implant alignment but knee kinetics are mainly influenced by muscle coordination strategy. J Biomech 2023; 161:111851. [PMID: 37907050 DOI: 10.1016/j.jbiomech.2023.111851] [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: 02/10/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023]
Abstract
Implant malalignment has been reported to be a primary reason for revision total knee arthroplasty (TKA). In addition, altered muscle coordination patterns are commonly observed in TKA patients, which is thought to alter knee contact loads. A comprehensive understanding of the influence of surgical implantation and muscle recruitment strategies on joint contact mechanics is crucial to improve surgical techniques, increase implant longevity, and inform rehabilitation protocols. In this study, a detailed musculoskeletal model with a 12 degrees of freedom knee was developed to represent a TKA subject from the CAMS-Knee datasets. Using motion capture and ground reaction force data, a level walking cycle was simulated and the joint movement and loading patterns were estimated using a novel technique for concurrent optimization of muscle activations and joint kinematics. In addition, over 12'000 Monte Carlo simulations were performed to predict knee contact mechanics during walking, considering numerous combinations of implant alignment and muscle activation scenarios. Validation of our baseline simulation showed good agreement between the model kinematics and loading patterns against the in vivo data. Our analyses reveal a considerable impact of implant alignment on the joint kinematics, while variation in muscle activation strategies mainly affects knee contact loading. Moreover, our results indicate that high knee compressive forces do not necessarily originate from extreme kinematics and vice versa. This study provides an improved understanding of the complex inter-relationships between loading and movement patterns resulting from different surgical implantation and muscle coordination strategies and presents a validated framework towards population-based modelling in TKA.
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Affiliation(s)
- Míriam Febrer-Nafría
- Institute for Biomechanics, ETH Zürich, Switzerland; Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Spain
| | - Michael J Dreyer
- Institute for Biomechanics, ETH Zürich, Switzerland; Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - Allan Maas
- Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany; Research and Development, Aesculap AG, Tuttlingen, Germany
| | | | - Colin R Smith
- Institute for Biomechanics, ETH Zürich, Switzerland; Steadman Philippon Research Institute, Vail, USA
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Ortigas Vásquez A, Taylor WR, Maas A, Woiczinski M, Grupp TM, Sauer A. A frame orientation optimisation method for consistent interpretation of kinematic signals. Sci Rep 2023; 13:9632. [PMID: 37316703 DOI: 10.1038/s41598-023-36625-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Abstract
In clinical movement biomechanics, kinematic data are often depicted as waveforms (i.e. signals), characterising the motion of articulating joints. Clinically meaningful interpretations of the underlying joint kinematics, however, require an objective understanding of whether two different kinematic signals actually represent two different underlying physical movement patterns of the joint or not. Previously, the accuracy of IMU-based knee joint angles was assessed using a six-degrees-of-freedom joint simulator guided by fluoroscopy-based signals. Despite implementation of sensor-to-segment corrections, observed errors were clearly indicative of cross-talk, and thus inconsistent reference frame orientations. Here, we address these limitations by exploring how minimisation of dedicated cost functions can harmonise differences in frame orientations, ultimately facilitating consistent interpretation of articulating joint kinematic signals. In this study, we present and investigate a frame orientation optimisation method (FOOM) that aligns reference frames and corrects for cross-talk errors, hence yielding a consistent interpretation of the underlying movement patterns. By executing optimised rotational sequences, thus producing angular corrections around each axis, we enable a reproducible frame definition and hence an approach for reliable comparison of kinematic data. Using this approach, root-mean-square errors between the previously collected (1) IMU-based data using functional joint axes, and (2) simulated fluoroscopy-based data relying on geometrical axes were almost entirely eliminated from an initial range of 0.7°-5.1° to a mere 0.1°-0.8°. Our results confirm that different local segment frames can yield different kinematic patterns, despite following the same rotation convention, and that appropriate alignment of reference frame orientation can successfully enable consistent kinematic interpretation.
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Affiliation(s)
- Ariana Ortigas Vásquez
- Research and Development, Aesculap AG, Tuttlingen, Germany.
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Ludwig Maximilians University Munich, Munich, Germany.
| | - William R Taylor
- Laboratory for Movement Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Allan Maas
- Research and Development, Aesculap AG, Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Ludwig Maximilians University Munich, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Ludwig Maximilians University Munich, Munich, Germany
| | - Thomas M Grupp
- Research and Development, Aesculap AG, Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Ludwig Maximilians University Munich, Munich, Germany
| | - Adrian Sauer
- Research and Development, Aesculap AG, Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Ludwig Maximilians University Munich, Munich, Germany
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Zee M, Keizer M, van Raaij J, Hijmans J, van den Akker-Scheek I, Diercks R. High-demand tasks show that ACL reconstruction is not the only factor in controlling range of tibial rotation: a preliminary investigation. J Orthop Surg Res 2023; 18:194. [PMID: 36915116 PMCID: PMC10009984 DOI: 10.1186/s13018-023-03639-2] [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: 10/27/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Excessive range of tibial rotation (rTR) may be a reason why athletes cannot return to sports after ACL reconstruction (ACLR). After ACLR, rTR is smaller in reconstructed knees compared to contralateral knees when measured during low-to-moderate-demand tasks. This may not be representative of the amount of rotational laxity during sports activities. The purpose of this study is to determine whether rTR is increased after ACL injury compared to the contralateral knee and whether it returns to normal after ACLR when assessed during high-demand hoptests, with the contralateral knee as a reference. METHODS Ten ACL injured subjects were tested within three months after injury and one year after reconstruction. Kinematic motion analysis was conducted, analysing both knees. Subjects performed a level-walking task, a single-leg hop for distance and a side jump. A paired t-test was used to detect a difference between mean kinematic variables before and after ACL reconstruction, and between the ACL-affected knees and contralateral knees before and after reconstruction. RESULTS RTR was greater during high-demand tasks compared to low-demand tasks. Pre-operative, rTR was smaller in the ACL-deficient knees compared to the contralateral knees during all tests. After ACLR, a greater rTR was seen in ACL-reconstructed knees compared to pre-operative, but a smaller rTR compared to the contralateral knees, even during high-demand tasks. CONCLUSION The smaller rTR, compared to the contralateral knee, seen after a subacute ACL tear may be attributed to altered landing technique, neuromuscular adaptation and fear of re-injury. The continued reduction in rTR one year after ACLR may be a combination of this neuromuscular adaptation and the biomechanical impact of the reconstruction. TRIAL REGISTRATION The trial was registered in the Dutch Trial Register (NTR: www.trialregister.nl , registration ID NL7686).
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Affiliation(s)
- Mark Zee
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands.
| | - Michele Keizer
- Department of Human Movement Science, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands
| | - Jos van Raaij
- Department of Orthopaedic Surgery, Martini Hospital, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - Juha Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands
| | - Ron Diercks
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands
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Chastain K, Wach A, Pekmezian A, Wimmer MA, Warren RF, Torzilli PA, Chen T, Maher SA. ACL transection results in a posterior shift and increased velocity of contact on the medial tibial plateau. J Biomech 2022; 144:111335. [DOI: 10.1016/j.jbiomech.2022.111335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 10/31/2022]
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PCL insufficient patients with increased translational and rotational passive knee joint laxity have no increased range of anterior-posterior and rotational tibiofemoral motion during level walking. Sci Rep 2022; 12:13232. [PMID: 35918487 PMCID: PMC9345965 DOI: 10.1038/s41598-022-17328-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Passive translational tibiofemoral laxity has been extensively examined in posterior cruciate ligament (PCL) insufficient patients and belongs to the standard clinical assessment. However, objective measurements of passive rotational knee laxity, as well as range of tibiofemoral motion during active movements, are both not well understood. None of these are currently quantified in clinical evaluations of patients with PCL insufficiency. The objective of this study was to quantify passive translational and rotational knee laxity as well as range of anterior–posterior and rotational tibiofemoral motion during level walking in a PCL insufficient patient cohort as a basis for any later clinical evaluation and therapy. The laxity of 9 patient knees with isolated PCL insufficiency or additionally posterolateral corner (PLC) insufficiency (8 males, 1 female, age 36.78 ± 7.46 years) were analysed and compared to the contralateral (CL) knees. A rotometer device with a C-arm fluoroscope was used to assess the passive tibiofemoral rotational laxity while stress radiography was used to evaluate passive translational tibiofemoral laxity. Functional gait analysis was used to examine the range of anterior–posterior and rotational tibiofemoral motion during level walking. Passive translational laxity was significantly increased in PCL insufficient knees in comparison to the CL sides (15.5 ± 5.9 mm vs. 3.7 ± 1.9 mm, p < 0.01). Also, passive rotational laxity was significantly higher compared to the CL knees (26.1 ± 8.2° vs. 20.6 ± 5.6° at 90° knee flexion, p < 0.01; 19.0 ± 6.9° vs. 15.5 ± 5.9° at 60° knee flexion, p = 0.04). No significant differences were observed for the rotational (16.3 ± 3.7° vs. 15.2 ± 3.6°, p = 0.43) and translational (17.0 ± 5.4 mm vs. 16.1 ± 2.8 mm, p = 0.55) range of anterior–posterior and rotational tibiofemoral motion during level walking conditions for PCL insufficient knees compared to CL knees respectively. The present study illustrates that patients with PCL insufficiency show a substantial increased passive tibiofemoral laxity, not only in tibiofemoral translation but also in tibiofemoral rotation. Our data indicate that this increased passive multiplanar knee joint laxity can be widely compensated during level walking. Further studies should investigate progressive changes in knee joint laxity and kinematics post PCL injury and reconstruction to judge the individual need for therapy and effects of physiotherapy such as quadriceps force training on gait patterns in PCL insufficient patients.
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van der Graaff SJA, Meuffels DE, Bierma-Zeinstra SMA, van Es EM, Verhaar JAN, Eggerding V, Reijman M. Why, When, and in Which Patients Nonoperative Treatment of Anterior Cruciate Ligament Injury Fails: An Exploratory Analysis of the COMPARE Trial. Am J Sports Med 2022; 50:645-651. [PMID: 35048733 DOI: 10.1177/03635465211068532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal treatment strategy for patients with an anterior cruciate ligament (ACL) rupture is still under debate. Different determinants of the need for a reconstruction have not been thoroughly investigated before. PURPOSE To investigate why, when, and which patients with an ACL rupture who initially started with rehabilitation therapy required reconstructive surgery. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS In the Conservative versus Operative Methods for Patients with ACL Rupture Evaluation (COMPARE) trial, 167 patients with an ACL rupture were randomized to early ACL reconstruction or rehabilitation therapy plus optional delayed ACL reconstruction. We conducted an exploratory analysis of a subgroup of 82 patients from this trial who were randomized to rehabilitation therapy plus optional delayed ACL reconstruction. The reasons for surgery were registered for the patients who underwent a delayed ACL reconstruction. For these patients, we used the International Knee Documentation Committee (IKDC) subjective knee form, Numeric Rating Scale for pain, and instability question from the Lysholm questionnaire before surgery. To determine between-group differences between the nonoperative treatment and delayed ACL reconstruction group, IKDC and pain scores during follow-up were determined using mixed models and adjusted for sex, age, and body mass index. RESULTS During the 2-year follow-up of the trial, 41 of the 82 patients received a delayed ACL reconstruction after a median time of 6.4 months after inclusion (interquartile range, 3.9-10.3 months). Most reconstructions occurred between 3 and 6 months after inclusion (n = 17; 41.5%). Ninety percent of the patients (n = 37) reported knee instability concerns as a reason for surgery at the moment of planning surgery. Of these patients, 18 had an IKDC score ≤60, 29 had a pain score of ≥3, and 33 patients had knee instability concerns according to the Lysholm questionnaire before surgery. During follow-up, IKDC scores were lower and pain scores were higher in the delayed reconstruction group compared with the nonoperative treatment group. Patients in the delayed reconstruction group had a significantly younger age (27.4 vs 35.3 years; P = .001) and higher preinjury activity level compared with patients in the nonoperative treatment group. CONCLUSION Patients who experienced instability concerns, had pain during activity, and had a low perception of their knee function had unsuccessful nonoperative treatment. Most patients received a delayed ACL reconstruction after 3 to 6 months of rehabilitation therapy. At baseline, patients who required reconstructive surgery had a younger age and higher preinjury activity level compared with patients who did not undergo reconstruction.
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Affiliation(s)
- Sabine J A van der Graaff
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Eline M van Es
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent Eggerding
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Rao L, Taylor WR, Horn N, List R, Preiss S, Schütz P. Can tibio-femoral kinematic and kinetic parameters reveal poor functionality and underlying deficits after total knee replacement? A systematic review. Knee 2022; 34:62-75. [PMID: 34883331 DOI: 10.1016/j.knee.2021.11.002] [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: 02/15/2021] [Revised: 09/13/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extensive efforts have been made to understand joint kinematics and kinetics in total knee arthroplasty (TKA) in subjects with satisfactory outcomes during daily functional activities and clinical tests, but it remains unclear whether such movement characteristics hold the potential to indicate the underlying aetiology of unsatisfactory or bad TKA outcomes. PURPOSE To investigate which kinematic and kinetic parameters assessed during passive clinical tests and functional activities of daily living are associated with poor functionality and underlying deficits after total knee replacement. METHODS We focused on studies characterizing the kinematic or kinetic parameters of the knee joint that are associated with poor clinical outcome after TKA. Seventeen articles were included for the review, and kinematic and kinetic data from 719 patients with minimal follow up of 6 months were extracted and analyzed. RESULTS Passive posterior translation at 90°flexionexhibited good potential for differentiating stable and unstable TKAs. Anterior-posterior (A-P) translation of the medial condyle at 0-30° and 30-60° flexion, A-P translation of the lateral condyle at 60-90°during closed chain exercises, as well asknee extension moment during stair ascent and descent, knee abduction moment during stair descent, knee internal rotation moment and plantar flexion moment during walking, 2ndpeak ground reaction force during stair ascent and walkingshowed the greatest promise as functional biomarkers for a dissatisfied/poor outcome knee after TKA. CONCLUSION In this study, we systematically reviewed the state-of-the-art knowledge of kinematics and kinetics associated with functional deficits, and found 11 biomechanical parameters that showed promise for supportingdecision making in TKA.
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Affiliation(s)
- L Rao
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - W R Taylor
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland.
| | - N Horn
- Schulthess Clinic, Zürich, Switzerland
| | - R List
- Schulthess Clinic, Zürich, Switzerland
| | - S Preiss
- Schulthess Clinic, Zürich, Switzerland
| | - P Schütz
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
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Ayala S, Delco ML, Fortier LA, Cohen I, Bonassar LJ. Cartilage articulation exacerbates chondrocyte damage and death after impact injury. J Orthop Res 2021; 39:2130-2140. [PMID: 33274781 PMCID: PMC8175450 DOI: 10.1002/jor.24936] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/21/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
Posttraumatic osteoarthritis (PTOA) is typically initiated by momentary supraphysiologic shear and compressive forces delivered to articular cartilage during acute joint injury and develops through subsequent degradation of cartilage matrix components and tissue remodeling. PTOA affects 12% of the population who experience osteoarthritis and is attributed to over $3 billion dollars annually in healthcare costs. It is currently unknown whether articulation of the joint post-injury helps tissue healing or exacerbates cellular dysfunction and eventual death. We hypothesize that post-injury cartilage articulation will lead to increased cartilage damage. Our objective was to test this hypothesis by mimicking the mechanical environment of the joint during and post-injury and determining if subsequent joint articulation exacerbates damage produced by initial injury. We use a model of PTOA that combines impact injury and repetitive sliding with confocal microscopy to quantify and track chondrocyte viability, apoptosis, and mitochondrial depolarization in a depth-dependent manner. Cartilage explants were harvested from neonatal bovine knee joints and subjected to either rapid impact injury (17.34 ± 0.99 MPa, 21.6 ± 2.45 GPa/s), sliding (60 min at 1 mm/s, under 15% axial compression), or rapid impact injury followed by sliding. Explants were then bisected and fluorescently stained for cell viability, caspase activity (apoptosis), and mitochondria polarization. Results show that compared to either impact or sliding alone, explants that were both impacted and slid experienced higher magnitudes of damage spanning greater tissue depths.
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Affiliation(s)
- Steven Ayala
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY
| | - Michelle L. Delco
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Lisa A. Fortier
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Itai Cohen
- Department of Physics, Cornell University, Ithaca, NY
| | - Lawrence J. Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY,Address Correspondence to: Lawrence J. Bonassar, PhD., Professor, Department of Biomedical Engineering, 149 Weill Hall, Cornell University, Ithaca, NY 14853, (607) 255-9381,
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Zee MJM, Keizer MNJ, Dijkerman L, van Raaij JJAM, Hijmans JM, Diercks RL. The correlation between posterior tibial slope and dynamic anterior tibial translation and dynamic range of tibial rotation. J Exp Orthop 2021; 8:71. [PMID: 34476648 PMCID: PMC8413430 DOI: 10.1186/s40634-021-00389-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The amount of passive anterior tibial translation (ATT) is known to be correlated to the amount of posterior tibial slope (PTS) in both anterior cruciate ligament-deficient and reconstructed knees. Slope-altering osteotomies are advised when graft failure after anterior cruciate ligament (ACL) reconstruction occurs in the presence of high PTS. This recommendation is based on studies neglecting the influence of muscle activation. On the other hand, if dynamic range of tibial rotation (rTR) is related to the amount of PTS, a “simple” anterior closing-wedge osteotomy might not be sufficient to control for tibial rotation. The purpose of this study was to evaluate the correlation between the amount of PTS and dynamic ATT and tibial rotation during high demanding activities, both before and after ACL reconstruction. We hypothesized that both ATT and rTR are strongly correlated to the amount of PTS. Methods Ten subjects were studied both within three months after ACL injury and one year after ACL reconstruction. Dynamic ATT and dynamic rTR were measured using a motion-capture system during level walking, during a single-leg hop for distance and during a side jump. Both medial and lateral PTS were measured on MRI. A difference between medial and lateral PTS was calculated and referred to as Δ PTS. Spearman’s correlation coefficients were calculated for the correlation between medial PTS, lateral PTS and Δ PTS and ATT and between medial PTS, lateral PTS and Δ PTS and rTR. Results Little (if any) to weak correlations were found between medial, lateral and Δ PTS and dynamic ATT both before and after ACL reconstruction. On the other hand, a moderate-to-strong correlation was found between medial PTS, lateral PTS and Δ PTS and dynamic rTR one year after ACL reconstruction. Conclusion During high-demand tasks, dynamic ATT is not correlated to PTS. A compensation mechanism may be responsible for the difference between passive and dynamic ATT in terms of the correlation to PTS. A moderate-to-strong correlation between amount of PTS and rTR indicates that such a compensation mechanism may fall short in correcting for rTR. These findings warrant prudence in the use of a pure anterior closing wedge osteotomy in ACL reconstruction. Trial registration Netherlands Trial Register, Trial 7686. Registered 16 April 2016—Retrospectively registered. Level of evidence Level 2, prospective cohort study
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Affiliation(s)
- M J M Zee
- Department of Orthopaedic Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RM, Groningen, The Netherlands.
| | - M N J Keizer
- Department of Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Dijkerman
- Department of Orthopaedic Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RM, Groningen, The Netherlands
| | - J J A M van Raaij
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - J M Hijmans
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - R L Diercks
- Department of Orthopaedic Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RM, Groningen, The Netherlands
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Wang W, Tsai T, Tian F, Li J, Zhao Y, Zhu R, Li J, Liu Y, Wang S. High-speed fluoroscopic imaging for investigation of three-dimensional knee kinematics before and after marathon running. Gait Posture 2021; 88:231-237. [PMID: 34119778 DOI: 10.1016/j.gaitpost.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/11/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee injuries often occur during or shortly after marathon running, and are linked to altered knee kinematics. RESEARCH QUESTION The kinematics of healthy knees during pre- and post-marathon running have not been examined with high-speed fluoroscopy. This study aimed to evaluate the effects of marathon running on knee kinematics during walking and running by using a combined high-speed fluoroscopy and MRI technique. METHODS Ten healthy runners underwent knee MRI within 24 h before marathon running to construct three-dimensional (3D) knee models. Knee kinematics during treadmill walking and running were evaluated using high-speed fluoroscopy (200hz) within 24 h before and as soon as possible (within 5 h) after marathon running. All pre- and post-marathon measurements were compared. RESULTS (1) For post-marathon walking, posterior femoral translation increased 1.4 mm at initial contact (p = 0.015); proximal-distal distance of tibia and femur decreased 0.7 mm and 0.8 mm at initial contact and after contact, respectively (p = 0.039, p = 0.046); and valgus femur rotation increased 1.2° after contact (p = 0.027). (2) For post-marathon running, proximal-distal distance decreased 0.7 mm and 1.0 mm at initial contact and after contact (p = 0.011, p = 0.003) respectively; knee flexion decreased 4.3° before contact (p = 0.007); knee flexion increased 1.8° and 2.6° at initial contact and after contact, respectively (p = 0.038, p = 0.011); external femoral rotation increased 1.2° and 1.8° at initial contact and after contact, respectively (p = 0.012, p = 0.037). Valgus femoral rotation after contact increased 2.3° (p = 0.001). SIGNIFICANCE Post-marathon changes in valgus and external femoral rotation, knee flexion, posterior femoral translation, and proximal-distal distance may increase the risk of knee injury. This study provides information to better understand the response of the knee to marathon running.
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Affiliation(s)
- Wenjin Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - TsungYuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Fei Tian
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China; Department of Rehabilitation Medicine, Heping Hospital Affiliated to Changzhi Medical College, Shanxi, 046000, China
| | - Jixin Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yaqi Zhao
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Renkun Zhu
- China Basketball College, Beijing Sport University, Beijing, 100048, China
| | - Junjie Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yu Liu
- 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.
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Zhang M, Li Y, Feng R, Wang Z, Wang W, Zheng N, Wang S, Yan F, Lu Y, Tsai TY, Wei H. Change in Susceptibility Values in Knee Cartilage After Marathon Running Measured Using Quantitative Susceptibility Mapping. J Magn Reson Imaging 2021; 54:1585-1593. [PMID: 34031930 DOI: 10.1002/jmri.27745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) has been used to study the magnetic susceptibility properties of collagen fibers in articular cartilage; however, it is unclear whether QSM is sensitive to changes due to degradation caused by long-distance running. It is clinically important to understand the link between long-distance running and microstructural changes in knee cartilage. PURPOSE To investigate the ability of QSM to assess microstructural changes within cartilage after repetitive loading. STUDY TYPE Prospective. POPULATION Thirteen recreational, male long-distance runners. FIELD STRENGTH/SEQUENCE Three-dimensional gradient recalled echo acquired at 3 T. ASSESSMENT Magnetic resonance imaging (MRI) and 3D kinematics (translations and rotations during treadmill walking and running) of the knee joint were collected before and after marathon running. The compartments for analysis included the patella, trochlea, and subregions of femoral and tibial cartilage. Changes in regional susceptibility and cartilage thickness were calculated after marathon running. A susceptibility profile was obtained by fitting susceptibility as a function of the normalized depth of cartilage from the superficial to deep layers. STATISTICAL TESTS Paired t-test or Wilcoxon signed-rank test, 95% confidence interval (CI) of the depth-wise susceptibility profile, Pearson correlation or Spearman correlation. RESULTS There was a statistically significant increase in susceptibility value in the weight-bearing region of central medial femoral cartilage (cMF-c) after marathon running (pre-marathon: -0.0219 ± 0.0151 ppm, post-marathon: -0.0070 ± 0.0213 ppm, P < 0.05), while the cartilage thickness did not show significant changes in any regions (P-value range: 0.068-0.963). Significant susceptibility elevations occurred in the middle and deep layers of cMF-c (95% CIs did not overlap). A trend toward a positive correlation was found between the changes in susceptibility value in cMF-c and proximal-distal translation of the knee joint during walking (r = 0.55, P = 0.101) and running (r = 0.57, P = 0.089). DATA CONCLUSION Localized magnetic susceptibility alterations were observed within knee cartilage in the weight-bearing area after repetitive loading without any morphologic changes. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ming Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yufei Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ruimin Feng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhongzheng Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjin Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shaobai Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Lu
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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13
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Keizer MNJ, Otten E, Beijersbergen CMI, Brouwer RW, Hijmans JM. Copers and Noncopers Use Different Landing Techniques to Limit Anterior Tibial Translation After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:2325967121998061. [PMID: 33948445 PMCID: PMC8053773 DOI: 10.1177/2325967121998061] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background: At 1 year after anterior cruciate ligament reconstruction (ACLR), two-thirds of patients manage to return to sports (copers), whereas one-third of patients do not return to sports (noncopers). Copers and noncopers have different muscle activation patterns, and noncopers may not be able to control dynamic anterior tibial translation (ATTd) as well as copers. Purpose/Hypothesis: To investigate whether (1) there is a positive correlation between passive ATT (ATTp; ie, general joint laxity) and ATTd during jump landing, (2) whether ATTd is moderated by muscle activating patterns, and (3) whether there is a difference in moderating ATTd between copers and noncopers. We hypothesized that patients who have undergone ACLR compensate for ATTd by developing muscle strategies that are more effective in copers compared with noncopers. Study Design: Controlled laboratory study. Methods: A total of 40 patients who underwent unilateral ACLR performed 10 single-leg hops for distance with both legs. Lower body kinematic and kinetic data were measured using a motion-capture system, and ATTd was determined with an embedded method. Muscle activity was measured using electromyographic signals. Bilateral ATTp was measured using a KT-1000 arthrometer. In addition, the Beighton score was obtained. Results: There was no significant correlation between ATTp and ATTd in copers; however, there was a positive correlation between ATTp and ATTd in the operated knee of noncopers. There was a positive correlation between the Beighton score and ATTp as well as between the Beighton score and ATTd in both copers and noncopers in the operated knee. Copers showed a negative correlation between ATTd and gastrocnemius activity in their operated leg during landing. Noncopers showed a positive correlation between ATTd and knee flexion moment in their operated knee during landing. Conclusion: Copers used increased gastrocnemius activity to reduce ATTd, whereas noncopers moderated ATTd by generating a smaller knee flexion moment. Clinical Relevance: This study showed that copers used different landing techniques than noncopers. Patients who returned to sports after ACLR had sufficient plantar flexor activation to limit ATTd.
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Affiliation(s)
- Michèle N J Keizer
- Center for Human Movement Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Egbert Otten
- Center for Human Movement Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Chantal M I Beijersbergen
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Reinoud W Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, the Netherlands
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14
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Zhong G, Zeng X, Xie Y, Lai J, Wu J, Xu H, Lin C, Li H, Cui C, Ma L, Li L, Huang W, Zhang Y. Prevalence and dynamic characteristics of generalized joint hypermobility in college students. Gait Posture 2021; 84:254-259. [PMID: 33383536 DOI: 10.1016/j.gaitpost.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/03/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Generalized joint hypermobility (GJH) is a common, but often ignored, condition characterized by general joint laxity, which is reported to increase one's risk of anterior cruciate ligament (ACL) injury and osteoarthritis. Nevertheless, it is not clearly learned in the prevalence and dynamic characteristics in college students. RESEARCH QUESTION Is the active motion stability in the six-degree-of-freedom (6DOF) kinematics of the knee joint of people with GJH poorer than that of others? METHODS This is a cross-sectional study. A population of 489 college students was recruited who was divided into two groups: a GJH group (Beighton score ≥ 4, n = 54) and a normal group (Beighton score < 4, n = 435). A paper questionnaire with questions about the participants' demographic characteristics and musculoskeletal disorder symptoms was collected. A three-dimensional gait analysis system was used to collect the participants' knee joint kinematic parameters during treadmill walking. Variables were evaluated using independent t-tests and Wilcoxon signed-rank tests. RESULTS The prevalence of GJH was found to be 11.0 % among college students. Participants with GJH exhibited a greater active range of motions in the anterior/posterior translation than the normal (P = 0.026). Participants with GJH exhibited greater flexion at the end of the terminal stance (P = 0.039) and greater anterior translation of the tibia during almost the whole gait period than the normal group (P<0.05) during the treadmill gait. A greater external angle was found in GJH group during the periods of middle stance (P = 0.008). SIGNIFICANCE GJH with a prevalence of 11.0 % among college students should be paid attention. Poor active motion stability in anterior/posterior translation may play an important role in the development of knee joint instability, potentially resulting in subsequent ACL deficiency and the development of knee osteoarthritis among people with GJH.
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Affiliation(s)
- Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China; Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Xiaolong Zeng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Yu Xie
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Junya Lai
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Junhan Wu
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Huan Xu
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Chaoying Lin
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Heng Li
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Can Cui
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Limin Ma
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Liping Li
- Shantou University Medical College, Shantou, 515041, Guangdong, China.
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
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15
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Keizer MNJ, Hijmans JM, Gokeler A, Otten E, Brouwer RW. Sagittal knee kinematics in relation with the posterior tibia slope during jump landing after an anterior cruciate ligament reconstruction. J Exp Orthop 2020; 7:69. [PMID: 32959098 PMCID: PMC7505908 DOI: 10.1186/s40634-020-00289-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose An increased posterior tibia plateau angle is associated with increased risk for anterior cruciate ligament injury and re-rupture after reconstruction. The aims of this study were to determine whether the tibia plateau angle correlates with dynamic anterior tibia translation (ATT) after an anterior cruciate ligament reconstruction and whether the tibia plateau angle correlates with aspects of knee kinematics and kinetics during jump landing. Methods Thirty-seven patients after anterior cruciate ligament reconstruction with autograft hamstring tendon were included. Knee flexion angle and knee extension moment during single leg hops for distance were determined using a motion capture system and the dynamic ATT with its embedded method. The medial and lateral posterior tibia plateau angle were measured using MRI. Moreover, passive ATT was measured using the KT-1000 arthrometer. Results A weak negative correlation was found between the maximal dynamic ATT and the medial tibia plateau angle (p = 0.028, r = − 0.36) and between the maximal knee flexion angle and the lateral tibia plateau angle (p = 0.025, r = − 0.37) during landing. Patients with a smaller lateral tibia plateau angle show larger maximal knee flexion angle during landing than the patients with larger lateral tibia plateau angle. Also, the lateral tibia plateau angle is associated the amount of with muscle activity. Conclusion The posterior medical tibia plateau angle is associated with dynamic ATT. The maximal knee flexion angle and muscle activity are associated with the posterior lateral tibia plateau angle. Level of evidence III
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Affiliation(s)
- Michèle N J Keizer
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, FA 23 - PO Box 219, Groningen, 9713, AV, The Netherlands.
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alli Gokeler
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, FA 23 - PO Box 219, Groningen, 9713, AV, The Netherlands.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg.,Department Exercise & Health, Exercise Science and Neuroscience, University of Paderborn, Paderborn, Germany
| | - Egbert Otten
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, FA 23 - PO Box 219, Groningen, 9713, AV, The Netherlands
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital Groningen, Groningen, The Netherlands
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16
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Keizer MNJ, Hijmans JM, Gokeler A, Benjaminse A, Otten E. Healthy subjects with lax knees use less knee flexion rather than muscle control to limit anterior tibia translation during landing. J Exp Orthop 2020; 7:32. [PMID: 32415565 PMCID: PMC7229106 DOI: 10.1186/s40634-020-00246-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose It has been reported that there is no correlation between anterior tibia translation (ATT) in passive and dynamic situations. Passive ATT (ATTp) may be different to dynamic ATT (ATTd) due to muscle activation patterns. This study aimed to investigate whether muscle activation during jumping can control ATT in healthy participants. Methods ATTp of twenty-one healthy participants was measured using a KT-1000 arthrometer. All participants performed single leg hops for distance during which ATTd, knee flexion angles and knee flexion moments were measured using a 3D motion capture system. During both tests, sEMG signals were recorded. Results A negative correlation was found between ATTp and the maximal ATTd (r = − 0.47, p = 0.028). An N-Way ANOVA showed that larger semitendinosus activity was seen when ATTd was larger, while less biceps femoris activity and rectus femoris activity were seen. Moreover, larger knee extension moment, knee flexion angle and ground reaction force in the anterior-posterior direction were seen when ATTd was larger. Conclusion Participants with more ATTp showed smaller ATTd during jump landing. Muscle activation did not contribute to reduce ATTd during impact of a jump-landing at the observed knee angles. However, subjects with large ATTp landed with less knee flexion and consequently showed less ATTd. The results of this study give information on how healthy people control knee laxity during jump-landing. Level of evidence III
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Affiliation(s)
- Michèle N J Keizer
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands.
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alli Gokeler
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands.,Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg.,Department Exercise & Health, Exercise Science and Neuroscience, University of Paderborn, Paderborn, Germany
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands.,School of Sport Studies, Hanze University Groningen, Groningen, The Netherlands
| | - Egbert Otten
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands
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17
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Shegaf A, Speirs A. Cartilage Biomechanical Response Differs Under Physiological Biaxial Loads and Uniaxial Cyclic Compression. J Biomech Eng 2020; 142:1071855. [DOI: 10.1115/1.4045661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Indexed: 01/31/2023]
Abstract
Abstract
The main function of articular cartilage is to distribute loads and provide low friction for the opposing surfaces in synovial joints. Biphasic lubrication provided by high fluid load support due to relative motion of the contact surfaces has been widely accepted as the main lubrication mode in diarthrodial joints. However, assessment of chondrocyte response to mechanical loads typically employed nonphysiological uniaxial loads with static contact area. This study aimed to introduce a more physiologically relevant loading protocol for in vitro mechanobiological testing of cartilage explants. Finite element analysis was conducted to examine the biomechanical response of cartilage to two different loading regimes, biaxial loading, that permits migrating contact area, and unconfined uniaxial cyclic compression, traditionally used in mechanobiological experiments. Results predicted in this study showed that continuous tissue rehydration provided by relative surface motion maintained constant fluid pressure and tissue strains through the simulation. On the contrary, due to rapid tissue consolidation predicted in cyclic compression simulation, fluid pressure and transverse strain were reduced by 19% and 26%, respectively. Furthermore, relative surface motion simulation resulted in depth-dependent distribution of fluid pressure and tissue strains while unconfined uniaxial cyclic compression produced nearly uniform fluid pressure through the depth but higher at the center of the sample. Based on the results obtained from this study and since sliding contact occurs in vivo, this physiological loading mode should be considered in assessing biomechanical and mechanobiological cartilage behavior.
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Affiliation(s)
- Ali Shegaf
- Department of Mechanical and Aerospace Engineering, Carleton University, 1125 Colonel By Drive, MC, Rm. 3037, Ottawa, ON K1S 5B6, Canada
| | - Andrew Speirs
- Department of Mechanical and Aerospace Engineering, Carleton University, 1125 Colonel By Drive, CB, Rm. 3203, Ottawa, ON K1S 5B6, Canada
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Technical note: sensitivity analysis of the SCoRE and SARA methods for determining rotational axes during tibiofemoral movements using optical motion capture. J Exp Orthop 2020; 7:6. [PMID: 32040787 PMCID: PMC7010897 DOI: 10.1186/s40634-020-0219-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/09/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose The first aim was to report the sensitivity of calculated tibiofemoral movements for the choice of placement of the set of femoral markers. The second aim was to report the influence of accuracy of the motion captured positions of the markers on the calculated tibiofemoral movements. Methods Tibiofemoral kinematics during single leg hops for distance were calculated. For the first aim, an experiment was conducted in which four different setups of the femoral markers were used to calculated tibiofemoral movements. For the second aim, an experiment was conducted in which all raw marker positions were mathematically moved independently with the known Vicon position error with a distance and in a random direction in each frame, repeated a hundred times. Each time, the tibiofemoral movements were calculated. Results The first experiment yields that the standard deviation of the calculated anterior tibia translation between marker setups was 0.88 mm and the standard deviation of the external tibia rotation between marker setups was 0.76 degrees. The second experiment yields that the standard deviation was 0.76 mm for anterior tibia translation and 0.38 degrees for external tibia rotation. Conclusion A combined standard deviation of both experiments revealed that transients in anterior tibia translation less than 2.32 mm and external tibia rotations less than 1.70 degrees should be taken with caution. These results are 19.42% of the range of the anterior tibia translation and 13.51% of the rotation range during the jump task. The marker setup should be chosen carefully.
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19
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Tian F, Li N, Zheng Z, Huang Q, Zhu T, Li Q, Wang W, Tsai TY, Wang S. The effects of marathon running on three-dimensional knee kinematics during walking and running in recreational runners. Gait Posture 2020; 75:72-77. [PMID: 31606722 DOI: 10.1016/j.gaitpost.2019.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/22/2019] [Accepted: 08/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Running-related musculoskeletal injuries are common. Knee injuries are most frequent, and often occur during or shortly after marathons. RESEARCH QUESTION The effects of a marathon on runners' knee kinematics remain unclear. No studies have shown comprehensive three-dimensional (3D) knee kinematic changes following a marathon. This study aimed to observe the effects of running a marathon on 3D knee kinematics and identify the phases of walking and running gait in which significant changes occur. METHODS Based on an electronic survey, 10 healthy, recreational runners (20 knees) with similar running experience were included. Their 3D knee kinematics (during treadmill walking and running) were collected using a portable, optical motion capture system within 24 h before and within 6 h after running a marathon. RESULTS All measurements after the marathon were compared with pre-marathon measurements. (1) For walking post-marathon: varus rotation increased by 1.8° [95% confidence interval (CI) 0.1-3.4, P = 0.036] at peak knee extension during stance; anterior translation increased by 2.2 mm (95% CI 0.3-4.1, P = 0.025) at initial contact; range of motion (ROM) in internal-external rotation increased less than 1°, P = 0.023; ROM in anteroposterior translation increased by 3.8 mm, P = 0.048. (2) For running post-marathon: flexion rotation increased by 1.6° (95% CI 0.2-2.9, P = 0.025) at initial contact; varus rotation increased by 2.0° (95% CI 0.2-3.8, P = 0.031) at peak knee extension during stance. SIGNIFICANCE Significant differences in varus rotation and anterior translation were identified following a marathon, which could potentially contribute to injury. These results provide important information for runners and coaches about knee kinematic alterations following a marathon.
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Affiliation(s)
- Fei Tian
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China; Department of Rehabilitation Medicine, Heping Hospital Affiliated to Changzhi Medical College, Shanxi, China
| | - Ningwei Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Zhi Zheng
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Qiuyue Huang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Ting Zhu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Qiang Li
- Department of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Wenjin Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China.
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Shimizu T, Cheng Z, Samaan MA, Tanaka MS, Souza RB, Li X, Ma CB. Increases in Joint Laxity After Anterior Cruciate Ligament Reconstruction Are Associated With Sagittal Biomechanical Asymmetry. Arthroscopy 2019; 35:2072-2079. [PMID: 31227398 PMCID: PMC10938056 DOI: 10.1016/j.arthro.2019.01.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the longitudinal changes in landing mechanics and knee kinematics for patients both before and 3 years after anterior cruciate ligament reconstruction (ACLR) and to investigate the association between changes in landing mechanics and magnetic resonance knee kinematics. METHODS Thirty-one ACLR patients were included in the study. All patients underwent magnetic resonance imaging and biomechanical analysis of a drop-landing task using the injured knee and contralateral knee preoperatively and at 6 months and 3 years after ACLR. For evaluations of knee joint anteroposterior laxity, tibial position was calculated using quantitative loaded magnetic resonance methods. RESULTS The ACLR knee exhibited a significantly lower peak vertical ground reaction force and peak external knee flexion moment and angle at 6 months compared with the contralateral knee; however, the differences were resolved at 3 years. Tibial position was significantly more anterior on the injured side, and the side-to-side difference (SSD) in tibial position exhibited a significant increase from 6 months to 3 years. Among ACLR knees, a greater SSD in peak knee flexion moment at 6 months was associated with an increase in the SSD in anterior tibial translation from 6 months to 3 years. CONCLUSIONS Although landing mechanics and clinical outcomes recovered in patients with ACLR in this study, anteroposterior translation failed to be restored at 3 years after surgery. In addition, patients who have low knee flexion moments in early stages could have greater anteroposterior laxity. CLINICAL RELEVANCE Because of the adverse consequences of abnormal knee kinetics on anterior laxity after ACLR, efforts to improve knee movement patterns should be initiated.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A.; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Zoe Cheng
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Michael A Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A
| | - Matthew S Tanaka
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A
| | - Richard B Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A.; Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, U.S.A
| | - Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A..
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Schrijvers JC, van den Noort JC, van der Esch M, Dekker J, Harlaar J. Objective parameters to measure (in)stability of the knee joint during gait: A review of literature. Gait Posture 2019; 70:235-253. [PMID: 30909003 DOI: 10.1016/j.gaitpost.2019.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Instability of the knee joint during gait is frequently reported by patients with knee osteoarthritis or an anterior cruciate ligament rupture. The assessment of instability in clinical practice and clinical research studies mainly relies on self-reporting. Alternatively, parameters measured with gait analysis have been explored as suitable objective indicators of dynamic knee (in)stability. RESEARCH QUESTION This literature review aimed to establish an inventory of objective parameters of knee stability during gait. METHODS Five electronic databases (Pubmed, Embase, Cochrane, Cinahl and SPORTDiscuss) were systematically searched, with keywords concerning knee, stability and gait. Eligible studies used an objective parameter(s) to assess knee (in)stability during gait, being stated in the introduction or methods section. Out of 10717 studies, 89 studies were considered eligible. RESULTS Fourteen different patient populations were investigated with kinematic, kinetic and/or electromyography measurements during (challenged) gait. Thirty-three possible objective parameters were identified for knee stability, of which the majority was based on kinematic (14 parameters) or electromyography (12 parameters) measurements. Thirty-nine studies used challenged gait (i.e. external perturbations, downhill walking) to provoke knee joint instability. Limited or conflicting results were reported on the validity of the 33 parameters. SIGNIFICANCE In conclusion, a large number of different candidates for an objective knee stability gait parameter were found in literature, all without compelling evidence. A clear conceptual definition for dynamic knee joint stability is lacking, for which we suggest : "The capacity to respond to a challenge during gait within the natural boundaries of the knee". Furthermore biomechanical gait laboratory protocols should be harmonized, to enable future developments on clinically relevant measure(s) of knee stability during gait.
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Affiliation(s)
- Jim C Schrijvers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Musculoskeletal Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands; Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Joost Dekker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Delft University of Technology, Department of Biomechanical Engineering, Delft, the Netherlands
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22
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Ehrig R, Heller M. On intrinsic equivalences of the finite helical axis, the instantaneous helical axis, and the SARA approach. A mathematical perspective. J Biomech 2019; 84:4-10. [DOI: 10.1016/j.jbiomech.2018.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 11/22/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
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Passive anterior tibia translation in anterior cruciate ligament-injured, anterior cruciate ligament-reconstructed and healthy knees: a systematic review. Musculoskelet Surg 2018; 103:121-130. [PMID: 30328030 PMCID: PMC6656892 DOI: 10.1007/s12306-018-0572-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 10/06/2018] [Indexed: 01/01/2023]
Abstract
Abstract Anterior tibia translation (ATT) is mainly prevented by the anterior cruciate ligament. Passive ATT tests are commonly used to diagnose an anterior cruciate ligament (ACL) injury, to select patients for an ACL reconstruction (ACLR), and as an outcome measure after an ACLR. The aim of this review was to present an overview of possible factors determining ATT. A second purpose was to give a summary of the ATT measured in the literature in healthy, ACL-injured and ACLR knees and a comparison between those groups. A literature search was conducted with PubMed. Inclusion criteria were full-text primary studies published in English between January 2006 and October 2016. Studies included reported ATT in explicit data in healthy as well as ACL-injured or ACLR knees or in ACL-injured as well as ACLR knees. Sixty-one articles met inclusion criteria. Two articles measured the ATT in healthy as well as ACL-injured knees, 51 in ACL-injured as well as in ACLR knees, three in ACLR as well as in healthy knees and three in healthy, ACL-injured and ACLR knees. A difference in ATT is found between healthy, contralateral, ACLR and ACL-injured knees and between chronic and acute ACL injury. Graft choices and intra-articular injuries are factors which could affect the ATT. The mean ATT was lowest to highest in ACLR knees using a bone–patella tendon–bone autograft, ACLR knees using a hamstring autograft, contralateral healthy knees, healthy knees, ACLR knees with an allograft and ACL-injured knees. Factors which could affect the ATT are graft choice, ACL injury or reconstruction, intra-articular injuries and whether an ACL injury is chronic or acute. Comparison of ATT between studies should be taken with caution as a high number of different measurement methods are used. To be able to compare studies, more consistency in measuring devices used should be introduced to measuring ATT. The clinical relevance is that an autograft ACLR might give better results than an allograft ACLR as knee laxity is greater when using an allograft tendon. Level of evidence III.
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Alessandro C, Rellinger BA, Barroso FO, Tresch MC. Adaptation after vastus lateralis denervation in rats demonstrates neural regulation of joint stresses and strains. eLife 2018; 7:38215. [PMID: 30175959 PMCID: PMC6150696 DOI: 10.7554/elife.38215] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022] Open
Abstract
In order to produce movements, muscles must act through joints. The translation from muscle force to limb movement is mediated by internal joint structures that permit movement in some directions but constrain it in others. Although muscle forces acting against constrained directions will not affect limb movements, such forces can cause excess stresses and strains in joint structures, leading to pain or injury. In this study, we hypothesized that the central nervous system (CNS) chooses muscle activations to avoid excessive joint stresses and strains. We evaluated this hypothesis by examining adaptation strategies after selective paralysis of a muscle acting at the rat’s knee. We show that the CNS compromises between restoration of task performance and regulation of joint stresses and strains. These results have significant implications to our understanding of the neural control of movements, suggesting that common theories emphasizing task performance are insufficient to explain muscle activations during behaviors. Although most of us will never achieve the grace and dexterity of professional ballerina Misty Copeland, we each make sophisticated, complex movements every day. Even simple movements often involve coordinating many muscles throughout the body. Moreover, because we have so many muscles, there are often multiple ways that we could use them to make the same movement. So which ones do we use, and why? Many studies into muscle control focus on how the muscles activate to perform a task like kicking a soccer ball. But muscles do more than just move the limbs; they also act on joints. Contracting a muscle exerts strain on bones and the ligaments that hold joints together. If these strains become excessive, they may cause pain and injury, and over a longer time may lead to arthritis. It would therefore make sense if the nervous system factored in the need to protect joints when turning on muscles. The quadriceps are a group of muscles that stretch along the front of the thigh bone and help to straighten the knee. To investigate whether the nervous system selects muscle activations to avoid joint injuries, Alessando et al. studied rats that had one particular quadriceps muscle paralyzed. The easiest way for the rats to adapt to this paralysis would be to increase the activation of a muscle that performs the same role as the paralyzed one, but places more stress on the knee joint. Instead, Alessando et al. found that the rats increase the activation of a muscle that minimizes the stress placed on the knee, even though this made it more difficult for the rats to recover their ability to use the leg in certain tasks. The results presented by Alessando et al. may have important implications for physical therapy. Clinicians usually work to restore limb movements so that a task is performed in a way that is similar to how it was done before the injury. But sometimes repairing the damage can change the mechanical properties of the joint – for example, reconstructive surgery may replace a damaged ligament with a graft that has a different strength or stiffness. In those cases, performing movements in the same way as before the surgery could place abnormal stress on the joint. However, much more research is needed before recommendations can be made for how to rehabilitate rats after injury, let alone humans.
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Affiliation(s)
| | - Benjamin A Rellinger
- Department of Biomedical Engineering, Northwestern University, Evanston, United States
| | | | - Matthew C Tresch
- Department of Physiology, Northwestern University, Chicago, United States.,Department of Biomedical Engineering, Northwestern University, Evanston, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, United States.,Shirley Ryan AbilityLab, Chicago, United States
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25
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Xu J, Zhou X, Guo X, Wang G, Fu S, Zhang L. Effects of Unilateral Electroacupuncture on Bilateral Proprioception in a Unilateral Anterior Cruciate Ligament Injury Model. Med Sci Monit 2018; 24:5473-5479. [PMID: 30082677 PMCID: PMC6094982 DOI: 10.12659/msm.909508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury can cause knee proprioception degeneration, on which the electroacupuncture (EA) treatment has a definite effect. However, it is still not clear whether conducting EA intervention on the injured side can promote bilateral proprioception recovery. MATERIAL AND METHODS We randomly selected 6 of 9 normal cynomolgus monkeys to develop unilateral ACL injury models via arthroscopy. All knees were divided into 5 groups: the normal control (NC) group, injured side of blank model (ISBM) group, contralateral side of blank model (CSBM) group, injured side of EA (ISE) group, and contralateral side of EA (CSE) group. Ten days after modeling, the monkeys in the EA group were treated with EA daily for 6 weeks at the acupoints. At 6 weeks, the 5 groups were examined by electrophysiology (SEPs and MCV). The ACL was separated to conduct the gold chloride staining for morphology observation and count the number of total and variant proprioceptors. RESULTS At 6 weeks, the latent period of the SEPs and MCV and the number of variant proprioceptors in the blank model group and the EA group were increased compared with the NC group, while the amplitude and the number of total proprioceptors were decreased. The changes in the ISBM and CSBM group were more remarkable than in the ISE and CSE group. All differences were statistically significant (P<0.05). CONCLUSIONS Unilateral ACL injury leads to bilateral proprioception degeneration, and the unilateral knee EA intervention can aid bilateral proprioception recovery.
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Affiliation(s)
- Jie Xu
- School of Traditional Chinese Medicine, Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland)
| | - Xin Zhou
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Xiaoguang Guo
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Guoyou Wang
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Shijie Fu
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Lei Zhang
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
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26
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Pfitzner T, Moewis P, Stein P, Boeth H, Trepczynski A, von Roth P, Duda GN. Modifications of femoral component design in multi-radius total knee arthroplasty lead to higher lateral posterior femoro-tibial translation. Knee Surg Sports Traumatol Arthrosc 2018; 26:1645-1655. [PMID: 28656456 DOI: 10.1007/s00167-017-4622-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/19/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE As the aims of changes in total knee arthroplasty (TKA) designs are to reinstate more natural kinematics, the current study evaluated the in vivo kinematics in patients who underwent a cruciate retaining gradually changing femoral radius ("G-CURVE") against a cruciate retaining conventional changing femoral radius ("J-CURVE") geometry TKA design. The hypothesis of the study is that the G-CURVE design would allow a substantial increase in the femoral rollback compared to the J-CURVE design. METHODS Retrospective study design. Thirty patients were included (G-CURVE, n = 20; J-CURVE, n = 10). Single-plane fluoroscopic analysis and marker-based motion capture gait analysis was performed to analyse dynamic tibiofemoral motion during weight-bearing and unloaded activities at 24 month after index surgery. RESULTS The analysis of the medial and lateral points on the tibia plateau during the unloaded flexion-extension and the weight-bearing lunge activities revealed a significant difference in femoral rollback in G-CURVE TKA above 60° (p = 0.001) and 30° (p = 0.02) of knee flexion, respectively. Moreover, the lateral condyle of the G-CURVE showed a higher extent of femoral rollback while the lateral condyle of the J-CURVE rolled forward. CONCLUSION At 2 years post-operative, the G-CURVE TKA showed significant differences in femoro-tibial translation in comparison with the J-CURVE system, in vivo. The G-CURVE resulted in an increased lateral rollback and simultaneously in an elimination of the paradoxical medial roll-forward present in the J-CURVE design. Moreover, knee kinematics analysis showed significant differences between unloaded and weight-bearing conditions revealing the impact of load and muscle force. The analysis conducted in this study contributes to further understand the principal movement characteristics in widely used older designs in comparison with recently developed concepts to get a better overview on their potential benefits on in vivo kinematics. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tilman Pfitzner
- Center for Muskuloskeletal Surgery, Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philippe Moewis
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Patrick Stein
- Center for Muskuloskeletal Surgery, Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Heide Boeth
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Adam Trepczynski
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Philipp von Roth
- Center for Muskuloskeletal Surgery, Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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27
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Multi-plane, multi-joint lower extremity support moments during a rapid deceleration task: Implications for knee loading. Hum Mov Sci 2018; 58:155-164. [DOI: 10.1016/j.humov.2018.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 01/13/2023]
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28
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Zhang L, Guan T, Qi J, Zhang S, Zhou X, Liu Y, Fu S. A model of anterior cruciate ligament injury in cynomolgus monkeys developed via arthroscopic surgery. Exp Ther Med 2018; 15:2239-2246. [PMID: 29456631 PMCID: PMC5795381 DOI: 10.3892/etm.2018.5722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/05/2018] [Indexed: 12/16/2022] Open
Abstract
The anterior cruciate ligament (ACL) is an important structure that maintains the stability of knee joints. Animal models of ACL injury are helpful to explore its underlying mechanisms, and strategies for prevention, treatment and rehabilitation. Therefore, the aim of the present study was to develop an efficient model of ACL injury in cynomolgus monkeys via arthroscopic techniques. In the present study, 18 cynomolgus monkeys were randomly divided into a model group (n=6), a sham operation group (n=6) and a blank control group (n=6). One-quarter of the ACL was removed under arthroscopy in the model group. In the sham operation group, only arthroscopic exploration was performed as a control. In the blank control group, monkeys were housed under the same conditions for the same length of time. Magnetic resonance imaging examination was performed pre- and post-operatively, as well as measurements of the circumference of the thigh and calf, and of the maximum flexion degree of the knee. Anterior drawer test, Lachman test and pivot-shift tests were also performed. The results revealed that the injured side of the knees in the model group became unstable, as determined from evaluation of the physical tests. In conclusion, based on these findings, the modeling method of ACL injury was effective, and may contribute to the associated research concerning ACL injury.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Taiyuan Guan
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Ji Qi
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shaoqun Zhang
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yang Liu
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Shijie Fu
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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Sadighi M, Sajjadi M, Okhovatpour M, Ebrahimpour A, Zandi R, Kafi-Abadi M. Anterior cruciate ligament reconstruction surgery timing with respect to meniscal-chondral damage. ARCHIVES OF TRAUMA RESEARCH 2018. [DOI: 10.4103/atr.atr_29_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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30
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Taylor WR, Schütz P, Bergmann G, List R, Postolka B, Hitz M, Dymke J, Damm P, Duda G, Gerber H, Schwachmeyer V, Hosseini Nasab SH, Trepczynski A, Kutzner I. A comprehensive assessment of the musculoskeletal system: The CAMS-Knee data set. J Biomech 2017; 65:32-39. [DOI: 10.1016/j.jbiomech.2017.09.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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31
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HAJIZADEH MARYAM, OSKOUEI ALIREZAHASHEMI, GHALICHI FARZAN, SOLE GISELA. INTRA-SESSION RELIABILITY AND REPEATABILITY OF KNEE KINEMATICS IN SUBJECTS WITH ACL DEFICIENCY DURING STAIR ASCENT. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Analysis of knee kinematics and ground reaction forces (GRFs) is widely used to determine compensatory mechanisms of people with anterior cruciate ligament deficiency (ACLD). However, the practicality of the measurements is subject to their reliability during different trials. This study aims to determine the reliability and repeatability of knee joint rotations and GRFs in people with ACLD during stair ascent. Eight participants with unilateral ACL-deficient knees performed five trials of stair ascent with each leg. The movements were captured by VICON motion analysis system, and GRF components were recorded using force plate. Three-dimensional tibiofemoral joint rotations were calculated. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and coefficient of multiple correlation (CMC) were calculated ACL-deficient legs showed lower absolute reliability during swing ([Formula: see text]–6.4) than stance phase ([Formula: see text]–2.2) for knee joint rotations. Moderate to high average measure ICCs (0.59–0.98), relative reliability, were achieved for injured and uninjured sides. The results also demonstrated high repeatability for the knee joint rotation ([Formula: see text]–0.97) and GRF ([Formula: see text]–0.99). The outcomes of this study confirmed the consistency and repeatability of the knee joint rotations and GRFs in ACL-deficient subjects. Additionally, ACL-deficient legs exhibited similar levels of reliability and repeatability compared to contralateral legs.
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Affiliation(s)
- MARYAM HAJIZADEH
- Division of Biomechanics, Department of Mechanical Engineering, Sahand University of Technology, Tabriz, Iran
| | - ALIREZA HASHEMI OSKOUEI
- Division of Biomechanics, Department of Mechanical Engineering, Sahand University of Technology, Tabriz, Iran
| | - FARZAN GHALICHI
- Division of Biomechanics, Department of Mechanical Engineering, Sahand University of Technology, Tabriz, Iran
| | - GISELA SOLE
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Oberhofer K, Hosseini Nasab SH, Schütz P, Postolka B, Snedeker JG, Taylor WR, List R. The influence of muscle-tendon forces on ACL loading during jump landing: a systematic review. Muscles Ligaments Tendons J 2017; 7:125-135. [PMID: 28717620 PMCID: PMC5505580 DOI: 10.11138/mltj/2017.7.1.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The goal of this review is to summarise and discuss the reported influence of muscle-tendon forces on anterior cruciate ligament (ACL) loading during the jump-landing task by means of biomechanical analyses of the healthy knee. METHODS A systematic review of the literature was conducted using different combinations of the terms "knee", "ligament", "load", "tension ", "length", "strain", "elongation" and "lengthening". 26 original articles (n=16 in vitro studies; n=10 in situ studies) were identified which complied with all inclusion/exclusion criteria. RESULTS No apparent trend was found between ACL loading and the ratio between hamstrings and quadriceps muscle-tendon forces prior to or during landing. Four in vitro studies reported reduced peak ACL strain if the quadriceps force was increased; while one in vitro study and one in situ study reported reduced ACL loading if the hamstrings force was increased. A meta-analysis of the reported results was not possible because of the heterogeneity of the confounding factors. CONCLUSION The reported results suggest that increased hip flexion during landing may help in reducing ACL strain by lengthening the hamstrings, and thus increasing its passive resistance to stretch. Furthermore, it appears that increased tensile stiffness of the quadriceps may help in stabilising the knee joint during landing, and thus protecting the passive soft-tissue structures from overloading. LEVEL OF EVIDENCE Ib.
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Affiliation(s)
| | | | | | | | - Jess G. Snedeker
- Institute for Biomechanics, ETH Zürich, Switzerland
- University Hospital Balgrist, Zürich, Switzerland
| | | | - Renate List
- Institute for Biomechanics, ETH Zürich, Switzerland
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33
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Moewis P, Duda GN, Jung T, Heller MO, Boeth H, Kaptein B, Taylor WR. The Restoration of Passive Rotational Tibio-Femoral Laxity after Anterior Cruciate Ligament Reconstruction. PLoS One 2016; 11:e0159600. [PMID: 27467744 PMCID: PMC4965218 DOI: 10.1371/journal.pone.0159600] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 01/15/2023] Open
Abstract
While the anterior cruciate ligament (ACL) is considered one of the most important ligaments for providing knee joint stability, its influence on rotational laxity is not fully understood and its role in resisting rotation at different flexion angles in vivo remains unknown. In this prospective study, we investigated the relationship between in vivo passive axial rotational laxity and knee flexion angle, as well as how they were altered with ACL injury and reconstruction. A rotometer device was developed to assess knee joint rotational laxity under controlled passive testing. An axial torque of ±2.5Nm was applied to the knee while synchronised fluoroscopic images of the tibia and femur allowed axial rotation of the bones to be accurately determined. Passive rotational laxity tests were completed in 9 patients with an untreated ACL injury and compared to measurements at 3 and 12 months after anatomical single bundle ACL reconstruction, as well as to the contralateral controls. Significant differences in rotational laxity were found between the injured and the healthy contralateral knees with internal rotation values of 8.7°±4.0° and 3.7°±1.4° (p = 0.003) at 30° of flexion and 9.3°±2.6° and 4.0°±2.0° (p = 0.001) at 90° respectively. After 3 months, the rotational laxity remained similar to the injured condition, and significantly different to the healthy knees. However, after 12 months, a considerable reduction of rotational laxity was observed towards the levels of the contralateral controls. The significantly greater laxity observed at both knee flexion angles after 3 months (but not at 12 months), suggests an initial lack of post-operative rotational stability, possibly due to reduced mechanical properties or fixation stability of the graft tissue. After 12 months, reduced levels of rotational laxity compared with the injured and 3 month conditions, both internally and externally, suggests progressive rotational stability of the reconstruction with time.
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Affiliation(s)
- Philippe Moewis
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Georg N. Duda
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Jung
- Knee Surgery and Sports Traumatology, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus O. Heller
- Bioengineering Research Group, University of Southhampton, Southhampton, United Kingdom
| | - Heide Boeth
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bart Kaptein
- Department of Orthopaedic Surgery, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, Netherlands
| | - William R. Taylor
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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Stettler M, Luder G, Schmid S, Mueller Mebes C, Stutz U, Ziswiler HR, Radlinger L. Passive anterior tibial translation in women with and without joint hypermobility: an exploratory study. Int J Rheum Dis 2016; 21:1756-1762. [PMID: 27456472 DOI: 10.1111/1756-185x.12917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Generalized joint hypermobility (GJH) is a frequent entity, which is still not fully understood. Symptoms associated with GJH are musculoskeletal disorders, decreased balance, impaired proprioception and chronic pain. The purpose of this study was to compare the passive anterior tibial translation (TT) in terms of distance and corresponding force between normomobile (NM) and hypermobile (HM) as well as between NM, symptomatic (HM-s) and asymptomatic (HM-as) hypermobile women. METHODS A total of 195 women, 67 NM and 128 HM, whereof 56 were further classified as HM-s and 47 as HM-as, participated in this study. Passive TT was measured using an adapted Rolimeter. A manual traction force was applied and the distance of the translation measured. For the analysis, maximal translation (TTmax) and the respective force as well as the distance at 40N (TTF40) and 80N (TTF80) traction force were determined. The NM and HM groups were compared using independent samples t-tests, whereas the NM, HM-s and HM-as groups were compared using one-way analyses of variance with Tukey post hoc tests (significance level P ≤ 0.05). RESULTS Comparisons revealed higher values for the variables TTmax, TTF40 and TTF80 in the HM compared to the NM group. In addition, TTmax and TTF80 were found to be higher in the HM-s compared to the NM group. CONCLUSIONS HM women showed significantly higher TT distances, which were even more accentuated in those having symptoms. The findings point toward less passive stability of the knee joint and thus maybe a need of higher muscle activation in order to stabilize the joint.
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Affiliation(s)
- Matthias Stettler
- Health Division, Discipline of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | - Gere Luder
- Health Division, Discipline of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland.,Inselspital, Department of Physiotherapy, Bern University Hospital, Bern, Switzerland
| | - Stefan Schmid
- Health Division, Discipline of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | | | - Ursula Stutz
- Inselspital, Department of Physiotherapy, Bern University Hospital, Bern, Switzerland
| | | | - Lorenz Radlinger
- Health Division, Discipline of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
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Yeung MY, Fu SC, Chua EN, Mok KM, Yung PSH, Chan KM. Use of a portable motion analysis system for knee dynamic stability assessment in anterior cruciate ligament deficiency during single-legged hop landing. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2016; 5:6-12. [PMID: 29264262 PMCID: PMC5730696 DOI: 10.1016/j.asmart.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/22/2016] [Accepted: 06/07/2016] [Indexed: 11/26/2022]
Abstract
Background/objective Anterior cruciate ligament (ACL) rupture results in knee instability, and patients are often unable to return to their previous level of activity. Current assessments rely on passive laxity tests, which do not correlate with function. Dynamic stability may be a better indicator for return to sport. However, equipment for measuring dynamic stability is ill suited for clinical use. The purpose of this study is to evaluate knee kinematics in ACL-deficient patients with a single-legged hop task using a portable motion analysis system. We hypothesize that the assessment task is able to differentiate ACL-deficient knees from healthy knees. Methods Ten ACL-deficient patients and 10 healthy controls were recruited. Participants were instructed to perform a single-legged hop, while kinematics was measured using a portable motion capture system (Opti-Knee; Shanghai Innomotion Inc., Shanghai, China). Kinematic changes after initial contact were examined. Repeatability of the results was examined by calculating the coefficient of variations of the pooled standard deviation of the tibiofemoral displacements. Side-to-side differences were calculated and compared between the two groups. Results One patient could not perform the task. Intraindividual variability was small after initial contact; the coefficient of variation in this region was 13-26%. ACL-deficient knees demonstrated lower flexion range of motion (p = 0.008) and increased internal/external rotation range of motion after landing (p = 0.038), while no significant differences were detected in the healthy group. Only the side-to-side difference in flexion was significantly different between the two groups (p = 0.002). Conclusion The altered knee kinematics in ACL-deficient patients can be revealed by a portable motion capture system, which may enable the clinical application of kinematic assessment in the evaluation of ACL deficiency.
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Affiliation(s)
- Man-Yi Yeung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Eldrich Norwin Chua
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kam-Ming Mok
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai-Ming Chan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Bartels T, Proeger S, Brehme K, Pyschik M, Delank KS, Schulze S, Schwesig R, Fieseler G. The SpeedCourt system in rehabilitation after reconstruction surgery of the anterior cruciate ligament (ACL). Arch Orthop Trauma Surg 2016; 136:957-66. [PMID: 27146667 DOI: 10.1007/s00402-016-2462-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study aimed at evaluating and finding the advantages of a program with unexpected disturbances (reaction time beyond 200 ms) in the late rehabilitation (5 months) after ACL-surgery compared to current sensomotoric based concepts. MATERIALS AND METHODS 50 athletic patients (14 females, 36 males, age: 32.7 ± 10.0 years) were randomized and followed either a new training with the SpeedCourt (28 athletes) or underwent a regular stabilization program (22 athletes). Subjects were assessed at baseline and after 3 weeks, i.e. six sessions in total. The comparison of evaluations (pre- and post-training) was calculated with a two-factorial (time, group) univariate analysis with parameters for flexibility, reaction time, tapping, jump force (uni- and bi-lateral) and anthropometry. RESULTS In between the two groups 5 out of 22 parameters (23 %) showed significant influences, i.e. highest in the lower leg dimensions 15 cm below joint-line of the operated knee joint (η (2) = 0.122), non-operated knee joint (η (2) = 0.200) and the lower leg dimensions 10 cm below joint-line of the non-operated knee joint (η (2) = 0.183). Jump height unilateral and reaction time on the surgically treated leg were also different and improved (η (2) = 0.148; η (2) = 0.138) significantly. Differences in the outcome parameters like tapping, jump height and ground reaction time between the operated and non-operated knee were remarkably reduced in the SpeedCourt intervention group. CONCLUSIONS Interventional training programs with the SpeedCourt system seem to be advantageous in the late rehabilitation following ACL-knee surgery compared to current sensomotoric based concepts. We achieved improvements of anthropometric and functional parameters. Further studies with larger groups and longer periods of evaluation are necessary to support these data and to possibly establish a new innovative rehabilitation concept. Clinically, the demonstrated SpeedCourt system might help to determine the time "back/return to sports" for athletes more objectively and prospectively reduce the rate of ACL re-injuries.
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Affiliation(s)
- Thomas Bartels
- SportsClinic Halle, Center of Joint Surgery, 06108, Halle (Saale), Germany
| | - Stefan Proeger
- SportsClinic Halle, Center of Joint Surgery, 06108, Halle (Saale), Germany
| | - Kay Brehme
- SportsClinic Halle, Center of Joint Surgery, 06108, Halle (Saale), Germany
| | - Martin Pyschik
- SportsClinic Halle, Center of Joint Surgery, 06108, Halle (Saale), Germany
| | - Karl-Stefan Delank
- Department of Orthopedic and Trauma Surgery, Martin-Luther University Halle-Wittenberg, 06120, Halle (Saale), Germany
| | - Stephan Schulze
- Department of Orthopedic and Trauma Surgery, Martin-Luther University Halle-Wittenberg, 06120, Halle (Saale), Germany
| | - René Schwesig
- Department of Orthopedic and Trauma Surgery, Martin-Luther University Halle-Wittenberg, 06120, Halle (Saale), Germany
| | - Georg Fieseler
- Division for Shoulder Surgery and Sports Medicine, Helios Clinic Warburg, Hueffertstrasse 50, 34414, Warburg, Germany.
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Ismail SA, Button K, Simic M, Van Deursen R, Pappas E. Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knee: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2016; 35:68-80. [PMID: 27132248 DOI: 10.1016/j.clinbiomech.2016.04.002] [Citation(s) in RCA: 14] [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] [Received: 11/25/2015] [Revised: 02/23/2016] [Accepted: 04/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered joint motion that occurs in people with an anterior cruciate ligament deficient knee is proposed to play a role in the initiation of knee osteoarthritis, however, the exact mechanism is poorly understood. Although several studies have investigated gait deviations in individuals with chronic anterior cruciate ligament deficient knee in the frontal and transverse planes, no systematic review has summarized the kinematic and kinetic deviations in these two planes. METHODS We searched five electronic databases from inception to 14th October 2013, with key words related to anterior cruciate ligament, biomechanics and gait, and limited to human studies only. Two independent reviewers assessed eligibility based on predetermined inclusion/exclusion criteria and methodological quality was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology statement checklist. FINDINGS We identified 16 studies, totaling 183 subjects with anterior cruciate ligament deficient knee and 211 healthy subjects. Due to the variability in reported outcomes, we could only perform meta-analysis for 13 sagittal plane outcomes. The only significant finding from our meta-analysis showed that individuals with anterior cruciate ligament deficient knee demonstrated a significantly greater external hip flexor angular impulse compared to control (P=0.03). INTERPRETATION No consensus about what constitutes a typical walking pattern in individuals with anterior cruciate ligament deficient knee can be made, nor can conclusions be derived to explain if gait deviations in the frontal and transverse plane contributed to the development of the knee osteoarthritis among this population.
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Affiliation(s)
- Shiek Abdullah Ismail
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Milena Simic
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Robert Van Deursen
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Kainz H, Modenese L, Lloyd D, Maine S, Walsh H, Carty C. Joint kinematic calculation based on clinical direct kinematic versus inverse kinematic gait models. J Biomech 2016; 49:1658-1669. [DOI: 10.1016/j.jbiomech.2016.03.052] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/31/2015] [Accepted: 03/28/2016] [Indexed: 11/28/2022]
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Brambilla L, Pulici L, Carimati G, Quaglia A, Prospero E, Bait C, Morenghi E, Portinaro N, Denti M, Volpi P. Prevalence of Associated Lesions in Anterior Cruciate Ligament Reconstruction: Correlation With Surgical Timing and With Patient Age, Sex, and Body Mass Index. Am J Sports Med 2015; 43:2966-73. [PMID: 26473010 DOI: 10.1177/0363546515608483] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knee instability resulting from anterior cruciate ligament (ACL) rupture is an important risk factor for the onset of meniscal tears and cartilage injuries. A delay of the ligament reconstruction further increases this risk. There is currently no agreement on the right time for surgical ACL reconstruction. PURPOSE To verify the correlation of time to ACL reconstruction, patient age, sex, and body mass index (BMI) with the prevalence of meniscal tears and cartilage injuries, as well as to identify the proper surgical timing to decrease the risk of developing associated injuries. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The medical records of 988 patients who underwent primary ACL reconstruction between January 2010 and May 2014 were analyzed to collect data on the prevalence of meniscal tears and cartilage injuries, surgical timing, and patient sex, age, and BMI. Logistic regression was performed to estimate the association between the prevalence of intra-articular lesions and the independent variables of surgical timing, sex, age, and BMI. RESULTS The risk of developing at least an associated lesion increased by an average of 0.6% for each month of delay of surgical reconstruction. The odds ratio (OR) for developing an intra-articular lesion was 1.989 (95% CI, 1.403-2.820) in those waiting more than 12 months for ACL reconstruction. A 12-month delay for the intervention nearly doubled the risk of developing a medial meniscal tear (OR, 1.806 [95% CI, 1.317-2.475]) but did not modify the risk for the lateral meniscus (OR, 1.183 [95% CI, 0.847-1.653]). Concerning cartilage lesions, the risk after a 12-month delay increased in the medial compartment (femoral condyle: OR, 2.347 [95% CI, 1.499-3.676]; tibial plateau: OR, 5.574 [95% CI, 1.911-16.258]). In the lateral femoral condyle, the risk became significant in patients who underwent surgery more than 60 months after ACL injury as compared with those treated in the first 3 months (OR, 5.949 [95% CI, 1.825-19.385]). Lateral tibial plateau lesions did not seem to increase significantly. Male sex was a risk factor for the onset of lateral meniscal tears (OR, 2.288 [95% CI, 1.596-3.280]) and medial tears (OR, 1.752 [95% CI, 1.280-2.399]). Older age (OR, 1.017 [95% CI, 1.006-1.029]) and increased BMI (OR, 1.120 [95% CI, 1.072-1.169]) were risk factors for the occurrence of at least 1 associated lesion. CONCLUSION ACL reconstruction within 12 months of injury can significantly reduce the risk of meniscal tears and chondral lesions. The close association between BMI and prevalence of associated lesions suggests that attention be paid to patients with an elevated BMI when considering the timing of ACL reconstruction surgery.
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Affiliation(s)
| | - Luca Pulici
- Università degli Studi di Milano, Milano, Italy
| | | | | | | | | | | | - Nicola Portinaro
- Università degli Studi di Milano, Milano, Italy Humanitas Research Hospital, Rozzano, Italy
| | | | - Piero Volpi
- Università degli Studi di Milano, Milano, Italy Humanitas Research Hospital, Rozzano, Italy
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Abstract
OBJECTIVE This study investigated exercise-induced effects of static stretching and playing soccer on anterior tibial translation (ATT) of the knee joint. DESIGN Randomized controlled trial. SETTING University biomechanics laboratory. PARTICIPANTS Thirty-one athletes were randomly assigned into a stretching (26.9 ± 6.2 years, 1.77 ± 0.09 m, 67.9 ± 10.7 kg) and a control group (27.9 ± 7.4 years, 1.75 ± 0.08 m, 72.0 ± 14.9 kg). Thirty-one amateur soccer players in an additional soccer group (25.1 ± 5.6 years, 1.74 ± 0.10 m, 71.8 ± 14.8 kg). All participants had no history of knee injury requiring surgery and any previous knee ligament or cartilage injury. INTERVENTIONS The stretching group performed 4 different static stretching exercises with a duration of 2 × 20 seconds interspersed with breaks of 10 seconds. The soccer group completed a 90-minute soccer-specific training program. The control group did not perform any physical activity for approximately 30 minutes. MAIN OUTCOME MEASURES Anterior tibial translation was measured with the KT-1000 knee arthrometer at forces of 67 N, 89 N, and maximal manual force (Max) before and after the intervention. RESULTS There was a significant increase in ATT after static stretching and playing soccer at all applied forces. Maximal manual testing revealed a mean increase of ATT after static stretching of 2.1 ± 1.6 mm (P < 0.0005) and after playing soccer of 1.0 ± 1.5 mm (P = 0.001). The ATT increase after static stretching at 67 and 89 N is significantly higher than in controls. At maximum manual testing, significant differences were evident between all groups. CONCLUSIONS Static stretching and playing soccer increase ATT and may consequently influence mechanical factors of the anterior cruciate ligament. The ATT increase after static stretching was greater than after playing soccer. CLINICAL RELEVANCE The observed increase in ATT after static stretching and playing soccer may be associated with changes in kinesthetic perception and sensorimotor control, activation of muscles, joint stability, overall performance, and higher injury risk.
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Gait changes of the ACL-deficient knee 3D kinematic assessment. Knee Surg Sports Traumatol Arthrosc 2015; 23:3259-65. [PMID: 25026934 DOI: 10.1007/s00167-014-3169-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/02/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE Static, one-dimensional testing cannot predict the behaviour of the anterior cruciate ligament (ACL)-deficient knee under realistic loading conditions. Currently, the most widely accepted method for assessing joint movement patterns is gait analysis. The purpose of the study was in vivo evaluation of the behaviour of the anterior cruciate ligament-deficient (ACLD) knees during walking, using 3D, real-time assessment tool. METHODS Biomechanical data were collected prospectively on 30 patients with ACL rupture and 15 healthy subjects as a control group, with KneeKg™ System. Kinematic data were recorded in vivo during treadmill walking at self-selected speed. Flexion/extension, abduction/adduction, anterior/posterior tibial translation and external/internal tibial rotation were compared between groups. RESULTS The ACLD patients showed a significant lower extension of the knee joint during stance phase (p < 0.05; 13.2° ± 2.1° and 7.3° ± 2.7°, for ACLD and control group, respectively). A significant difference in tibial rotation angle was found in ACLD knees compared to control knees (p < 0.05). The patients with ACLD rotated the tibia more internally (-1.4° ± 0.2°) during the mid-stance phase, than control group (0.2° ± 0.3°). There was no significant difference in anteroposterior translation and adduction-abduction angles. CONCLUSION Significant alterations of joint kinematics in the ACLD knee were revealed in this study by manifesting a higher flexion gait strategy and excessive internal tibial rotation during walking that could result in a more rapid cartilage thinning throughout the knee. The preoperative data obtained in this study will be useful to understand the post-ACL reconstruction kinematic behaviour of the knee. CLINICAL RELEVANCE The findings in this study indicate that ACLD knee may adapt functionally to prevent excessive anterior-posterior translation but they fail to avoid rotational instability.
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Harato K, Niki Y, Kudo Y, Sakurai A, Nagura T, Hasegawa T, Masumoto K, Otani T. Effect of unstable meniscal injury on three-dimensional knee kinematics during gait in anterior cruciate ligament-deficient patients. Knee 2015; 22:395-9. [PMID: 26006771 DOI: 10.1016/j.knee.2015.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/13/2015] [Accepted: 03/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our purpose was to clarify the differences of three-dimensional knee kinematics in anterior cruciate ligament (ACL)-deficient patients between with and without meniscal injury using gait analysis. METHODS A total of 72 knees in 36 young athletes with primary and unilateral ACL injury, with a mean age of 22 years, participated. Gait analysis was done before surgery. According to the arthroscopic findings, patients were divided into two groups. The patients with an unstable meniscal tear were allocated to the meniscal injury group (ACL+M group), and the patients without a meniscal tear were allocated to the no meniscal injury group (ACL group). In the gait analysis, three-dimensional knee kinematics was evaluated and compared. RESULTS The patients in both groups exhibited lower sagittal plane knee excursions and peak knee extension angles on the affected limb than on the unaffected limb during the mid-stance. In terms of the axial plane, a rotation angle was significantly smaller in the affected knees than in the unaffected knees in the ACL group. On the other hand, an opposite phenomenon was observed in the ACL+M group. Moreover, a significantly larger rotation angle in the affected knees during the stance phase and the whole gait cycle was observed in the ACL+M group than in the ACL group. CONCLUSION Increased rotational motion during the gait was observed in the ACL-deficient knees combined with unstable meniscal injuries. Meniscal condition may be a key factor for compensatory gait mechanics to prevent rotatory instability in ACL-deficient patients patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kudo
- Department of Physical Therapy, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Aiko Sakurai
- Department of Physical Therapy, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Hasegawa
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Toshiro Otani
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
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Towards understanding knee joint laxity: Errors in non-invasive assessment of joint rotation can be corrected. Med Eng Phys 2014; 36:889-95. [DOI: 10.1016/j.medengphy.2014.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 03/06/2014] [Accepted: 03/24/2014] [Indexed: 12/20/2022]
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