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Lin F, Hengli L, Zhu K, Bao Y, Pan J. Predictors of Postoperative Outcomes after Arthroscopic Partial Meniscectomy: A Retrospective Analysis. Orthop Surg 2024. [PMID: 39238478 DOI: 10.1111/os.14218] [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: 04/20/2024] [Revised: 07/27/2024] [Accepted: 08/07/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE Arthroscopic partial meniscectomy is a widely used surgical technique for treating meniscus injuries, while individual differences in postoperative outcomes remain a significant concern. This retrospective study aimed to identify the factors influencing clinical outcomes following arthroscopic partial meniscectomy. METHODS We retrospectively examined the clinical data of 52 patients who underwent arthroscopic partial meniscectomy at our institution from January to May 2022. Observation indicators, including gender, age, type of medical insurance, various surgeons, the self-pay portion of hospital costs, and total hospital costs, were systematically recorded. Subjective symptoms were evaluated with ΔTenger, ΔLysholm, and International Knee Documentation Committee (IKDC) scores during follow-up. The trends of the above questionnaires and potential predictors were statistically evaluated through regression analysis. RESULTS Binary logistic analysis revealed that female patients (OR: 32.42; 95% confidence interval [CI]: 2.22, 473.86) and higher preoperative visual analog scale (VAS) (odds ratio [OR]: 3.58; 95% CI: 1.55, 8.28) were significantly associated with FP Lysholm score. Similarly, patients with elevated preoperative VAS (OR: 1.47; 95% CI: 1.01, 2.15) were significantly more likely to have FP IKDC scores. Multiple linear regression analysis revealed that traumatic meniscus tear (β = -0.324; 95% CI: -0.948, -0.036; p = 0.035) emerged as a negative independent predictor of ΔTegner, while higher preoperative VAS scores (β = 0.330; 95% CI: 0.013, 0.217; p = 0.028) were identified as positive independent predictors of ΔTegner. The duration of symptoms (β = -0.327; 95% CI: -0.010, -0.001; p = 0.023) had a negative impact on the ΔLysholm scores. Factors such as body mass index (BMI) (β = -0.250; 95% CI: -1.000, -0.020; p = 0.042), duration of symptoms (β = -0.302; 95% CI: -0.009, -0.001; p = 0.014), and preoperative VAS (β = -0.332; 95% CI: -1.813, -0.250; p = 0.011) were negatively associated with ΔIKDC scores. CONCLUSION The study offers insights into multiple factors for patient outcomes after arthroscopic partial meniscectomy. Orthopedic surgeons need to consider variables such as gender, BMI, duration of symptoms, preoperative VAS, and the traumatic/degenerative types of meniscal tears to optimize postoperative outcomes.
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Affiliation(s)
- Fan Lin
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Hengli
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kunpeng Zhu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuchen Bao
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianfeng Pan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Feng Y, Yang J, Zhang M, Wang H, Xi G. Association of Spontaneous Osteonecrosis of the Knee with Ipsilateral Meniscus and Posterior Root Tear: Systematic Review and Meta-analysis. Indian J Orthop 2024; 58:1188-1195. [PMID: 39170661 PMCID: PMC11333424 DOI: 10.1007/s43465-024-01140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/23/2024] [Indexed: 08/23/2024]
Abstract
Objective The relationship between spontaneous osteonecrosis of the knee (SONK) and ipsilateral meniscus tear remains to be established, and the possible causes are clarified and summarized. Methods We conducted a search in Pubmed, Web of Science, Embase, and the Cochrane Library to include all English articles published from the establishment of the database until April 2023. The odds ratio (OR) and 95% confidence interval (CI) were calculated to evaluate the relationship between SONK and ipsilateral meniscus lesions. Results A total of 405 patients were included in eight articles, including 157 males and 248 females, with an average age of 63.94 years and an average BMI of 26.36 kg/m2. In patients with medial SONK, the prevalence of ipsilateral meniscus tear was 0.8982, 95% CI (0.7389, 0.9648), and the prevalence of ipsilateral posterior root tear was 0.6198, 95% CI (0.5169, 0.7118). The prevalence of ipsilateral meniscus tears in patients with lateral SONK was 0.2188, 95% CI (0.1150, 0.3711), and the prevalence of ipsilateral posterior root tears was 0.1667, 95% CI (0.1071, 0.2424). Conclusions SONK is significantly associated with meniscus or root tears, which limit meniscus function and lead to changes in the stress environment between the knee and the tibiofemur, increasing the chance of incomplete fracture. We suggest that the expression of SONK can be replaced with subchondral insufficiency fracture of the knee. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-024-01140-4.
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Affiliation(s)
- Yuhua Feng
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
| | - Jiaju Yang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
| | - Min Zhang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
| | - Haohao Wang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
| | - Gang Xi
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
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Wan Y, McGuigan P, Bilzon J, Wade L. The effect of foot orientation modifications on knee joint biomechanics during daily activities in people with and without knee osteoarthritis. Clin Biomech (Bristol, Avon) 2024; 117:106287. [PMID: 38870877 DOI: 10.1016/j.clinbiomech.2024.106287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Altered gait could influence knee joint moment magnitudes and cumulative damage over time. Gait modifications have been shown to reduce knee loading in people with knee osteoarthritis during walking, although this has not been explored in multiple daily activities. Therefore, this study investigated the effect of different foot orientations on knee loading during multiple daily activities in people with and without knee osteoarthritis. METHODS Thirty people with knee osteoarthritis and twenty-nine without (control) performed walking, stair ambulation and sit-to-stand across a range of foot progression angles (neutral, toe-in, toe-out and preferred). Peak knee adduction moment, knee adduction moment impulse and knee pain were compared across a continuous range of foot orientations, between activities, and groups. FINDINGS Increased foot progression angle (more toe-in) reduced 1st peak knee adduction moment across all activities in both knee osteoarthritis and control (P < 0.001). There was a greater reduction in knee adduction moment in the control group during walking and stair ambulation (P ≤ 0.006), where the knee osteoarthritis group already walked preferably less toe-out than the control group. Under preferred condition, stair descent had the greatest knee loading and knee pain compared to other activities. INTERPRETATION Although increased foot progression angle (toward toe-in) appeared to be more effective in reducing knee loading for all activities, toe-in modification might not benefit stair ambulation. Future gait modification should likely be personalised to each patient considering the individual difference in preferred gait and knee alignment required to shift the loading medially or laterally.
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Affiliation(s)
- Yi Wan
- Department for Health, University of Bath, Bath, UK; Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, UK.
| | - Polly McGuigan
- Department for Health, University of Bath, Bath, UK; Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK; Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, UK; Centre for Sport Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - Logan Wade
- Department for Health, University of Bath, Bath, UK; Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, UK
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Neumann AM, Kebbach M, Bader R, Hildebrandt G, Wree A. Evaluation of 3D Footprint Morphology of Knee-Related Muscle Attachments Based on CT Data Reconstruction: A Feasibility Study. Life (Basel) 2024; 14:778. [PMID: 38929760 PMCID: PMC11204608 DOI: 10.3390/life14060778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
A three-dimensional (3D) understanding of muscle attachment footprints became increasingly relevant for musculoskeletal modeling. The established method to project attachments as points ignores patient-specific individuality. Research focuses on investigating certain muscle groups rather than comprehensively studying all muscles spanning a joint. Therefore, we present a reliable method to study several muscle attachments in order to reconstruct the attachment sites in 3D based on CT imaging for future applications in musculoskeletal modeling. For the present feasibility study, 23 knee-related muscle attachments were CT-scanned postmortem from four nonadipose male specimens. For this, the specific muscle attachments were dissected and marked with a barium sulfate containing paint (60 g BaSO4 in 30 mL water and 10 mL acrylic paint). Subsequently, bone geometries and muscle attachments were reconstructed and evaluated from CT datasets. Bone morphology and footprint variations were studied. Exemplarily, variations were high for pes anserinus insertions (mean 56%) and the origins of M. biceps femoris (mean 54%). In contrast, the origins of the vastus muscles as well as the insertion of the Achilles tendon showed low variation (mean 9% and 13%, respectively). Most attachment sites showed variation exceeding the individuality of bone morphology. In summary, the present data were consistent with the few published studies of specific muscle footprints. Our data shed light on the high variability of muscle attachments, which need to be addressed when studying muscle forces and movements through musculoskeletal modeling. This is the first step to achieving a more profound understanding of muscle morphology to be utilized in numerical simulations.
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Affiliation(s)
- Anne-Marie Neumann
- Institute for Anatomy, Rostock University Medical Center, Gertrudenstraße 9, 18057 Rostock, Germany;
- Institute of Molecular and Cellular Anatomy, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18055 Rostock, Germany; (M.K.); (R.B.)
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18055 Rostock, Germany; (M.K.); (R.B.)
| | - Guido Hildebrandt
- Department of Radiotherapy and Radiation Oncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany;
| | - Andreas Wree
- Institute for Anatomy, Rostock University Medical Center, Gertrudenstraße 9, 18057 Rostock, Germany;
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Li W, Wang S, Jin M, Wang L, Nan J, Wang C, Xiong P, Hu QM, Liu L, Ren J, Zhang J. Near-Infrared Dual-Modal Sensing of Force and Temperature in Total Knee Replacement Using Mechanoluminescent Phosphor of Sr 3Sn 2O 7: Nd, Yb. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2310180. [PMID: 38342676 DOI: 10.1002/smll.202310180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/02/2024] [Indexed: 02/13/2024]
Abstract
Knee replacement surgery confronts challenges including patient dissatisfaction and the necessity for secondary procedures. A key requirement lies in dual-modal measurement of force and temperature of artificial joints during postoperative monitoring. Here, a novel non-toxic near-infrared (NIR) phosphor Sr3Sn2O7:Nd, Yb, is designed to realize the dual-modal measurement. The strategy is to entail phonon-assisted upconversion luminescence (UCL) and trap-controlled mechanoluminescence (ML) in a single phosphor well within the NIR biological transmission window. The phosphor is embedded in medical bone cement forming a smart joint in total knee replacements illustrated as a proof-of-concept. The sensing device can be charged in vitro by a commercial X-ray source with a safe dose rate for ML, and excited by a low power 980 nm laser for UCL. It attains impressive force and temperature sensing capabilities, exhibiting a force resolution of 0.5% per 10 N, force detection threshold of 15 N, and a relative temperature sensitive of up to 1.3% K-1 at 309 K. The stability against humidity and thermal shock together with the robustness of the device are attested. This work introduces a novel methodological paradigm, paving the way for innovative research to enhance the functionality of artificial tissues and joints in living organisms.
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Affiliation(s)
- Wenhao Li
- Key Laboratory of Photonic Materials and Devices Physics for Oceanic Applications, Ministry of Industry and Information Technology of China, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
- Key Laboratory of In-Fiber Integrated Optics of Ministry of Education, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
| | - Sikai Wang
- Key Laboratory of Photonic Materials and Devices Physics for Oceanic Applications, Ministry of Industry and Information Technology of China, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
- Key Laboratory of In-Fiber Integrated Optics of Ministry of Education, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
| | - Minyu Jin
- Key Laboratory of Photonic Materials and Devices Physics for Oceanic Applications, Ministry of Industry and Information Technology of China, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
- Key Laboratory of In-Fiber Integrated Optics of Ministry of Education, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
| | - Lu Wang
- Key Laboratory of Photonic Materials and Devices Physics for Oceanic Applications, Ministry of Industry and Information Technology of China, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
- Key Laboratory of In-Fiber Integrated Optics of Ministry of Education, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
| | - Jinlong Nan
- Key Laboratory of Photonic Materials and Devices Physics for Oceanic Applications, Ministry of Industry and Information Technology of China, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
- Key Laboratory of In-Fiber Integrated Optics of Ministry of Education, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
| | - Ci Wang
- Key Laboratory of Photonic Materials and Devices Physics for Oceanic Applications, Ministry of Industry and Information Technology of China, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
- Key Laboratory of In-Fiber Integrated Optics of Ministry of Education, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
| | - Puxian Xiong
- State Key Laboratory of Luminescent Materials and Devices, Institute of Optical Communication Materials, Guangdong Engineering Technology Research and Development Center of Special Optical Fiber Materials and Devices, and Guangdong Provincial Key Laboratory of Fiber Laser Materials and Applied Techniques, South China University of Technology, Guangzhou, Guangdong, 511442, China
| | - Qing Miao Hu
- Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang, 110016, China
| | - Lu Liu
- Key Laboratory of Photonic Materials and Devices Physics for Oceanic Applications, Ministry of Industry and Information Technology of China, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
- Key Laboratory of In-Fiber Integrated Optics of Ministry of Education, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
| | - Jing Ren
- Key Laboratory of Photonic Materials and Devices Physics for Oceanic Applications, Ministry of Industry and Information Technology of China, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
- Key Laboratory of In-Fiber Integrated Optics of Ministry of Education, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
| | - Jianzhong Zhang
- Key Laboratory of Photonic Materials and Devices Physics for Oceanic Applications, Ministry of Industry and Information Technology of China, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
- Key Laboratory of In-Fiber Integrated Optics of Ministry of Education, College of Physics and Optoelectronic Engineering, Harbin Engineering University, Harbin, 150001, China
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Ando J, Takahashi T, Matsumura T, Nibe Y, Takeshita K. Biomechanical comparisons of plate placement for medial tibial plateau fractures (Schatzker type IV): A biomechanical study using porcine tibias. Injury 2024; 55:111158. [PMID: 38579154 DOI: 10.1016/j.injury.2023.111158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Biomechanical studies on medial tibial plateau fractures (MTPFs) (Schatzker classification type IV) are currently few, while studies using locking plates (LPs) placed on medial proximal tibias are unavailable. Hence, we compared the biomechanical properties of plate osteosynthesis at the medial and anteromedial placements using large- and small-fragment LPs in porcine bones. MATERIALS AND METHODS MTPFs were internally fixed using LPs on 40 porcine tibias. Specimens were equally divided into four groups: medial placement using a large-fragment LP (LPs for the medial (LM) group), anteromedial placement using a large-fragment LP (LAM group), medial placement using a small-fragment LP (SM group), and anteromedial placement using a small-fragment LP (SAM group). The translation patterns of the constructs in each group were examined by cycling loading test (displacement and translation along the mechanical axis at 10-100, 100-500, 500-1000, 1000-1500, and 1500-2000 cycles). Then, articular gaps and step-off changes after 2000 cycles were compared among the four groups. RESULTS One-way analysis of variance (ANOVA) revealed no significant differences in displacement and translation during cyclic loading. One-way ANOVA followed by post hoc analysis revealed that the anterior gap was lower in LPs for the medial (LM) than in SM (P = 0.029) and SAM (P = 0.0026). The central gap was also lower in LM than in SM (P = 0.042) and SAM (P < 0.001), and it was lower in LAM than in SAM (P = 0.047). Likewise, the posterior gap was lower in LM than in LAM (P = 0.025) and SAM (P < 0.001). Furthermore, the central step-off of SAM was higher than that of LM, LAM, and SM (P < 0.001, P = 0.0014, and P = 0.0077, respectively). The posterior step-off was lower in LM than in SAM and LAM (P = 0.037 and P < 0.001), and it was also lower in SM than in SAM (P = 0.0082). CONCLUSION Medial LP placement for MTPFs in porcine bones resulted in significantly lower posterior step-offs after cyclic loading than anteromedial placement, and large-fragment LPs for MTPFs caused significantly lower fracture gaps in the central articular after cyclic loading than small-fragment LPs.
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Affiliation(s)
- Jiro Ando
- Department of Orthopedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, 1-15-4, Shimotsuke 329-0502, Japan.
| | - Tomohiro Matsumura
- Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yoshiya Nibe
- Department of Orthopedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Koh J, Mungalpara N, Kim S, Bedi A, Hutchinson M, Amirouche F. Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints. J Orthop Surg Res 2024; 19:280. [PMID: 38711149 DOI: 10.1186/s13018-024-04744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION The escalating incidence of anterior cruciate ligament (ACL) injuries, particularly among adolescents, is a pressing concern. The study of ACL biomechanics in this demographic presents challenges due to the scarcity of cadaveric specimens. This research endeavors to validate the adolescent porcine stifle joint as a fitting model for ACL studies. METHODS We conducted experiments on 30 fresh porcine stifle knee joints. (Breed: Yorkshire, Weight: avg 90 lbs, Age Range: 2-4 months). They were stored at - 22 °C and a subsequent 24-h thaw at room temperature before being prepared for the experiment. These joints were randomly assigned to three groups. The first group served as a control and underwent only the load-to-failure test. The remaining two groups were subjected to 100 cycles, with forces of 300N and 520N, respectively. The load values of 300N and 520N correspond to three and five times the body weight (BW) of our juvenile porcine, respectively. RESULT The 520N force demonstrated a higher strain than the 300N, indicating a direct correlation between ACL strain and augmented loads. A significant difference in load-to-failure (p = 0.014) was observed between non-cyclically loaded ACLs and those subjected to 100 cycles at 520N. Three of the ten samples in the 520N group failed before completing 100 cycles. The ruptured ACLs from these tests closely resembled adolescent ACL injuries in detachment patterns. ACL stiffness was also measured post-cyclical loading by applying force and pulling the ACL at a rate of 1 mm per sec. Moreover, ACL stiffness measurements decreased from 152.46 N/mm in the control group to 129.42 N/mm after 100 cycles at 300N and a more significant drop to 86.90 N/mm after 100 cycles at 520N. A one-way analysis of variance (ANOVA) and t-test were chosen for statistical analysis. CONCLUSIONS The porcine stifle joint is an appropriate model for understanding ACL biomechanics in the skeletally immature demographic. The results emphasize the ligament's susceptibility to injury under high-impact loads pertinent to sports activities. The study advocates for further research into different loading scenarios and the protective role of muscle co-activation in ACL injury prevention.
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Affiliation(s)
- Jason Koh
- Institute of Orthopaedics and Spine, Department of Orthopaedic Surgery, Northshore University HealthSystem, 9669 Kenton Avenue, Suite 305, Skokie, IL, 60076, USA
| | - Nirav Mungalpara
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Sunjung Kim
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Asheesh Bedi
- Institute of Orthopaedics and Spine, Department of Orthopaedic Surgery, Northshore University HealthSystem, 9669 Kenton Avenue, Suite 305, Skokie, IL, 60076, USA
| | - Mark Hutchinson
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Farid Amirouche
- Institute of Orthopaedics and Spine, Department of Orthopaedic Surgery, Northshore University HealthSystem, 9669 Kenton Avenue, Suite 305, Skokie, IL, 60076, USA.
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA.
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Padhye AA, Meardon SA, Kulas A, Willson J. Lower extremity joint contact force symmetry during walking and running, 2-7 years post-ACL reconstruction. J Orthop Res 2024; 42:1009-1019. [PMID: 38044474 DOI: 10.1002/jor.25751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/15/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
Premature osteoarthritis after anterior cruciate ligament reconstruction (ACLR) is common among athletes. Reduced knee contact forces after ACLR likely contribute to the multifactorial etiology of the disease. Whether this reduction is accompanied by compensatory increases in joint contact forces (JCF) at adjacent or contralateral joints is unclear. It is also unclear if compensatory effects depend on the task demands. Thus, we compared hip, knee, and ankle JCF symmetry between individuals with reconstruction and a matched control group during walking and running. Thirty participants (19 females), 2-7 years post-unilateral ACLR (mean = 47.8 months), and 30 controls matched on sex, mass, and activity level were recruited. Limb symmetry indices of peak contact forces and force impulses were calculated for each joint during walking and running, and analyzed using two-factor (group, activity) analysis of variances. Lower ACLR group peak knee JCF (p = 0.009) and knee JCF impulse (p = 0.034) during walking and running were observed. An interaction of group and activity was observed for peak hip JCF, with ACLR participants demonstrating greater involved limb peak hip JCF during running (p = 0.012). Ankle JCF and ground reaction force symmetry indices were not different between groups or across tasks. Decreased knee and increased ipsilateral peak hip JCF during running suggests that proximal adaptations exist at 2-7 years after ACLR, particularly during activities with increased task demand. Clinical significance: Knee and hip JCF asymmetry at 2-7 years after ACLR may underscore a need for clinical strategies and follow-up assessments to identify and target such outcomes.
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Affiliation(s)
- Ankur Anand Padhye
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - Stacey A Meardon
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - Anthony Kulas
- Kinesiology Department, East Carolina University, Greenville, North Carolina, USA
| | - John Willson
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
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Kleist E, Henke P, Ruehrmund L, Kebbach M, Bader R, Woernle C. Impact of Structural Compliance of a Six Degree of Freedom Joint Simulator on Virtual Ligament Force Calculation in Total Knee Endoprosthesis Testing. Life (Basel) 2024; 14:531. [PMID: 38672801 PMCID: PMC11050787 DOI: 10.3390/life14040531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The AMTI VIVO™ six degree of freedom joint simulator allows reproducible preclinical testing of joint endoprostheses under specific kinematic and loading conditions. When testing total knee endoprosthesis, the articulating femoral and tibial components are each mounted on an actuator with two and four degrees of freedom, respectively. To approximate realistic physiological conditions with respect to soft tissues, the joint simulator features an integrated virtual ligament model that calculates the restoring forces of the ligament apparatus to be applied by the actuators. During joint motion, the locations of the ligament insertion points are calculated depending on both actuators' coordinates. In the present study, we demonstrate that unintended elastic deformations of the actuators due to the specifically high contact forces in the artificial knee joint have a considerable impact on the calculated ligament forces. This study aims to investigate the effect of this structural compliance on experimental results. While the built-in algorithm for calculating the ligament forces cannot be altered by the user, a reduction of the ligament force deviations due to the elastic deformations could be achieved by preloading the articulating implant components in the reference configuration. As a proof of concept, a knee flexion motion with varying ligament conditions was simulated on the VIVO simulator and compared to data derived from a musculoskeletal multibody model of a total knee endoprosthesis.
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Affiliation(s)
- Eric Kleist
- Chair of Technical Mechanics/Dynamics, Faculty of Mechanical Engineering and Marine Technologies, University of Rostock, Justus-von-Liebig-Weg 6, 18059 Rostock, Germany;
| | - Paul Henke
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany; (P.H.); (L.R.); (M.K.)
| | - Leo Ruehrmund
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany; (P.H.); (L.R.); (M.K.)
| | - Maeruan Kebbach
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany; (P.H.); (L.R.); (M.K.)
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany; (P.H.); (L.R.); (M.K.)
| | - Christoph Woernle
- Chair of Technical Mechanics/Dynamics, Faculty of Mechanical Engineering and Marine Technologies, University of Rostock, Justus-von-Liebig-Weg 6, 18059 Rostock, Germany;
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10
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Lachance AD, Steika R, Lutton J, Chessa F. Total Joint Arthroplasty in Patients Who Are Obese or Morbidly Obese: An Ethical Analysis. J Bone Joint Surg Am 2024; 106:659-664. [PMID: 38377222 DOI: 10.2106/jbjs.23.00617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Andrew D Lachance
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, Pennsylvania
| | - Roman Steika
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, Pennsylvania
| | - Jeffrey Lutton
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, Pennsylvania
| | - Frank Chessa
- Maine Medical Center, Portland, Maine
- Tufts University School of Medicine, Boston, Massachusetts
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11
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Richardson MK, DiGiovanni RM, McCrae BK, Cooperman WS, Ludington J, Heckmann ND, Oakes DA. Robotic-Assisted Total Knee Arthroplasty in Obese Patients. Arthroplast Today 2024; 26:101320. [PMID: 38404408 PMCID: PMC10885316 DOI: 10.1016/j.artd.2024.101320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 01/21/2024] [Indexed: 02/27/2024] Open
Abstract
Background Robotic-assisted systems have gained popularity in total knee arthroplasty (TKA). The purpose of this study was to evaluate operative characteristics and radiographic outcomes of obese patients undergoing robotic-assisted TKA. Methods A retrospective review of consecutive cases performed by a single surgeon was performed from January 1, 2016, to January 31, 2022. Adult patients with body mass index ≥35 kg/m2 who underwent primary TKA using a computed tomography-assisted robotic system were compared to patients who underwent primary TKA using conventional instrumentation. Demographics, preoperative and postoperative radiographic measurements, and intraoperative outcomes were compared between cohorts. In total, 119 patients were identified, 60 in the robotic-assisted cohort and 59 in the conventional instrumentation cohort. Results Age, body mass index, and estimated blood loss were not significantly different between the cohorts. The robotic-assisted cohort experienced longer tourniquet times (93.3 vs 75.5 minutes, P < .001). Preoperative hip-knee-ankle angle (HKA) was similar between the robotic-assisted and conventional cohorts (8.4° ± 4.9° vs 9.3° ± 5.3°, P = .335). Postoperative HKA was 2.0° ± 1.4° in the robotic-assisted group and 3.1° ± 3.23° in the conventional group (P = .040). The proportion of patients with postoperative HKA > 3° of varus or valgus was 9 of 60 (15.0%) in the robotic-assisted cohort compared to 18 of 59 (30.5%) using conventional instrumentation (P = .043). Conclusions Obese patients treated with robotic-assisted TKA had postoperative alignment closer to neutral and fewer postoperative radiographic outliers than patients treated with conventional instrumentation. The results of this study support use of robotic-assisted technologies in TKA, particularly in obese patients.
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Affiliation(s)
- Mary K. Richardson
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
| | - Ryan M. DiGiovanni
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
| | - Brian K. McCrae
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Wesley S. Cooperman
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
| | - John Ludington
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
| | | | - Daniel A. Oakes
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
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12
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Kang M, Seo S, Lee H, Han MW. Knee Measurement System with Osteoarthritis Levels Using Artificial Cartilage and Skeletons. Biomimetics (Basel) 2024; 9:166. [PMID: 38534851 DOI: 10.3390/biomimetics9030166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Knee osteoarthritis (OA), also known as degenerative arthritis, is a disease characterized by irreversible changes in the cartilage and bones comprising the joints, resulting in pain, impaired function, and deformity. Furthermore, independent of natural aging, the rate of change in joint cartilage has increased in recent years, which is mainly attributed to environmental factors. The rising incidence of knee-related disorders emphasizes the importance of analyzing the morphology and kinematics of knee structure. This study introduces a knee measurement system designed to replicate the motions of knee using 3D-printing technology, providing insights into knee mechanics with OA level. The research explores the stages of OA using the Kellgren-Lawrence (KL) grade scale, highlighting the variations in the force applied to the knee bone according to movement. The developed knee-simulation system, utilizing the four-bar-link theory, presents a novel approach to studying OA levels 0 to 4. As OA progresses, the cartilage deteriorates, affecting the movement of OA. The OA-based knee measurement system that incorporates soft tissues and skeletons can assist in developing a personalized diagnostic approach for knee disease. This will also help to enhance surgical effectiveness by facilitating the creation of personalized prosthetic joints for individual patients and offering a customized surgical simulation.
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Affiliation(s)
- Minchae Kang
- Department of Mechanical Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
| | - Suyeon Seo
- Department of Mechanical Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
| | - Hyewon Lee
- Department of Mechanical, Robotics and Energy Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
| | - Min-Woo Han
- Department of Mechanical Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
- Department of Mechanical, Robotics and Energy Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
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13
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Jahn J, Ehlen QT, Huang CY. Finding the Goldilocks Zone of Mechanical Loading: A Comprehensive Review of Mechanical Loading in the Prevention and Treatment of Knee Osteoarthritis. Bioengineering (Basel) 2024; 11:110. [PMID: 38391596 PMCID: PMC10886318 DOI: 10.3390/bioengineering11020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
In this review, we discuss the interaction of mechanical factors influencing knee osteoarthritis (KOA) and post-traumatic osteoarthritis (PTOA) pathogenesis. Emphasizing the importance of mechanotransduction within inflammatory responses, we discuss its capacity for being utilized and harnessed within the context of prevention and rehabilitation of osteoarthritis (OA). Additionally, we introduce a discussion on the Goldilocks zone, which describes the necessity of maintaining a balance of adequate, but not excessive mechanical loading to maintain proper knee joint health. Expanding beyond these, we synthesize findings from current literature that explore the biomechanical loading of various rehabilitation exercises, in hopes of aiding future recommendations for physicians managing KOA and PTOA and athletic training staff strategically planning athlete loads to mitigate the risk of joint injury. The integration of these concepts provides a multifactorial analysis of the contributing factors of KOA and PTOA, in order to spur further research and illuminate the potential of utilizing the body's own physiological responses to mechanical stimuli in the management of OA.
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Affiliation(s)
- Jacob Jahn
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Quinn T Ehlen
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chun-Yuh Huang
- Department of Biomedical Engineering, College of Engineering, University of Miami, Coral Gables, FL 33146, USA
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14
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Wang J, Chu J, Song J, Li Z. The application of impantable sensors in the musculoskeletal system: a review. Front Bioeng Biotechnol 2024; 12:1270237. [PMID: 38328442 PMCID: PMC10847584 DOI: 10.3389/fbioe.2024.1270237] [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: 07/31/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
As the population ages and the incidence of traumatic events rises, there is a growing trend toward the implantation of devices to replace damaged or degenerated tissues in the body. In orthopedic applications, some implants are equipped with sensors to measure internal data and monitor the status of the implant. In recent years, several multi-functional implants have been developed that the clinician can externally control using a smart device. Experts anticipate that these versatile implants could pave the way for the next-generation of technological advancements. This paper provides an introduction to implantable sensors and is structured into three parts. The first section categorizes existing implantable sensors based on their working principles and provides detailed illustrations with examples. The second section introduces the most common materials used in implantable sensors, divided into rigid and flexible materials according to their properties. The third section is the focal point of this article, with implantable orthopedic sensors being classified as joint, spine, or fracture, based on different practical scenarios. The aim of this review is to introduce various implantable orthopedic sensors, compare their different characteristics, and outline the future direction of their development and application.
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Affiliation(s)
- Jinzuo Wang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
| | - Jian Chu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Jinhui Song
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
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15
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Armstrong K, Zhang L, Wen Y, Willmott AP, Lee P, Ye X. A marker-less human motion analysis system for motion-based biomarker identification and quantification in knee disorders. Front Digit Health 2024; 6:1324511. [PMID: 38384738 PMCID: PMC10880093 DOI: 10.3389/fdgth.2024.1324511] [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: 10/19/2023] [Accepted: 01/09/2024] [Indexed: 02/23/2024] Open
Abstract
In recent years the healthcare industry has had increased difficulty seeing all low-risk patients, including but not limited to suspected osteoarthritis (OA) patients. To help address the increased waiting lists and shortages of staff, we propose a novel method of automated biomarker identification and quantification for the monitoring of treatment or disease progression through the analysis of clinical motion data captured from a standard RGB video camera. The proposed method allows for the measurement of biomechanics information and analysis of their clinical significance, in both a cheap and sensitive alternative to the traditional motion capture techniques. These methods and results validate the capabilities of standard RGB cameras in clinical environments to capture clinically relevant motion data. Our method focuses on generating 3D human shape and pose from 2D video data via adversarial training in a deep neural network with a self-attention mechanism to encode both spatial and temporal information. Biomarker identification using Principal Component Analysis (PCA) allows the production of representative features from motion data and uses these to generate a clinical report automatically. These new biomarkers can then be used to assess the success of treatment and track the progress of rehabilitation or to monitor the progression of the disease. These methods have been validated with a small clinical study, by administering a local anaesthetic to a small population with knee pain, this allows these new representative biomarkers to be validated as statistically significant (p -value < 0.05 ). These significant biomarkers include the cumulative acceleration of elbow flexion/extension in a sit-to-stand, as well as the smoothness of the knee and elbow flexion/extension in both a squat and sit-to-stand.
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Affiliation(s)
- Kai Armstrong
- Laboratory of Vision Engineering, School of Computer Science, University of Lincoln, Lincoln, United Kingdom
| | - Lei Zhang
- Laboratory of Vision Engineering, School of Computer Science, University of Lincoln, Lincoln, United Kingdom
| | - Yan Wen
- Laboratory of Vision Engineering, School of Computer Science, University of Lincoln, Lincoln, United Kingdom
| | - Alexander P. Willmott
- School of Sport and Exercise Science, University of Lincoln, Lincoln, United Kingdom
| | - Paul Lee
- School of Sport and Exercise Science, University of Lincoln, Lincoln, United Kingdom
- MSK Doctors, Sleaford, United Kingdom
| | - Xujiong Ye
- Laboratory of Vision Engineering, School of Computer Science, University of Lincoln, Lincoln, United Kingdom
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16
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Clancy CE, Gatti AA, Ong CF, Maly MR, Delp SL. Muscle-driven simulations and experimental data of cycling. Sci Rep 2023; 13:21534. [PMID: 38057337 PMCID: PMC10700567 DOI: 10.1038/s41598-023-47945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
Muscle-driven simulations have provided valuable insights in studies of walking and running, but a set of freely available simulations and corresponding experimental data for cycling do not exist. The aim of this work was to develop a set of muscle-driven simulations of cycling and to validate them by comparison with experimental data. We used direct collocation to generate simulations of 16 participants cycling over a range of powers (40-216 W) and cadences (75-99 RPM) using two optimization objectives: a baseline objective that minimized muscle effort and a second objective that additionally minimized tibiofemoral joint forces. We tested the accuracy of the simulations by comparing the timing of active muscle forces in our baseline simulation to timing in experimental electromyography data. Adding a term in the objective function to minimize tibiofemoral forces preserved cycling power and kinematics, improved similarity between active muscle force timing and experimental electromyography, and decreased tibiofemoral joint reaction forces, which better matched previously reported in vivo measurements. The musculoskeletal models, muscle-driven simulations, simulation software, and experimental data are freely shared at https://simtk.org/projects/cycling_sim for others to reproduce these results and build upon this research.
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Affiliation(s)
- Caitlin E Clancy
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Anthony A Gatti
- Department of Radiology, Stanford University, Stanford, CA, USA.
| | - Carmichael F Ong
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Monica R Maly
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Scott L Delp
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
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17
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Jones BW, Willson JD, DeVita P, Wedge RD. Tibiofemoral Load Magnitude and Distribution During Load Carriage. J Appl Biomech 2023; 39:432-439. [PMID: 37739402 DOI: 10.1123/jab.2022-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 09/24/2023]
Abstract
Chronic exposure to high tibiofemoral joint (TFJ) contact forces can be detrimental to knee joint health. Load carriage increases TFJ contact forces, but it is unclear whether medial and lateral tibiofemoral compartments respond similarly to incremental load carriage. The purpose of our study was to compare TFJ contact forces when walking with 15% and 30% added body weight. Young healthy adults (n = 24) walked for 5 minutes with no load, 15% load, and 30% load on an instrumented treadmill. Total, medial, and lateral TFJ contact peak forces and impulses were calculated via an inverse dynamics informed musculoskeletal model. Results of 1-way repeated measures analyses of variance (α = .05) demonstrated total, medial, and lateral TFJ first peak contact forces and impulses increased significantly with increasing load. Orthogonal polynomial trends demonstrated that the 30% loading condition led to a curvilinear increase in total and lateral TFJ impulses, whereas medial first peak TFJ contact forces and impulses responded linearly to increasing load. The total and lateral compartment impulse increased disproportionally with load carriage, while the medial did not. The medial and lateral compartments responded differently to increasing load during walking, warranting further investigation because it may relate to risk of osteoarthritis.
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Affiliation(s)
- Blake W Jones
- Department of Kinesiology, East Carolina University, Greenville, NC,USA
- Department of Physical Therapy, East Carolina University, Greenville, NC,USA
| | - John D Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC,USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, NC,USA
| | - Ryan D Wedge
- Department of Physical Therapy, East Carolina University, Greenville, NC,USA
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18
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Reina-Mahecha A, Beers MJ, van der Veen HC, Zuhorn IS, van Kooten TG, Sharma PK. A Review of the Role of Bioreactors for iPSCs-Based Tissue-Engineered Articular Cartilage. Tissue Eng Regen Med 2023; 20:1041-1052. [PMID: 37861960 PMCID: PMC10645985 DOI: 10.1007/s13770-023-00573-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is the most common degenerative joint disease without an ultimate treatment. In a search for novel approaches, tissue engineering (TE) has shown great potential to be an effective way for hyaline cartilage regeneration and repair in advanced stages of OA. Recently, induced pluripotent stem cells (iPSCs) have been appointed to be essential stem cells for degenerative disease treatment because they allow a personalized medicine approach. For clinical translation, bioreactors in combination with iPSCs-engineerd cartilage could match patients needs, serve as platform for large-scale patient specific cartilage production, and be a tool for patient OA modelling and drug screening. Furthermore, to minimize in vivo experiments and improve cell differentiation and cartilage extracellular matrix (ECM) deposition, TE combines existing approaches with bioreactors. METHODS This review summarizes the current understanding of bioreactors and the necessary parameters when they are intended for cartilage TE, focusing on the potential use of iPSCs. RESULTS Bioreactors intended for cartilage TE must resemble the joint cavity niche. However, recreating human synovial joints is not trivial because the interactions between various stimuli are not entirely understood. CONCLUSION The use of mechanical and electrical stimulation to differentiate iPSCs, and maintain and test chondrocytes are key stimuli influencing hyaline cartilage homeostasis. Incorporating these stimuli to bioreactors can positively impact cartilage TE approaches and their possibility for posterior translation into the clinics.
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Affiliation(s)
- Alejandro Reina-Mahecha
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, FB40, Antonius Deusinglaan -1, 9713AV, Groningen, The Netherlands
| | - Martine J Beers
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge S Zuhorn
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, FB40, Antonius Deusinglaan -1, 9713AV, Groningen, The Netherlands
| | - Theo G van Kooten
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, FB40, Antonius Deusinglaan -1, 9713AV, Groningen, The Netherlands
| | - Prashant K Sharma
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, FB40, Antonius Deusinglaan -1, 9713AV, Groningen, The Netherlands.
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19
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Lavikainen J, Stenroth L, Alkjær T, Karjalainen PA, Korhonen RK, Mononen ME. Prediction of Knee Joint Compartmental Loading Maxima Utilizing Simple Subject Characteristics and Neural Networks. Ann Biomed Eng 2023; 51:2479-2489. [PMID: 37335376 PMCID: PMC10598099 DOI: 10.1007/s10439-023-03278-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
Joint loading may affect the development of osteoarthritis, but patient-specific load estimation requires cumbersome motion laboratory equipment. This reliance could be eliminated using artificial neural networks (ANNs) to predict loading from simple input predictors. We used subject-specific musculoskeletal simulations to estimate knee joint contact forces for 290 subjects during over 5000 stance phases of walking and then extracted compartmental and total joint loading maxima from the first and second peaks of the stance phase. We then trained ANN models to predict the loading maxima from predictors that can be measured without motion laboratory equipment (subject mass, height, age, gender, knee abduction-adduction angle, and walking speed). When compared to the target data, our trained models had NRMSEs (RMSEs normalized to the mean of the response variable) between 0.14 and 0.42 and Pearson correlation coefficients between 0.42 and 0.84. The loading maxima were predicted most accurately using the models trained with all predictors. We demonstrated that prediction of knee joint loading maxima may be possible without laboratory-measured motion capture data. This is a promising step in facilitating knee joint loading predictions in simple environments, such as a physician's appointment. In future, the rapid measurement and analysis setup could be utilized to guide patients in rehabilitation to slow development of joint disorders, such as osteoarthritis.
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Affiliation(s)
- Jere Lavikainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Lauri Stenroth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Tine Alkjær
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Pasi A. Karjalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Rami K. Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Mika E. Mononen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
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20
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He K, Lin H, Zhang S, Ou Y, Lu J, Chen W, Zhou Y, Li Y, Lin Y, Su J, Xing Y, Chen H, Chen J. BNTA attenuates temporomandibular joint osteoarthritis progression by directly targeting ALDH3A1: An in vivo and in vitro study. Int Immunopharmacol 2023; 124:110963. [PMID: 37741125 DOI: 10.1016/j.intimp.2023.110963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023]
Abstract
BNTA is known to have a therapeutic effect on knee osteoarthritis and inflammatory osteoclastogenesis. However, the protective effect of BNTA regarding temporomandibular mandibular joint osteoarthritis (TMJOA) and its underlying mechanism and physiological target remains unclear. In the present study, BNTA ameliorated cartilage degradation and inflammation responses in monosodium iodoacetate (MIA)-induced TMJOA in vivo. In IL-1β-induced condylar chondrocytes, BNTA prevents oxidative stress, inflammatory responses and increasing synthesis of cartilage extracellular matrix through activating nuclear factor-E2-related factor 2 (NRF2) signaling. Suppression of NRF2 signaling abolishes the protective effect of BNTA in TMJOA. Notably, BNTA may bind directly to ALDH3A1 and act as a stabilizer, as evidenced by drug affinity responsive target stability assay (DARTS), cellular thermal shift assay (CETSA) and molecular docking results. Further investigation of the underlying molecular and cellular mechanism infers a positive correlation of ALDH3A1 regulating NRF2 signaling. In conclusion, BNTA may attenuate TMJOA progression via the ALDH3A1/NRF2 axis, inferring that BNTA is a therapeutic target for treating temporomandibular mandibular joint osteoarthritis.
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Affiliation(s)
- Kaixun He
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China; Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Hanyu Lin
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China; Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Sihui Zhang
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China; Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Yanjing Ou
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China; Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Jie Lu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Wenqian Chen
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Yuwei Zhou
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Yang Li
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Yanjun Lin
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China; Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Jingjing Su
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Yifeng Xing
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Huachen Chen
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China
| | - Jiang Chen
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China; Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian 350002, PR China.
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21
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Kozakowski J, Dudek P, Zgliczyński W. Obesity in rheumatological practice. Reumatologia 2023; 61:318-325. [PMID: 37745148 PMCID: PMC10515124 DOI: 10.5114/reum/170401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
Obesity is a chronic disease that leads to the development of secondary metabolic disturbances and diseases and strongly contributes to increased morbidity and mortality. On the other hand, musculoskeletal disorders are currently the main cause of disability and the second most frequent reason for visits to the doctor. Many studies clearly show that excessive body weight adversely affects the course of almost all musculoskeletal system diseases, from osteoarthritis, through metabolic, systemic connective tissue, to rarely diagnosed diseases. The impact of increased fat mass on the musculoskeletal system is presumably complex in nature and involves the influence of biomechanical, dietary, genetic, inflammatory and metabolic factors. Due to the epidemic nature of obesity and its serious health consequences, this disease requires energetic treatment. It is always based on lifestyle modification enriched, if necessary, by pharmacological and, in justified cases, surgical treatment.
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Affiliation(s)
- Jarosław Kozakowski
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - Piotr Dudek
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
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22
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Noda M, Adachi K, Takahara S. A Scientific Proposal for Surgical Decision-Making in Occult Intertrochanteric Fractures Based on Finite Element Analysis. Cureus 2023; 15:e44491. [PMID: 37791154 PMCID: PMC10544485 DOI: 10.7759/cureus.44491] [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] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Background In the treatment of femoral intertrochanteric fractures, there is still a lack of consensus on the optimal approach for isolated greater trochanteric fractures and insufficient intertrochanteric fractures. The limited number of patients and restricted access to accurate assessment of fracture extension using magnetic resonance imaging contribute to the unclear treatment strategy. This study aims to utilize finite element (FE) analysis to analyze stress values at the fracture line and investigate their influence on intertrochanteric fracture extension under different loading conditions. The hypothesis is that fracture extension occurs following certain conditions, supporting the need for surgery based on scientific evidence. Methodology Osseous data from a computed tomography (CT) scan was used to create a proximal femur FE model using FEA software. CT scan data were converted to Digital Imaging and Communications in Medicine format and used to generate the FE model. Trabecular bone and cortex were meshed into tetrahedral elements. The model consisted of 1,592,642 elements and 282,530 nodes. Two models were created, namely, healthy proximal femur (HF) and femoral insufficient intertrochanteric fracture (FIF). Material properties were assigned based on CT values and conversion equations. The distal end of the femur was constrained. Stress analysis using the dynamic explicit approach was performed. Von Mises stresses were calculated for the proximal femur. The number of elements exceeding yield stress was counted to predict fracture risk by focusing on fracture line spots. In this study, the distribution of von Mises stress was compared between the HF and the FIF models. Six loading combinations were considered, namely, two weight-bearing conditions (3 W loading simulating for walking and 1/3 W for touch-down standing) and three hip flexion angles (0°, 15°, and 23°). Results Under 3 W loading, no significant stress elevations were observed in the HF model at any flexion angles. However, the FIF model exhibited increased stress at the site of the posterior fracture line extension. This stress-induced element destruction was observed in both cortical and cancellous bone. For the 1/3 W loading condition, only minimal stress elevation was observed in both HF and FIF models. To assess the influence on fracture extension, the number of yielded elements was evaluated along the fracture line edges (greater trochanter and middle of the intertrochanteric ridge). Under 3 W loading, the HF model had only one yielded element, indicating minimal fracture risk. In contrast, the FIF model exhibited a notable presence of yield elements in various regions (total/greater trochanter/shaft) at different flexion angles: 0° (115/16/28), 15° (265/158/23), and 23° (446/233/34). Under the 1/3 W loading condition, neither the HF nor the FIF models showed any yielding elements, regardless of the direction of external force. Conclusions The results demonstrated elevated stress levels at the fracture line in the FIF model, particularly during walking, indicating a higher risk of fracture extension at the flex position. However, under reduced weight-bearing conditions, the stress at the fracture site remained within the yield stress range, suggesting a relatively low risk of fracture extension. These findings hold significant clinical implications for developing surgical protocols that consider patients' compliance with weight-bearing restrictions.
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Affiliation(s)
| | - Kazuhiko Adachi
- Department of Mechanical Engineering, Chubu University, Kasugai, JPN
| | - Shunsuke Takahara
- Department of Orthopaedics, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, JPN
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23
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Thorsen T, Wen C, Porter J, Reinbolt JA, Weinhandl JT, Zhang S. Do Interlimb Knee Joint Loading Asymmetries Persist throughout Stance during Uphill Walking Following Total Knee Arthroplasty? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6341. [PMID: 37510574 PMCID: PMC10378950 DOI: 10.3390/ijerph20146341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
The purpose of this study was to determine differences in total (TCF), medial compartment (MCF), and lateral compartment (LCF) tibiofemoral joint compressive forces and related muscle forces between replaced and non-replaced limbs during level and uphill walking at an incline of 10°. A musculoskeletal modeling and simulation approach using static optimization was used to determine the muscle forces and TCF, MCF, and LCF for 25 patients with primary TKA. A statistical parametric mapping repeated-measures ANOVA was conducted on knee compressive forces and muscle forces using statistical parametric mapping. Greater TCF, MCF, and LCF values were observed throughout the loading response, mid-stance, and late stance during uphill walking. During level walking, knee extensor muscle forces were greater throughout the first 50% of the stance during level walking, yet greater during uphill walking during the last 50% of the stance. Conversely, knee flexor muscle forces were greater through the loading response and push-off phases of the stance. No between-limb differences were observed for compressive or muscle forces, suggesting that uphill walking may promote a more balanced loading of replaced and non-replaced limbs. Additionally, patients with TKA appear to rely on the hamstrings muscle group during the late stance for knee joint control, thus supporting uphill walking as an effective exercise modality to improve posterior chain muscle strength.
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Affiliation(s)
- Tanner Thorsen
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Chen Wen
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Jared Porter
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Jeffery A Reinbolt
- Department of Mechanical, Aerospace, and Biomedical Engineering, The University of Tennessee, Knoxville, TN 37996, USA
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
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24
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Kaneda JM, Seagers KA, Uhlrich SD, Kolesar JA, Thomas KA, Delp SL. Can static optimization detect changes in peak medial knee contact forces induced by gait modifications? J Biomech 2023; 152:111569. [PMID: 37058768 PMCID: PMC10231980 DOI: 10.1016/j.jbiomech.2023.111569] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/13/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
Medial knee contact force (MCF) is related to the pathomechanics of medial knee osteoarthritis. However, MCF cannot be directly measured in the native knee, making it difficult for therapeutic gait modifications to target this metric. Static optimization, a musculoskeletal simulation technique, can estimate MCF, but there has been little work validating its ability to detect changes in MCF induced by gait modifications. In this study, we quantified the error in MCF estimates from static optimization compared to measurements from instrumented knee replacements during normal walking and seven different gait modifications. We then identified minimum magnitudes of simulated MCF changes for which static optimization correctly identified the direction of change (i.e., whether MCF increased or decreased) at least 70% of the time. A full-body musculoskeletal model with a multi-compartment knee and static optimization was used to estimate MCF. Simulations were evaluated using experimental data from three subjects with instrumented knee replacements who walked with various gait modifications for a total of 115 steps. Static optimization underpredicted the first peak (mean absolute error = 0.16 bodyweights) and overpredicted the second peak (mean absolute error = 0.31 bodyweights) of MCF. Average root mean square error in MCF over stance phase was 0.32 bodyweights. Static optimization detected the direction of change with at least 70% accuracy for early-stance reductions, late-stance reductions, and early-stance increases in peak MCF of at least 0.10 bodyweights. These results suggest that a static optimization approach accurately detects the direction of change in early-stance medial knee loading, potentially making it a valuable tool for evaluating the biomechanical efficacy of gait modifications for knee osteoarthritis.
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Affiliation(s)
- Janelle M Kaneda
- Department of Bioengineering, Stanford University, Stanford, CA, United States.
| | - Kirsten A Seagers
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Scott D Uhlrich
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Julie A Kolesar
- Department of Bioengineering, Stanford University, Stanford, CA, United States; Musculoskeletal Research Lab, VA Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Kevin A Thomas
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Scott L Delp
- Department of Bioengineering, Stanford University, Stanford, CA, United States; Department of Mechanical Engineering, Stanford University, Stanford, CA, United States; Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
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25
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Alonso MG, Yawny A, Bertolino G. A numerical study towards shape memory alloys application in orthotic management of pediatric knee lateral deviations. Sci Rep 2023; 13:2134. [PMID: 36747043 PMCID: PMC9902535 DOI: 10.1038/s41598-023-29254-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Exerting a constant load would likely improve orthosis effectiveness in treating knee lateral deviations during childhood and early adolescence. Shape memory alloys are potential candidates for such applications due to their so called pseudoelastic effect. The present study aims to quantitatively define the applicable mechanical loads, in order to reduce treatment duration while avoiding tissular damage and patient discomfort. This is essential for performing a more efficient design of correction devices. We use a patient-specific finite elements model of a pediatric knee to determine safe loading levels. The achievable correction rates are estimated using a stochastic three-dimensional growth model. Results are compared against those obtained for a mechanical stimulus decreasing in proportion to the achieved correction, emulating the behavior of conventional orthoses. A constant flexor moment of 1.1 Nm is estimated to change femorotibial angle at a rate of (7.4 ± 4.6) deg/year (mean ± std). This rate is similar to the achieved by more invasive growth modulation methods, and represents an improvement in the order of 25% in the necessary time for reducing deformities of (10 ± 5) deg by half, as compared with conventional orthoses.
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Affiliation(s)
- M G Alonso
- División Física de Metales, CNEA, 8400, Bariloche, Argentina.
- Instituto Balseiro, Universidad Nacional de Cuyo, Bariloche, Argentina.
| | - A Yawny
- División Física de Metales, CNEA, 8400, Bariloche, Argentina
- Instituto Balseiro, Universidad Nacional de Cuyo, Bariloche, Argentina
- CONICET, Patagonia Norte, 8400, Bariloche, Argentina
| | - G Bertolino
- División Física de Metales, CNEA, 8400, Bariloche, Argentina
- Instituto Balseiro, Universidad Nacional de Cuyo, Bariloche, Argentina
- CONICET, Patagonia Norte, 8400, Bariloche, Argentina
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26
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Kainz H, Jonkers I. Imaging-based musculoskeletal models alter muscle and joint contact forces but do not improve the agreement with experimentally measured electromyography signals in children with cerebral palsy. Gait Posture 2023; 100:91-95. [PMID: 36502666 DOI: 10.1016/j.gaitpost.2022.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Musculoskeletal simulations are used to estimate muscle-tendon and joint contact forces (JCF). Personalizing the model's femoral geometry has been shown to improve the accuracy of JCF calculations. It is, however, unknown if the personalized geometry improves the agreement between estimated muscle activations and experimentally measured electromyography (EMG) signals. RESEARCH QUESTION Does personalizing the musculoskeletal geometry improve the agreement between estimated muscle activations and EMG signals in terms of timing? METHODS We retrospectively analysed data from Bosmans et al. [5], which included three-dimensional motion capture data, EMG signals of eight lower limb muscles on each leg, and magnetic resonance imaging (MRI) data from seven children with cerebral palsy. For each patient we created a generic-scaled model and MRI-based model, which accounted for the subject-specific musculoskeletal geometry. We calculated muscle activations, muscle-tendon forces and JCF. Muscle activations were compared to the EMG signals using coefficient of determination and cosines similarity. RESULTS MRI-based models altered the magnitude of muscle activations and had a large impact on JCF but did not change the muscle activations profiles and therefore did not improve the agreement with EMG signals. SIGNIFICANCE MRI-based models do not alter the shape of muscle activations. Hence, if detailed muscle activations are a desired output of the simulations, EMG-informed modeling approaches should be used for musculoskeletal simulation in children with cerebral palsy. Furthermore, our study highlighted that altered JCF does not necessarily mean accurate muscle activations. To improve patient-specific simulations, future work should focus on developing methods to estimate cost functions representative for the neural control of children with cerebral palsy.
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Affiliation(s)
- Hans Kainz
- Centre for Sport Science and University Sports, Department of Biomechanics, Kinesiology and Computer Science in Sport, Neuromechanics Research Group, University of Vienna, Austria.
| | - Ilse Jonkers
- Department of Movement Science, Human Movement Biomechanics Research Group, KU Leuven, Belgium
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27
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Bengler K, Harbauer CM, Fleischer M. Exoskeletons: A challenge for development. WEARABLE TECHNOLOGIES 2023; 4:e1. [PMID: 38487778 PMCID: PMC10936272 DOI: 10.1017/wtc.2022.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 03/17/2024]
Abstract
The development of exoskeletons is currently a lengthy process full of challenges. We are proposing a framework to accelerate the process and make the resulting exoskeletons more user-centered. The needed accomplishments in science are described in an effort to lay the foundation for future research projects. Since the early 2000s, exoskeletons have been discussed as an emerging technology in industrial, medical, or military applications. Those systems are designed to support people during manual tasks. At first, those systems lacked broad acceptance. Many models found their niches in ongoing developments and more diverse systems entering the market. There are still applications that are in dire need of such assistance. Due to the lack of experience with body-worn robotics, the development of such systems has been shaped by trial and error. The lack of legacy products results in longer development times. In this paper, a process to generate a framework is presented to display the required research to enable future exoskeleton designers. Owing to their proximity to the user's body, exoskeletons are highly complex systems that need sophisticated subsystems, such as kinematic, control, interaction design, or actuators, to be accepted by users. Due to the wide variety of fields and high user demands, a synchronized multidisciplinary effort is necessary. To achieve this, a process to develop a modular framework for exoskeleton design is proposed. It focuses on user- and use-case-centered solutions for matching kinematics, actuation, and control. To ensure the usefulness of the framework, an evaluation of the incorporated solutions is required.
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Affiliation(s)
- Klaus Bengler
- Chair of Ergonomics, TUM School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Christina M. Harbauer
- Chair of Ergonomics, TUM School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Martin Fleischer
- Chair of Ergonomics, TUM School of Engineering and Design, Technical University of Munich, Munich, Germany
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28
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Yang B, Li X, Fu C, Cai W, Meng B, Qu Y, Kou X, Zhang Q. Extracellular vesicles in osteoarthritis of peripheral joint and temporomandibular joint. Front Endocrinol (Lausanne) 2023; 14:1158744. [PMID: 36950682 PMCID: PMC10025484 DOI: 10.3389/fendo.2023.1158744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Osteoarthritis (OA) is a disabling disease with significant morbidity worldwide. OA attacks the large synovial joint, including the peripheral joints and temporomandibular joint (TMJ). As a representative of peripheral joint OA, knee OA shares similar symptoms with TMJ OA. However, these two joints also display differences based on their distinct development, anatomy, and physiology. Extracellular vesicles (EVs) are phospholipid bilayer nanoparticles, including exosomes, microvesicles, and apoptotic bodies. EVs contain proteins, lipids, DNA, micro-RNA, and mRNA that regulate tissue homeostasis and cell-to-cell communication, which play an essential role in the progression and treatment of OA. They are likely to partake in mechanical response, extracellular matrix degradation, and inflammatory regulation during OA. More evidence has shown that synovial fluid and synovium-derived EVs may serve as OA biomarkers. More importantly, mesenchymal stem cell-derived EV shows a therapeutic effect on OA. However, the different function of EVs in these two joints is largely unknown based on their distinct biological characteristic. Here, we reviewed the effects of EVs in OA progression and compared the difference between the knee joint and TMJ, and summarized their potential therapeutic role in the treatment of OA.
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Affiliation(s)
- Benyi Yang
- Guangdong Provincial Key Laboratory of Stomatology Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, South China Center of Craniofacial Stem Cell Research, Guangzhou, China
| | - Xin Li
- Department of Temporomandibular Joint, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou, China
| | - Chaoran Fu
- Guangdong Provincial Key Laboratory of Stomatology Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, South China Center of Craniofacial Stem Cell Research, Guangzhou, China
| | - Wenyi Cai
- Department of Temporomandibular Joint, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou, China
| | - Bowen Meng
- Guangdong Provincial Key Laboratory of Stomatology Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, South China Center of Craniofacial Stem Cell Research, Guangzhou, China
| | - Yan Qu
- Guangdong Provincial Key Laboratory of Stomatology Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, South China Center of Craniofacial Stem Cell Research, Guangzhou, China
| | - Xiaoxing Kou
- Guangdong Provincial Key Laboratory of Stomatology Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, South China Center of Craniofacial Stem Cell Research, Guangzhou, China
- *Correspondence: Qingbin Zhang, ; Xiaoxing Kou,
| | - Qingbin Zhang
- Department of Temporomandibular Joint, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou, China
- *Correspondence: Qingbin Zhang, ; Xiaoxing Kou,
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29
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Daugulis P, Kataševs A, Okss A. Estimation of the knee joint load using plantar pressure data measured by smart socks: A feasibility study. Technol Health Care 2023; 31:2423-2434. [PMID: 38042996 DOI: 10.3233/thc-235008] [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] [Indexed: 12/04/2023]
Abstract
BACKGROUND Unsupervised sports activities could cause traumas, about 70% of them are those of the low extremities. To avoid traumas, the athlete should be aware of dangerous forces acting within low extremity joints. Research in gait analysis indicated that plantar pressure alteration rate correlates with the gait pace. Thus, the changes in plantar pressure should correlate with the accelerations of extremities, and with the forces, acting in the joints. Smart socks provide a budget solution for the measurement of plantar pressure. OBJECTIVE To estimate the correlation between the plantar pressure, measured using smart socks, and forces, acting in the joints of the lower extremities. METHODS The research is case study based. The volunteer performed a set of squats. The arbitrary plantar pressure-related data were obtained using originally developed smart socks with embedded knitted pressure sensors. Simultaneously, the lower extremity motion data were recorded using two inertial measurement units, attached to the tight and the ankle, from which the forces acted in the knee joint were estimated. The simplest possible model of knee joint mechanics was used to estimate force. RESULTS The estimates of the plantar pressure and knee joint forces demonstrate a strong correlation (r= 0.75, P< 0.001). The established linear regression equation enables the calculation of the knee joint force with an uncertainty of 22% using the plantar pressure estimate. The accuracy of the classification of the joint force as excessive, i.e., being more than 90% of the maximal force, was 82%. CONCLUSION The results demonstrate the feasibility of the smart socks for the estimation of the forces in the knee joints. Smart socks therefore could be used to develop excessive joint force alert devices, that could replace less convenient inertial sensors.
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Affiliation(s)
- Pauls Daugulis
- Institute of Biomedical Engineering and Nanotechnologies, Riga Technical University, Riga, Latvia
| | - Aleksejs Kataševs
- Institute of Biomedical Engineering and Nanotechnologies, Riga Technical University, Riga, Latvia
| | - Aleksandrs Okss
- Institute of Design Technologies, Riga Technical University, Riga, Latvia
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30
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Sinclair J, Huang G, Taylor PJ, Chockalingam N, Fan Y. Effects of Running in Minimal and Conventional Footwear on Medial Tibiofemoral Cartilage Failure Probability in Habitual and Non-Habitual Users. J Clin Med 2022; 11:jcm11247335. [PMID: 36555951 PMCID: PMC9788348 DOI: 10.3390/jcm11247335] [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: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
This study examined the effects of minimal and conventional running footwear on medial tibiofemoral cartilage mechanics and longitudinal failure probability. The current investigation examined twenty males who habitually ran in minimal footwear and 20 males who habitually ran in conventional footwear. Kinematic data during overground running were collected using a motion-capture system and ground reaction forces using a force plate. Medial tibiofemoral loading was examined using musculoskeletal simulation and cartilage failure probability via probabilistic modelling. In habitual minimal footwear users, peak medial tibiofemoral cartilage force, stress and strain were significantly greater in conventional (force = 7.43 BW, stress = 5.12 MPa and strain = 0.30), compared to minimal footwear (force = 7.11 BW, stress 4.65 MPa and strain = 0.28), though no significant differences in these parameters were evident in non-habitual minimal footwear users (conventional: force = 7.50 BW, stress = 5.05 MPa and strain = 0.30; minimal: force = 7.40 BW, stress = 4.77 MPa and strain = 0.29). However, in both habitual and non-habitual minimal footwear users, the probability of medial tibiofemoral cartilage failure was significantly greater in conventional (habitual = 47.19% and non-habitual = 50.00%) compared to minimal footwear (habitual = 33.18% and non-habitual = 32.81%) users. The observations from this investigation show that compared to minimal footwear, conventional footwear appears to have a negative influence on medial tibiofemoral cartilage health.
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Affiliation(s)
- Jonathan Sinclair
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, Lancashire, UK
- Correspondence: (J.S.); (G.H.)
| | - Guohao Huang
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou 350117, China
- Correspondence: (J.S.); (G.H.)
| | - Paul John Taylor
- School of Psychology & Computer Sciences, Faculty of Science and Technology, University of Central Lancashire, Preston PR1 2HE, Lancashire, UK
| | | | - Yifang Fan
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou 350117, China
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31
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Nigg BM, Subramanium A, Matijevich ES. Towards a biomechanical understanding of performance improvement with advanced running shoes. FOOTWEAR SCIENCE 2022. [DOI: 10.1080/19424280.2022.2127543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- B. M. Nigg
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - A. Subramanium
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - E. S. Matijevich
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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32
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Ledet EH, Caparaso SM, Stout M, Cole KP, Liddle B, Cady NC, Archdeacon MT. Smart fracture plate for quantifying fracture healing: Preliminary efficacy in a biomechanical model. J Orthop Res 2022; 40:2414-2420. [PMID: 34989023 DOI: 10.1002/jor.25254] [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: 03/08/2021] [Revised: 10/31/2021] [Accepted: 12/19/2021] [Indexed: 02/04/2023]
Abstract
The diagnosis of fracture nonunion following plate osteosynthesis is subjective and frequently ambiguous. Initially following osteosynthesis, loads applied to the bone are primarily transmitted through the plate. However, as callus stiffness increases, the callus is able to bear load proportional to its stiffness while forces through the plate decrease. The purpose of this study was to use a "smart" fracture plate to distinguish between phases of fracture healing by measuring forces transmitted through the plate. A wireless force sensor and small adapter were placed on the outside of a distal femoral locking plate. The adapter converts the slight bending of the plate under axial load into a transverse force which is measurable by the sensor. An osteotomy was created and then plated in the distal femur of biomechanical Sawbones. Specimens were loaded to simulate single-leg stance first with the osteotomy defect empty (acute healing), then sequentially filled with silicone (early callus) and then polymethyl methacrylate (hard callus). There was a strong correlation between applied axial load and force measured by the "smart" plate. Data demonstrate statistically significant differences between each phase of healing with as little as 150 N of axial load applied to the femur. Forces measured in the plate were significantly different between acute (100%), early callus (66.4%), and hard callus (29.5%). This study demonstrates the potential of a "smart" fracture plate to distinguish between phases of healing. These objective data may enable early diagnosis of nonunion and enhance outcomes for patients.
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Affiliation(s)
- Eric H Ledet
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute & Research and Development Service, Stratton VA Medical Center, Albany, New York, USA
| | - Sydney M Caparaso
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Madelyn Stout
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Keegan P Cole
- Division of Orthopaedic Surgery, Albany Medical College, Albany, New York, USA
| | - Benjamin Liddle
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Nathaniel C Cady
- Department of Nanobio Science, State University of New York Polytechnic Institute, Utica, New York, USA
| | - Michael T Archdeacon
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Ahmad Muslim MY, Draman MR, Merican AM, Chong DYR. Changes in the Tibial Strain After Proximal Fibular Osteotomy: A Biomechanical Cadaveric Study. Orthopedics 2022; 45:314-319. [PMID: 35576486 DOI: 10.3928/01477447-20220511-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Total knee arthroplasty surgery is an increasingly common procedure for the treatment of uni- and tricompartmental knee osteoarthritis, particularly in advanced stages and in the older population. Its usage is being extended to younger patients, where implant longevity is of concern. In the younger age group, especially with early disease, other options merit consideration. On the other hand, it may not be possible for elderly patients with medical comorbidities to undergo joint replacement surgery. Proximal fibular osteotomy (PFO) has recently been advocated to treat medial knee osteoarthritis. Although there have been clinical reports showing promising outcomes, the biomechanical basis of this procedure is still unclear. We performed a cadaveric study to investigate the effect of PFO on proximal tibial strain. Eight unpaired cadaveric lower limb specimens were loaded in compression at 2 times body weight. Strain gauges were mounted on various sites on the proximal tibia and fibula. After PFO, there was a significant increase in the lateral tibial strain adjacent to the proximal tibiofibular joint (P<.05). There was moderate effect size reduction in the anteromedial tibial strain as well as moderate effect size increase in the posterior tibial strain. The strain reduction seen at the anteromedial tibia can offer a possible explanation for symptomatic relief after PFO. However, the increase in the lateral and posterior tibial strain raises concern about long-term accelerated wear in these regions. [Orthopedics. 2022;45(5):314-319.].
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Bär M, Luger T, Seibt R, Gabriel J, Rieger MA, Steinhilber B. Effects of a Passive Back-Support Exoskeleton on Knee Joint Loading during Simulated Static Sorting and Dynamic Lifting Tasks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9965. [PMID: 36011596 PMCID: PMC9408483 DOI: 10.3390/ijerph19169965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Due to the load shifting mechanism of many back-support exoskeletons (BSEs), this study evaluated possible side effects of using a BSE on knee joint loading. Twenty-nine subjects (25.9 (±4.4) years, 179.0 (±6.5) cm; 73.6 (±9.4) kg) performed simulated static sorting and dynamic lifting tasks, including stoop and squat styles and different trunk rotation postures. Ground reaction force, body posture and the force between the chest and the BSE's contact interface were recorded using a force plate, two-dimensional gravimetric position sensors, and a built-in force sensor of the BSE, respectively. Using these parameters and the subject's anthropometry, median and 90th percentile horizontal (HOR50, HOR90) and vertical (VERT50, VERT90) tibiofemoral forces were calculated via a self-developed inverse quasi-static biomechanical model. BSE use had a variable effect on HOR50 dependent on the working task and body posture. Generally, VERT50 increased without significant interaction effects with posture or task. HOR90 and VERT90 were not affected by using the BSE. In conclusion, utilizing the investigated exoskeleton is likely to induce side effects in terms of changed knee joint loading. This may depend on the applied working task and the user's body posture. The role of these changes in the context of a negative contribution to work-related cumulative knee exposures should be addressed by future research.
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Chen WM, Yu Y, Geng X, Wang C, Chen L, Ma X. Modulation of internal tissue stresses of the knee via control of variable-stiffness properties in a 3D-printed footwear: A combined experimental and finite element analysis. Med Eng Phys 2022; 104:103800. [DOI: 10.1016/j.medengphy.2022.103800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 03/19/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
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Kuptniratsaikul V, Chaiworapuek W, Kovintaset K, Meesawang M, Chinsawangwatanakul P, Danoi A. Pain management and strength gains compared between pneumatic partial weight support treadmill and underwater treadmill in overweight patients with knee osteoarthritis: A randomized controlled trial. Clin Rehabil 2022; 36:1214-1228. [PMID: 35506932 DOI: 10.1177/02692155221097032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the efficacy of the pneumatic partial weight support treadmill compared to the underwater treadmill (UTM) for reducing pain and increasing quadriceps strength in overweight patients with knee osteoarthritis. DESIGN Non-inferiority trial with a pre-specified 1-point range. METHODS Participants (N = 109) were randomly assigned to the study (pneumatic partial weight support treadmill) (n = 55) or control (UTM) (n = 54) groups. Patients in both groups started with 50% weight support during the first week, 40% during the second week, and 30% during the third week and until the end of the study. Both groups received exercise for 30 min, 3 times per week for 8 weeks (24 sessions). Outcome measurements, including numerical pain rating scale, Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, quadriceps strength, body weight, 6-min walking test, and quality of life, were evaluated at baseline, 8 weeks, and 12 weeks. RESULTS Only 74 participants completed the study. Numerical pain rating scale and the Western Ontario and McMaster Universities Osteoarthritis Index showed non-inferiority of the study to control group. Improvement in quadriceps strength was significantly greater in the study than in control group. Adverse events were not significantly different between groups. Most subjects were satisfied and rated themselves as improved or much improved. Approximately three-quarters of participants attended more than 20 sessions, and there was no significant difference in outcomes between good and poor compliance. CONCLUSION Pneumatic partial weight support treadmill can significantly decrease pain non-inferior to UTM, and can significantly increase quadriceps strength compared to UTM.
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Affiliation(s)
- V Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
| | - W Chaiworapuek
- Department of Mechanical Engineering, Faculty of Engineering, 122106Kasetsart University, Bangkok, Thailand
| | - K Kovintaset
- Division of Physical Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
| | - M Meesawang
- Division of Physical Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
| | - P Chinsawangwatanakul
- Research Group and Research Network Division, Research Department, Faculty of Medicine Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
| | - A Danoi
- Division of Surgical Nursing, Department of Nursing, Siriraj Hospital, Bangkok, Thailand
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Aghdam HA, Haghighat F, Rezaee MR, Kavyani M, Karimi MT. Comparison of the knee joint reaction force between individuals with and without acute anterior cruciate ligament rupture during walking. J Orthop Surg Res 2022; 17:250. [PMID: 35505440 PMCID: PMC9066915 DOI: 10.1186/s13018-022-03136-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background Anterior cruciate ligament plays a significant role in knee joint stability. It is claimed that the incidence of knee osteoarthritis increases in individuals with anterior cruciate ligament (ACL) rupture. The aim of this study was to evaluate the knee joints reaction force in ACL rupture group compared to normal subjects.
Method Fifteen patients with acute ACL rupture and 15 healthy subjects participated in this study. The ground reaction force (GRF) and kinematic data were collected at a sampling rate of 120 Hz during level-ground walking. Spatiotemporal parameters, joint angles, muscle forces and moments, and joint reaction force (JRF) of lower extremity were analyzed by OpenSIM software. Results The hip, knee and ankle joints reaction force at loading response and push-off intervals of the stance phase during walking was significantly higher in individuals with ACL rupture compared to healthy controls (p value < 0.05). Walking velocity (p value < 0.001), knee (p value = 0.065) and ankle (p value = 0.001) range of motion in the sagittal plane were significantly lower in the patients with ACL rupture compared to healthy subjects. The mean value of vertical GRF in the mid-stance, the peak of the hip adduction moment in loading response and push-off phases, the hip abductor, knee flexor and vastus intermedius part of quadriceps muscle forces were significantly higher compared to healthy subjects (p < 0.05) while vastus medialis and vastus lateralis produced significantly lower force (p < 0.001). Conclusions Based on results of this study, lower limb JRF was higher in those with ACL rupture compared to healthy subjects may be due to the compensatory mechanisms used by this group of subjects. An increase in knee JRF in patients with ACL rupture may be the reason for the high incidence of knee OA.
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Affiliation(s)
- Hossein Akbari Aghdam
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Haghighat
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Rezaee
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Kavyani
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Taghi Karimi
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Effect of Assistance Using a Bilateral Robotic Knee Exoskeleton on Tibiofemoral Force Using a Neuromuscular Model. Ann Biomed Eng 2022; 50:716-727. [PMID: 35344119 DOI: 10.1007/s10439-022-02950-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 03/13/2022] [Indexed: 11/01/2022]
Abstract
Tibiofemoral compression forces present during locomotion can result in high stress and risk damage to the knee. Powered assistance using a knee exoskeleton may reduce the knee load by reducing the work required by the muscles. However, the exact effect of assistance on the tibiofemoral force is unknown. The goal of this study was to investigate the effect of knee extension assistance during the early stance phase on the tibiofemoral force. Nine able-bodied adults walked on an inclined treadmill with a bilateral knee exoskeleton with assistance and with no assistance. Using an EMG-informed neuromusculoskeletal model, muscle forces were estimated, then utilized to estimate the tibiofemoral contact force. Results showed a 28% reduction in the knee moment, which resulted in approximately a 15% decrease in knee extensor muscle activation and a 20% reduction in subsequent muscle force, leading to a significant 10% reduction in peak and 9% reduction in average tibiofemoral contact force during the early stance phase (p < 0.05). The results indicate the tibiofemoral force is highly dependent on the knee kinetics and quadricep muscle activation due to their influence on knee extensor muscle forces, the primary contributor to the knee load.
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Etoundi AC, Dobner A, Agrawal S, Semasinghe CL, Georgilas I, Jafari A. A Robotic Test Rig for Performance Assessment of Prosthetic Joints. Front Robot AI 2022; 8:613579. [PMID: 35321419 PMCID: PMC8936071 DOI: 10.3389/frobt.2021.613579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
Movement within the human body is made possible by joints connecting two or more elements of the musculoskeletal system. Losing one or more of these connections can seriously limit mobility, which in turn can lead to depression and other mental issues. This is particularly pertinent due to a dramatic increase in the number of lower limb amputations resulting from trauma and diseases such as diabetes. The ideal prostheses should re-establish the functions and movement of the missing body part of the patient. As a result, the prosthetic solution has to be tested stringently to ensure effective and reliable usage. This paper elaborates on the development, features, and suitability of a testing rig that can evaluate the performance of prosthetic and robotic joints via cyclic dynamic loading on their complex movements. To establish the rig’s validity, the knee joint was chosen as it provides both compound support and movement, making it one of the major joints within the human body, and an excellent subject to ensure the quality of the prosthesis. Within the rig system, a motorised lead-screw simulates the actuation provided by the hamstring-quadricep antagonist muscle pair and the flexion experienced by the joint. Loads and position are monitored by a load cell and proximity sensors respectively, ensuring the dynamics conform with the geometric model and gait analysis. Background: Robotics, Prosthetics, Mechatronics, Assisted Living. Methods: Gait Analysis, Computer Aided Design, Geometry Models. Conclusion: Modular Device, Streamlining Rehabilitation.
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Affiliation(s)
- Appolinaire C. Etoundi
- Bristol Robotics Laboratory, Department of Engineering Design and Mathematics, University of the West of England, Bristol, United Kingdom
- *Correspondence: Appolinaire C. Etoundi,
| | - Alexander Dobner
- Bristol Robotics Laboratory, Department of Engineering Design and Mathematics, University of the West of England, Bristol, United Kingdom
| | - Subham Agrawal
- Bristol Robotics Laboratory, Department of Engineering Design and Mathematics, University of the West of England, Bristol, United Kingdom
| | - Chathura L. Semasinghe
- Bristol Robotics Laboratory, Department of Engineering Design and Mathematics, University of the West of England, Bristol, United Kingdom
| | - Ioannis Georgilas
- Department of Mechanical Engineering, University of Bath, Bath, United Kingdom
| | - Aghil Jafari
- Bristol Robotics Laboratory, Department of Engineering Design and Mathematics, University of the West of England, Bristol, United Kingdom
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Pedersen JR, Skou ST, Roos EM, Shakoor N, Thorlund JB. Changes in medial-to-lateral knee joint loading patterns assessed by Dual-Energy X-ray Absorptiometry following supervised neuromuscular exercise therapy and patient education in patients with knee osteoarthritis: an exploratory cohort study. Physiother Theory Pract 2022; 39:1205-1214. [PMID: 35139736 DOI: 10.1080/09593985.2022.2036885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The mechanisms underlying pain reductions following exercise therapy in patients with knee osteoarthritis (OA) are poorly understood. One mechanism could be changes in mechanical knee joint loading. OBJECTIVE To investigate if a neuromuscular exercise therapy and patient education intervention could alter knee joint loading assessed by Dual-Energy X-ray Absorptiometry (DXA) in people with knee OA. METHODS Participants with symptomatic knee OA were evaluated before and 26 weeks after an 8-week supervised neuromuscular exercise therapy and patient education intervention (Good Life with OsteoArthritis in Denmark). DXA scans were used to estimate the medial-to-lateral tibial plateau bone mineral density (BMD) ratio. The Knee Injury and Osteoarthritis Outcome Score was used to assess improvements in knee pain, symptoms, physical function, and knee-related quality of life. Changes in physical function were assessed with the 30-second chair stand test and the 40-meter fast paced walk test. RESULTS Of 42 participants recruited, 30 (21 females, mean age 64 ± 7.9 years) had full data available. Medial-to-lateral tibial BMD ratio increased non-significantly by 0.02 (95% CI -0.01 to 0.06) (indicating higher medial load) from baseline to 26-weeks follow-up. Participants had statistically significant improvements of 21% in pain, 17% in symptoms, 14% in ADL, 17% in knee-related quality of life, 13% in chair stand ability, and 6% in walking speed. CONCLUSIONS In this exploratory cohort study, following an 8-weeks supervised exercise therapy and patient education intervention, the medial-to-lateral tibial BMD ratio did not seem to change.
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Affiliation(s)
- Julie Rønne Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Najia Shakoor
- Department of Internal Medicine, Division of Rheumatology Rush University Medical Center, Chicago, IL, USA
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Thamyongkit S, Abbasi P, Parks BG, Shafiq B, Hasenboehler EA. Weightbearing after combined medial and lateral plate fixation of AO/OTA 41-C2 bicondylar tibial plateau fractures: a biomechanical study. BMC Musculoskelet Disord 2022; 23:86. [PMID: 35078451 PMCID: PMC8790864 DOI: 10.1186/s12891-022-05024-2] [Citation(s) in RCA: 2] [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: 01/27/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Combined medial and lateral plate fixation is recommended for complex tibial plateau fractures with medial fragments or no cortical bone contact. Although such fixation is adequate to resist forces during range of motion, it may be insufficient to support immediate postoperative weightbearing. Here, we analyzed displacement, stiffness, and fixation failure during simulated full weightbearing of bicondylar tibial plateau fractures treated with combined medial and lateral locking plate fixation. Methods We used 10 fresh-frozen adult human cadaveric tibias and mated femurs. Osteotomies were performed with an oscillating saw and cutting template to simulate an AO Foundation and Orthopaedic Trauma Association (AO/OTA) 41-C2 fracture (simple articular, multifragmentary metaphyseal fracture). Specimens were anatomically reduced and stabilized with combined medial and lateral locking plates (AxSOS, Stryker, Mahwah, NJ). Specimens were loaded axially to simulate 4 weeks of walking in a person weighing 70 kg. The specimens were cyclically loaded from 200 N to a maximum of 2800 N. Then, if no failure, loading continued for 200,000 cycles. We measured displacement of each bone fragment and defined fixation failure as ≥5 mm of displacement. Construct stiffness and load at failure were calculated. Categorical and continuous data were analyzed using Chi-squared and unpaired t-tests, respectively. Results Mean total displacement values after 10,000 loading cycles were as follows: lateral, 0.4 ± 0.8 mm; proximal medial, 0.3 ± 0.7 mm; distal medial, 0.3 ± 0.6 mm; and central 0.4 ± 0.5 mm. Mean stiffness of the construct was 562 ± 164 N/mm. Fixation failure occurred in 6 of 10 specimens that reached 5 mm of plastic deformation before test completion. In the failure group, the mean load at failure was 2467 ± 532 N, and the mean number of cycles before failure was 53,155. After test completion, the greatest displacement was found at the distal medial fracture site (2.3 ± 1.4 mm) and lateral fracture site (2.2 ± 1.7 mm). Conclusions Although combined medial and lateral plate fixation of complex tibial plateau fractures provides adequate stability to allow early range of motion, immediate full weightbearing is not recommended.
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Affiliation(s)
- Sorawut Thamyongkit
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA.,Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pooyan Abbasi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Brent G Parks
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA
| | - Erik A Hasenboehler
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA.
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Wen C, Cates HE, Weinhandl JT, Crouter SE, Zhang S. Knee biomechanics of patients with total knee replacement during downhill walking on different slopes. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:50-57. [PMID: 33540108 PMCID: PMC8847919 DOI: 10.1016/j.jshs.2021.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/29/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to compare knee biomechanics of the replaced limb to the non-replaced limb of total knee replacement (TKR) patients and healthy controls during walking on level ground and on decline surfaces of 5°, 10°, and 15°. METHODS Twenty-five TKR patients and 10 healthy controls performed 5 walking trials on different decline slopes on a force platform and an instrumented ramp system. Two analyses of variance, 2 × 2 (limb × group) and 2 × 4 (limb × decline slope), were used to examine selected biomechanics variables. RESULTS The replaced limb of TKR patients had lower peak loading-response and push-off knee extension moment than the non-replaced and the matched limb of healthy controls. No differences were found in loading-response and push-off knee internal abduction moments among replaced, non-replaced, and matched limb of healthy controls. The knee flexion range of motion, peak loading-response vertical ground reaction force, and peak knee extension moment increased across all slope comparisons between 0° and 15° in both the replaced and non-replaced limb of TKR patients. CONCLUSION Downhill walking may not be appropriate to include in early stage rehabilitation exercise protocols for TKR patients.
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Affiliation(s)
- Chen Wen
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA
| | | | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA
| | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA
| | - Songning Zhang
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA.
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Kaynak G, Karaismailoglu B, Ozsahin MK, Gorgun B, Inan M, Erdogan F. High hip center arthroplasty in the treatment of severe hip dysplasia: Are knee and ankle compromised? Clin Biomech (Bristol, Avon) 2022; 91:105542. [PMID: 34861496 DOI: 10.1016/j.clinbiomech.2021.105542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited information about the effect of hip center location on gait parameters of knee and ankle. This study aimed to compare anatomical vs. high hip center arthroplasty according to gait parameters of knee and ankle and investigate whether the high hip center has any adverse effect on these joints or not. METHODS 20 patients who underwent unilateral total hip arthroplasty (Group 1; 10 patients with anatomical reconstruction, Group 2; 10 patients with high hip center) due to Crowe type III-IV developmental dysplasia of the hip and completed 2 years of follow-up were included. The patients were examined by 3-D gait analysis. FINDINGS The maximum extension of the knee on the operated side was lower in Group 2 (p = 0.044). Longitudinal knee joint force was higher in Group 2 on both operated (p = 0.041) and non-operated sides (p = 0.031). Lateral knee joint force was also higher in Group 2 (p = 0.023). No significant difference was detected in ankle parameters. INTERPRETATION Unilateral high hip center has been shown to restrict the dynamic knee range of motion on the operated side and increase the knee load on both sides, thus putting the knees at risk for osteoarthritis. LEVEL OF EVIDENCE Level III, Retrospective comparative study.
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Affiliation(s)
- Gokhan Kaynak
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Bedri Karaismailoglu
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Mahmut Kursat Ozsahin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Gharehbaghi S, Jeong HK, Safaei M, Inan OT. A Feasibility Study on Tribological Origins of Knee Acoustic Emissions. IEEE Trans Biomed Eng 2021; 69:1685-1695. [PMID: 34757899 PMCID: PMC9132215 DOI: 10.1109/tbme.2021.3127030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Considering the knee as a fluid-lubricated system, articulating surfaces undergo different lubrication modes and generate joint acoustic emissions (JAEs) while moving. The goal of this study is to compare knee biomechanical signals against synchronously recorded joint sounds and assess the hypothesis that these JAEs are attributed to tribological origins. METHODS JAE, electromyography, ground reaction force signals, and motion capture markers were synchronously recorded from 10 healthy subjects while performing two-leg and one-leg squat exercises. The biomechanical signals were processed with standard inverse dynamic analysis through musculoskeletal modeling, and a tribological parameter, lubrication coefficient, was calculated from these signals. Besides, JAEs were divided into short windows, and 64 time-frequency features were extracted. The lubrication coefficients and joint sound features of the two-leg squats were used to label the windows and train a classifier that discriminates the knee lubrication modes only based on JAE features. Then, the classifier was used to predict the label of one-leg squat JAE windows. To evaluate these results, the predicted joint sound labels were directly compared against the associated lubrication coefficients. RESULTS The trained classifier achieves a high test-accuracy of 84% distinguishing lubrication modes of the one-leg squat JAE windows. The Pearson correlation coefficient between the estimated friction coefficient and the predicted JAE scores was 0.830.08. Furthermore, the lubrication coefficient threshold, separating two lubrication modes, was calculated from joint sound labels, and it decreased by half from two-leg to one-leg squats. This result was consistent with the tribological changes in the knee load as it was inversely doubled in one-leg squats. These results verify that JAEs contain salient information on knee tribology. SIGNIFICANCE This study supports the potential use of JAEs as a quantitative digital biomarker to extract tribological information about joint lubrication modes and loading conditions. Since arthritis and many other conditions impact the roughness of cartilage and other surfaces within the knee, the use of JAEs in clinical applications could thereby have broad implications for studying joint frictions and monitoring joint structural changes with wearable devices.
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Jeong HK, An S, Herrin K, Scherpereel K, Young A, Inan OT. Quantifying Asymmetry between Medial and Lateral Compartment Knee Loading Forces using Acoustic Emissions. IEEE Trans Biomed Eng 2021; 69:1541-1551. [PMID: 34727023 DOI: 10.1109/tbme.2021.3124487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Osteoarthritis is the most common type of knee arthritis that can be affected by excessive and compressive loads and can affect one or more compartments of the knee: medial, lateral, and patellofemoral. The medial compartment tends to be the most vulnerable to injuries and research suggests that a better understanding of the medial to lateral load distribution conditions could provide insights to the quantitative usage of knee compartments in activities of daily life. METHODS To that end, we present a novel method to quantify the directional bias of asymmetry between the medial and lateral compartment knee joint load by recording knee acoustical emissions and analyzing them using a deep neural network in a subject independent model. We placed four miniature contact microphones on the medial and lateral sides of the patella on both the left and right leg. We compared the handcrafted audio features with the automated features extracted from the convolutional autoencoder which is an unsupervised model that learns the comprehensive representation of the input to determine whether these automated features can better represent the signals characteristic in regard to the structural asymmetry of the knee joint. The input to the convolutional auto encoder (CAE) is a time-frequency representation and different types of these images such as spectrogram and scalogram are compared. We also compared the multi-sensor fusion approach with the performance of a single sensor to determine the robustness of using multiple sensors. RESULTS Using a representation learning based approach, we developed a subject independent classification model capable of classifying the asymmetry of the medial and lateral joint load across subjects (accuracy = 83%). CONCLUSION The result indicates that wavelet coherence which is the time-frequency correlation of two signals using a wavelet transform yields the best accuracy. SIGNIFICANCE These findings suggest that acoustic signals could potentially quantify the direction of medial to lateral load distribution which would broaden the implications for wearable sensing technology for monitoring cartilage health and factors responsible for cartilage breakdown and assessing appropriate rehabilitation exercises without overloading on one side.
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Crowder HA, Mazzoli V, Black MS, Watkins LE, Kogan F, Hargreaves BA, Levenston ME, Gold GE. Characterizing the transient response of knee cartilage to running: Decreases in cartilage T 2 of female recreational runners. J Orthop Res 2021; 39:2340-2352. [PMID: 33483997 PMCID: PMC8295402 DOI: 10.1002/jor.24994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/20/2020] [Accepted: 01/19/2021] [Indexed: 02/04/2023]
Abstract
Cartilage transmits and redistributes biomechanical loads in the knee joint during exercise. Exercise-induced loading alters cartilage hydration and is detectable using quantitative magnetic resonance imaging (MRI), where T2 relaxation time (T2 ) is influenced by cartilage collagen composition, fiber orientation, and changes in the extracellular matrix. This study characterized short-term transient responses of healthy knee cartilage to running-induced loading using bilateral scans and image registration. Eleven healthy female recreational runners (33.73 ± 4.22 years) and four healthy female controls (27.25 ± 1.38 years) were scanned on a 3T GE MRI scanner with quantitative 3D double-echo in steady-state before running over-ground (runner group) or resting (control group) for 40 min. Subjects were scanned immediately post-activity at 5-min intervals for 60 min. T2 times were calculated for femoral, tibial, and patellar cartilage at each time point and analyzed using a mixed-effects model and Bonferroni post hoc. There were immediate decreases in T2 (mean ± SEM) post-run in superficial femoral cartilage of at least 3.3% ± 0.3% (p = .002) between baseline and Time 0 that remained for 25 min, a decrease in superficial tibial cartilage T2 of 2.9% ± 0.4% (p = .041) between baseline and Time 0, and a decrease in superficial patellar cartilage T2 of 3.6% ± 0.3% (p = .020) 15 min post-run. There were decreases in the medial posterior region of superficial femoral cartilage T2 of at least 5.3 ± 0.2% (p = .022) within 5 min post-run that remained at 60 min post-run. These results increase understanding of transient responses of healthy cartilage to repetitive, exercise-induced loading and establish preliminary recommendations for future definitive studies of cartilage response to running.
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Affiliation(s)
- Hollis A. Crowder
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA,Department of Radiology, Stanford University, Stanford, California, USA
| | - Valentina Mazzoli
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Marianne S. Black
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Lauren E. Watkins
- Department of Radiology, Stanford University, Stanford, California, USA,Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Brian A. Hargreaves
- Department of Radiology, Stanford University, Stanford, California, USA,Department of Bioengineering, Stanford University, Stanford, California, USA,Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Marc E. Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA,Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E. Gold
- Department of Radiology, Stanford University, Stanford, California, USA
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Chen TC, Huang TH, Tseng WC, Tseng KW, Hsieh CC, Chen MY, Chou TY, Huang YC, Chen HL, Nosaka K. Changes in plasma C1q, apelin and adropin concentrations in older adults after descending and ascending stair walking intervention. Sci Rep 2021; 11:17644. [PMID: 34480035 PMCID: PMC8417101 DOI: 10.1038/s41598-021-96631-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
This study compared changes in plasma complement component 1q (C1q), apelin and adropin concentrations in older obese women after descending (DSW) and ascending stair walking (ASW) training (n = 15/group) performed twice a week for 12 weeks, with gradual increases in exercise time from 5 to 60 min. Fasting blood samples were collected 3 days before the first and 4 days after the last training session. The improvements in the maximal voluntary isometric contraction (MVIC) strength of the knee extensors, functional physical fitness [e.g., 30-s chair stand (CS) performance], resting systolic blood pressure (SBP), insulin sensitivity [e.g., oral glucose tolerance test (OGTT)] and blood lipid profiles [e.g., total cholesterol (TC)] were greater (p < 0.05) in the DSW than ASW group. Plasma C1q decreased (− 51 ± 30%), and apelin (23 ± 15%) and adropin (127 ± 106%) increased (p ≤ .0.05) only after DSW. Significant (p ≤ 0.01) partial correlations were found between the pre- to post-DSW changes in C1q, apelin or adropin and changes in outcome measures [e.g., C1q and MVIC (r = − 0.837), apelin and SBP (r = − 0.854), and andropin and OGTT (r = − 0.729)]. These results showed that greater decreases in plasma C1q and greater increases in apelin and adropin concentrations were associated with greater improvements in outcome measures after DSW than after ASW.
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Affiliation(s)
- Trevor C Chen
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, P.O. Box 97-71, Wenshan Wansheng, Taipei City, 11699, Taiwan.
| | - Tsang-Hai Huang
- Institute of Physical Education, Health and Recreation, National Cheng-Kung University, Tainan City, Taiwan
| | - Wei-Chin Tseng
- Department of Exercise and Health Sciences, University of Taipei, Taipei City, Taiwan
| | - Kuo-Wei Tseng
- Department of Exercise and Health Sciences, University of Taipei, Taipei City, Taiwan
| | - Chung-Chan Hsieh
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, P.O. Box 97-71, Wenshan Wansheng, Taipei City, 11699, Taiwan
| | - Mei-Yen Chen
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, Taipei City, Taiwan
| | - Tai-Ying Chou
- Department of Athletic Performance, National Taiwan Normal University, Taipei City, Taiwan
| | - Yuh-Chuan Huang
- Physical Education Office, Ming Chuan University, Taipei City, Taiwan
| | - Hsin-Lian Chen
- Department of Physical Education, Health and Recreation, National Chiayi University, Chaiyi County, Taiwan
| | - Kazunori Nosaka
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Abstract
Meniscus surgery is one of the most commonly performed orthopedic procedures worldwide. Modifiable risk factors for meniscus injury include body mass index, participation in athletics and occupation. Nonmodifiable risk factors include age, sex, lower extremity alignment, discoid meniscus, ligamentous laxity, and biconcave tibial plateau. Conditions commonly associated with meniscal injury are osteoarthritis, anterior cruciate ligament injury, and tibial plateau fractures. Tear type and location vary by patient age and functional status. Surgical management of meniscus injury is typically cost-effective in terms of quality-adjusted life years. The purpose of this review is to provide an overview of meniscal injury epidemiology by summarizing tear types and locations, associated conditions, and factors that increase the risk for meniscal injury. The economic burden of meniscus injury and strategies to prevent injury to the meniscus are also reviewed.
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Affiliation(s)
- Bryan G Adams
- Department of Orthopedic Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Megan N Houston
- Department of Orthopedic Surgery, John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, West Point, NY
| | - Kenneth L Cameron
- Department of Orthopedic Surgery, John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, West Point, NY
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Chen TLW, Lam WK, Wong DWC, Zhang M. A half marathon shifts the mediolateral force distribution at the tibiofemoral joint. Eur J Sport Sci 2021; 22:1017-1024. [PMID: 34077303 DOI: 10.1080/17461391.2021.1938690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Runners' gait patterns vary during a half marathon and influence the knee joint mechanics. Joint contact force is a better estimate of the net joint loadings than external joint moments and closely correlates to injury risks. This study explored the changes of lower limb joint kinematics, muscle activities, and knee joint loading in runners across the running mileages of a half marathon. Fourteen runners completed a half marathon on an instrumented treadmill where motion capture was conducted every 2 km (from 2 to 20 km). A musculoskeletal model incorporating medial/lateral tibiofemoral compartments was used to process the movement data and report outcome variables at the selected distance checkpoints. Statistics showed no changes in joint angles, muscle co-contraction index, ground reaction force variables, and medial tibiofemoral contact force (p > 0.05). Knee adduction moment at 18 km was significantly lower than those at 2 km (p = 0.002, γ = 0.813) and 6 km (p = 0.001, γ = 0.663). Compared to that at 2 km, lateral tibiofemoral contact force was reduced at 18 km (p = 0.030, Hedges' g = 0.690), 16 km (p < 0.001, Hedges' g = 0.782), 14 km (p = 0.045, Hedges' g = 0.859), and 10 km (p < 0.001, Hedges' g = 0.771) respectively. Mechanical realignment of the lower limb may be the cause of the altered knee loadings and possibly led to reduced running economy in response to a prolonged run. The injury potential of the redistributed tibiofemoral forces warranted further studies.
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Affiliation(s)
- Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, People's Republic of China.,Li Ning Sports Technology (Shenzhen) Co. Ltd., Shenzhen, People's Republic of China
| | - Wing-Kai Lam
- Li Ning Sports Technology (Shenzhen) Co. Ltd., Shenzhen, People's Republic of China.,Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co. Ltd., Beijing, People's Republic of China.,Department of Kinesiology, Shenyang Sports Institute, Shenyang, People's Republic of China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, People's Republic of China.,Department of Kinesiology, Shenyang Sports Institute, Shenyang, People's Republic of China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, People's Republic of China.,Department of Kinesiology, Shenyang Sports Institute, Shenyang, People's Republic of China
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Bjerre-Bastos JJ, Nielsen HB, Andersen JR, Karsdal M, Boesen M, Mackey AL, Byrjalsen I, Thudium CS, Bihlet AR. A biomarker perspective on the acute effect of exercise with and without impact on joint tissue turnover: an exploratory randomized cross-over study. Eur J Appl Physiol 2021; 121:2799-2809. [PMID: 34156534 DOI: 10.1007/s00421-021-04751-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate acute changes in biochemical markers of bone and cartilage turnover in response to moderate intensity exercise with and without joint impact in healthy human subjects. METHODS A randomized, cross-over, exploratory, clinical study was conducted. Twenty healthy subjects with no history of joint trauma completed 30 min interventions of standardized moderate intensity cycling and running as well as a resting intervention 1 week apart. Blood samples were taken immediately before, four times after exercise and again the next day. Urine was sampled, before, after and the next day. On the day of rest, samples were taken at timepoints similar to the days of exercise. Markers of type I (CTX-I), II (C2M, CTX-II) and VI (C6M) collagen degradation, cartilage oligomeric matrix protein (COMP) and procollagen C-2 (PRO-C2) was measured. TRIAL REGISTRATION NUMBER NCT04542655, 02 September 2020, retrospectively registered. RESULTS CTX-I was different from cycling (4.2%, 95%CI: 0.4-8.0%, p = 0.03) and resting (6.8%, 95%CI: 2.9-10.7%, p = 0.001) after running and the mean change in COMP was different from cycling (10.3%, 95%CI: 1.1-19.5%, p = 0.03), but not from resting (8.6%, 95%CI: - 0.7-17.8%, p = 0.07) after running. Overall, changes in other biomarkers were not different between interventions. CONCLUSION In this exploratory study, running, but not cycling, at a moderate intensity and duration induced acute changes in biomarkers of bone and cartilage extra-cellular matrix turnover.
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Affiliation(s)
- Jonathan J Bjerre-Bastos
- Xlab, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
- Nordic Bioscience Clinical Development, Herlev, Denmark.
| | - Henning Bay Nielsen
- Sanos Clinic, Herlev, Denmark
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Mikael Boesen
- Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Abigail L Mackey
- Xlab, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
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