Immediate and six-week effects of wearing a knee sleeve following anterior cruciate ligament reconstruction on knee kinematics and kinetics: a cross-over laboratory and randomised clinical trial

Knee sleeves improve gait symmetry during fast walking in older adults

Knee sleeves are commonly used to address knee-related concerns, particularly in older individuals. Although previous studies have demonstrated their efficacy in improving gait and functional outcomes in knees with pathological conditions, the effectiveness of knee sleeves for improving gait characteristics in healthy older adults remains unclear. The harmonic ratio (HR), an index for assessing gait symmetry commonly used to discriminate between individuals with different functional levels, can be used to detect alterations in gait characteristics. This study investigated the effects of knee sleeves on gait symmetry in healthy older adults. Sixteen healthy community-dwelling older adults walked barefoot with and without knee sleeves at normal and fast speeds. Gait symmetry indices (HR and improved HR [iHR]) and spatiotemporal gait parameters were compared under different conditions. A significant interaction between knee condition and walking speed was observed for mean iHR in the anteroposterior direction (p = 0.006). A significant simple main effect of knee condition was found during fast walking, with a larger iHR with knee sleeves than without (p = 0.002). In the condition without knee sleeves, the iHR was significantly lower during fast walking than during normal walking (p = 0.035). Furthermore, a significant main effect of knee condition was observed for the variability of iHR in the anteroposterior direction, with a smaller variability when walking with knee sleeves than when walking without (p = 0.006). These results suggest that knee sleeves may enhance gait symmetry along the anteroposterior direction, particularly during fast walking, where symmetry disruption is more likely than walking at a comfortable pace. A significant reduction in gait symmetry variability also suggests a stabilizing effect on gait dynamics. These findings provide the first evidence supporting the efficacy of knee sleeves for improving gait symmetry. The use of knee sleeves could be a valuable option for restoring disrupted gait symmetry during fast walking, with potential implications for reducing the risk of falls.

Functions and Effectiveness of Unloader, Patellofemoral, and Knee Sleeve Orthoses: A Review

Background

Knee orthoses have been extensively used as a nonsurgical approach to improving knee deficiencies. Currently, arthritic knee conditions remain the leading cause of disability, and this number is expected to increase. As the use of knee orthoses varies widely, so has their effectiveness which is still largely debatable. Here, we present the functions and effectiveness of the three most prominent knee orthotic models dedicated to supporting knee osteoarthritis-unloader, patellofemoral, and knee sleeves.

Purpose/Research Question

Considering the depth and diversity of the many clinical studies and documented laboratory reports published to date, this literature review was created to educate the clinician, patient, and researcher on common knee orthoses used for the management of arthritic knee conditions. In doing so, we discuss their design, biomechanical effects, and clinical efficacy, as well as broader outcomes, limitations, and recommendations for use.

Results/Synthesis

The knee orthoses discussed within the scope of this paper are dedicated to protecting the knee against strenuous compressive loads that may affect the patellofemoral and tibiofemoral joints of the knee. Since the knee has multiple axes of motion and articulating surfaces that experience different loads during functional activities, it can be implied that, to a large extent, knee brace designs can differ drastically. Unloader knee orthoses are designed to decrease tibiofemoral and patellofemoral joint pressures. Patellofemoral knee orthoses are designed to decrease strain on the patellofemoral and quadriceps tendons while stabilizing the patella. Knee sleeves are designed to stabilize movements, reduce pain in joints, and improve proprioception across the knee joint.

Conclusion

Although patients often report benefits from wearing braces, these benefits have not been confirmed by clinicians and scientific investigators. Results from these three orthosis types show that clinical efficacy is still elusive due to the different methodologies used by researchers.

Layman Summary

Knee orthoses also referred to as knee brace are commonly used for support and stability of the knee. Unloader knee braces are designed to relieve and support those suffering from knee osteoarthritis by improving physical impairment and reducing pain. Patellofemoral knee braces aim to help patients manage patellofemoral pain syndrome. Rehabilitative compression sleeves, also known as knee sleeves, are often used to assist patients suffering from knee pain and laxity. Important findings on the three knee braces discussed show discrepancies in results. Their effectiveness and validity are yet to be understood.

Biomechanics of step-off drop landings are affected by limb dominance and lead limb in task initiation

This study examines the effects of limb dominance and lead limb in task initiation on the kinetics and kinematics of step-off drop landings. Nineteen male participants performed drop landings led by the dominant and non-dominant limbs at 45-cm and 60-cm drop heights. Ground reaction force (GRF) and lower body kinematic data were collected. Between-limb time differences at the initial ground contact were calculated to indicate temporal asymmetry. Statistical Parametric Mapping (SPM) was applied for waveform analysis while two-way repeated measures ANOVA was used for discrete parameters. SPM results revealed greater GRF and lesser ankle dorsiflexion in the lead limb compared to the trail limb in 3 out of 4 landing conditions. The dominant limb displayed a greater forefoot loading rate (45 cm: p=.009, ηp2 = 0.438; 60 cm: p=.035, ηp2 = 0.225) and greater ankle joint quasi-stiffness (45 cm: p < .001, ηp2 = 0.360; 60 cm: p < .001, ηp2 = 0.597) than the non-dominant limb. Not all 380 trials were lead-limb first landings, with a smaller between-limb time difference (p=.009, d = 0.60) at 60 cm (4.1 ± 2.3 ms) than 45 cm (5.6 ± 2.7 ms). In conclusion, the step-off drop landing is not an ideal protocol for examining bilateral asymmetry in lower limb biomechanics due to potential biases introduced by limb dominance and the step-off limb.

One-dimension statistical parametric mapping in lower limb biomechanical analysis: A systematic scoping review

BACKGROUND

Biomechanics significantly impacts sports performance and injury prevention. Traditional methods like discrete point analysis simplify continuous kinetic and kinematic data, while one-dimensional Statistical Parametric Mapping (spm1d) evaluates entire movement curves. Nevertheless, spm1d's application in sports and injury research is limited. As no systematic review exists, we conducted a scoping systematic review, synthesizing the current applications of spm1d across various populations, activities, and injuries. This review concludes by identifying gaps in the literature and suggesting areas for future research.

RESEARCH QUESTION

What research exists using spm1d in sports biomechanics, focusing on the lower limbs, in what populations, and what are the current research gaps?

METHODS

We searched PubMed, Embase, Web of Science, and ProQuest databases for the following search string: "(((knee) OR (hip)) OR (ankle)) OR (foot) OR (feet) AND (statistical parametric mapping)". English peer-reviewed studies assessing lower limb kinetics or kinematics in different sports or sports-related injuries were included. Reviews, meta-analyses, conference abstracts, and grey literature were excluded.

RESULTS

Our search yielded 165 papers published since 2012. Among these, 112 examined healthy individuals (67 %), and 53 focused on injured populations (33 %). Running (n = 45), cutting (n = 25), and jumping/landing (n = 18) were the most common activities. The predominant injuries were anterior cruciate ligament rupture (n = 21), chronic ankle instability (n = 18), and hip-related pain (n = 9). The main research gaps included the unbalanced populations, underrepresentation of common sports and sport-related injuries, gender inequality, a lack of studies in non-laboratory settings, a lack of studies on varied sports gear, and a lack of reporting standardization.

SIGNIFICANCE

This review spotlights crucial gaps in spm1d research within sports biomechanics. Key issues include a lack of studies beyond laboratory settings, underrepresentation of various sports and injuries, and gender disparities in research populations. Addressing these gaps can significantly enhance the application of spm1d in sports performance, injury analysis, and rehabilitation.

Can a knee sleeve influence ground reaction forces and knee joint power during a step-down hop in participants following anterior cruciate ligament reconstruction? A secondary analysis

PURPOSE

Elastic knee sleeves are often worn following anterior cruciate ligament (ACL) reconstruction. The study aimed to define immediate and 6-week effects of wearing a knee sleeve on ground reaction forces (GRF) and knee joint power during a step-down hop task.

METHODS

Using a cross-over design, we estimated GRF and knee kinematics and kinetics during a step-down hop for 30 participants following ACL reconstruction (median 16 months post-surgery) with and without wearing a knee sleeve. In a subsequent randomised clinical trial, participants in the 'Sleeve Group' (n = 9) wore the sleeve for 6 weeks at least 1 hour daily, while a 'Control Group' (n = 9) did not wear the sleeve. We compared the following outcomes using statistical parametric mapping (SPM): (1) GRF and knee joint power trajectories between three conditions at baseline (uninjured side, unsleeved injured and sleeved injured side); (2) GRF and knee joint power trajectories within-participant changes from baseline to follow-up between groups. We also compared discrete peak GRFs and power, rate of (vertical) force development, and mean knee joint power in the first 5% of stance phase.

RESULTS

SPM showed no differences for GRF for the (unsleeved) injured compared to the uninjured sides; when wearing the sleeve, injured side mean power in the first 5% of stance increased significantly from a concentric to an eccentric power. Discrete variables showed lower peak anterior (propulsive) GRF, mean power in the first 5% of stance, peak eccentric and concentric power for the injured compared to the uninjured sides. After six weeks, a directional change for vertical GRF differed showed slightly decreased forces for the Control Group and increased forces for the Sleeve Group.

CONCLUSION

Wearing a knee sleeve on the anterior cruciate ligament injured knee improved knee power during the first 5% of stance during the step-down hop. No consistent changes were observed for ground reaction forces for SPM and discrete variable analyses. Wearing the knee sleeve at least one hour daily for 6-weeks lead to a directional change of increased vertical GRF for the Sleeve Group at follow-up.

TRIAL REGISTRATION

The trial was prospectively registered with the Australia New Zealand Clinical Trials Registry No: ACTRN12618001083280, 28/06/2018. https: //anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375347&isClinicalTrial=False.