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Wang M, Zhang C, Yang Z, Cheng T, Lan C, Mo F. Muscle activation patterns and gait changes in unilateral knee osteoarthritis patients: a comparative study with healthy controls. Clin Rheumatol 2024; 43:2963-2972. [PMID: 39088118 DOI: 10.1007/s10067-024-07057-5] [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: 12/13/2023] [Revised: 06/23/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024]
Abstract
The objective of this study was to investigate the differences in muscle activation and kinematic parameters between patients with unilateral knee osteoarthritis (OA) and healthy individuals. Additionally, the study aimed to determine the correlation between muscle activation and kinematic parameters with knee OA symptoms. Participants with unilateral knee OA (n = 32) and healthy individuals (n = 32) completed the gait test. Electromyography (EMG) and motion capture were employed to collect muscle activation data and kinematic parameters. Spearman's correlation coefficient was used to analysis the correlation between BMI, symptomatic side EMG parameters, kinematic parameters, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Furthermore, a multiple linear regression analysis of WOMAC pain was also conducted. The peak root mean square, integrated electromyography, and co-activation index (CCI) were increased bilaterally in the unilateral knee OA group compared to the healthy group. Furthermore, these values were higher on the symptomatic side than on the asymptomatic side. Compared with the healthy group, the knee OA group had lower gait speed, decreased stride length and cadence on bilateral sides, longer total stance time and double-stance time, and shorter single stance time and swing time. The maximum knee flexion angle of the swing phase on the symptomatic side of the knee OA group was smaller than that on the asymptomatic side and healthy group. Changes in EMG and gait parameters on the symptomatic side correlated with WOMAC scores. The main factors influencing WOMAC pain were the CCI values of the lateral femoral and biceps femoris muscles and gait speed. Muscle activation and kinematic parameters in the lower limbs of patients with unilateral knee OA were altered bilaterally during walking. These alterations on the symptomatic side were associated with knee OA-related pain. ChiCTR2200064958. Date of registration: 2022-10-24. Key Points • Unilateral symptomatic knee OA leads to bilateral alterations in muscle activation and gait parameters. • Symptomatic muscle activation and gait parameter changes in knee OA patients are associated with knee OA symptoms. • Correcting abnormal muscle activation conditions and gait training may reduce knee OA-related pain.
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Affiliation(s)
- Meiyi Wang
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Changjie Zhang
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Zhi Yang
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, Hunan, China
| | - Tiefeng Cheng
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, Hunan, China
| | - Chunna Lan
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Fuhao Mo
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, Hunan, China.
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Bacon KL, Felson DT, Jafarzadeh SR, Kolachalama VB, Hausdorff JM, Gazit E, Stefanik JJ, Corrigan P, Segal NA, Lewis CE, Nevitt MC, Kumar D. Gait Alterations and Association With Worsening Knee Pain and Physical Function: A Machine Learning Approach With Wearable Sensors in the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2024; 76:984-992. [PMID: 38523250 PMCID: PMC11209802 DOI: 10.1002/acr.25327] [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] [Received: 06/16/2023] [Revised: 01/23/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE The objective of this study was to identify gait alterations related to worsening knee pain and worsening physical function, using machine learning approaches applied to wearable sensor-derived data from a large observational cohort. METHODS Participants in the Multicenter Osteoarthritis Study (MOST) completed a 20-m walk test wearing inertial sensors on their lower back and ankles. Parameters describing spatiotemporal features of gait were extracted from these data. We used an ensemble machine learning technique ("super learning") to optimally discriminate between those with and without worsening physical function and, separately, those with and without worsening pain over two years. We then used log-binomial regression to evaluate associations of the top 10 influential variables selected with super learning with each outcome. We also assessed whether the relation of altered gait with worsening function was mediated by changes in pain. RESULTS Of 2,324 participants, 29% and 24% had worsening knee pain and function over two years, respectively. From the super learner, several gait parameters were found to be influential for worsening pain and for worsening function. After adjusting for confounders, greater gait asymmetry, longer average step length, and lower dominant frequency were associated with worsening pain, and lower cadence was associated with worsening function. Worsening pain partially mediated the association of cadence with function. CONCLUSION We identified gait alterations associated with worsening knee pain and those associated with worsening physical function. These alterations could be assessed with wearable sensors in clinical settings. Further research should determine whether they might be therapeutic targets to prevent worsening pain and worsening function.
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Affiliation(s)
- Kathryn L. Bacon
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - David T. Felson
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - S. Reza Jafarzadeh
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | - Jeffrey M. Hausdorff
- Tel Aviv University, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Rush University Medical Center, Chicago, IL, U.S
| | - Eran Gazit
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Cora E. Lewis
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Deepak Kumar
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Physical Therapy, Boston University, Boston, Massachusetts
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Thomas J, Hall JB, Schauffler R, Guess TM. Objective Clinical Measurement Tools for Functional Evaluation of the Surgical Patient. J Knee Surg 2024; 37:577-585. [PMID: 37562433 DOI: 10.1055/s-0043-1772222] [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: 08/12/2023]
Abstract
Following knee surgery, clinicians have traditionally used visually rated or time-based assessments of lower extremity movement quality to measure surgical outcomes, plan rehabilitation interventions, and measure success. These methods of assessment are prone to error and do not fully capture a patient's inefficient movement patterns post surgery. Further, currently available systems which objectively measure kinematics during these tasks are expensive and unidimensional. For these reasons, recent research has called for the development of objective and low-cost precision rehabilitation tools to improve clinical measurement of movement tasks. The purpose of this article is to highlight two such tools and their applications to knee surgery. The systems highlighted within this article are the Mizzou Point-of-Care Assessment System (MPASS) and the Mizzou Knee Arthrometer Testing System (MKATS). MPASS has demonstrated high levels of agreement with the gold-standard Vicon system in measuring kinematics during sit-to-stand (R > 0.71), lateral step-down (intraclass correlation coefficient [ICC] > 0.55, apart from ankle flexion), and drop vertical jump tasks (ICC > 0.62), as well as gait (R > 0.87). MKATS has been used to quantify differences in tibiofemoral motion between groups during lateral step-down, step-up-and-over, and step-up/step-down tasks. Objective measurement of clinical tasks using portable and inexpensive instruments, such as the MPASS and MKATS, can help clinicians identify inefficient movement patterns and asymmetries which may damage and wear down supporting structures within the knee and throughout the kinetic chain causing pain and discomfort. Identifying these issues can help clinicians to plan interventions and measure their progress at a lower cost than currently available systems. The MPASS and MKATS are useful tools which have many applications to knee surgery.
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Affiliation(s)
- Jacob Thomas
- College of Health Sciences, University of Missouri, Columbia, Missouri
| | - Jamie B Hall
- Department of Physical Therapy, University of Missouri, Columbia, Missouri
| | - Rose Schauffler
- Department of Mechanical Engineering, University of Missouri, Columbia, Missouri
| | - Trent M Guess
- Department of Physical Therapy, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Sharifi A, Esmaeili H, Zolaktaf V. Walking and running roll-off characteristics in patients with ACL reconstruction history. Gait Posture 2024; 107:330-336. [PMID: 37926656 DOI: 10.1016/j.gaitpost.2023.10.025] [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: 07/06/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Gait mechanics alternation is one of side effects after anterior cruciate ligament reconstruction (ACLR). Foot roll-off characteristics shows whole gait mechanics and is not well known in ACLR patients. The purpose of present study was to investigate the roll-off process characteristics while walking and running in patients with ACLR history. RESEARCH QUESTION Is there any difference in walking and running roll-off characteristics between patients with ACLR history and healthy individuals? METHODS 48 physically active males (24 healthy and 24 with ACLR history) participated in this study. Participants walked and ran on a footscan (Rsscan International) which was mounted in the midway of a 18 m runway at the speeds of 2 m·s-1 and 3.3 m·s-1. Center of pressure (COP) trajectory, timing of stance subphases, foot progression angle and contact time were calculated bilaterally in walking and running. Mixed-design MANOVA was used to examine effect of ACLR on the outcomes. RESULTS The results showed that ACLR participants had greater foot progression angle (p = .001) and more medially oriented COP trajectory in forefoot push-off phase (FFPOP) of waking (p = .001) and running (p = .001), but showed shorter contact time in running compared to healthy group (p = .02). Involved leg in ACLR group showed greater foot progression angle (p = .001) and more medially directed COP trajectory in FFPOP of walking (p = .001) and running (p = .01) compared to uninvolved side. Also, involved leg had shorter contact time (p = .04) and shorter relative time in the forefoot contact phase (p = .001), and longer relative time in forefoot flat phase (p = .001) during running. SIGNIFICANCE Based on the results, it can be concluded that ACLR affects running and walking roll-off characteristics which can show altered mechanics. Running shows remarkable differences in roll-off process than walking. So, it is recommended to use running in post-ACLR assessments rather than walking.
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Affiliation(s)
- Ali Sharifi
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
| | - Hamed Esmaeili
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran.
| | - Vahid Zolaktaf
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
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Falvey KT, Kinshaw CM, Warren GL, Tsai LC. Persistent altered knee loading in patients with meniscectomy: A systematic review and meta-analysis. Phys Ther Sport 2024; 65:14-22. [PMID: 37980779 DOI: 10.1016/j.ptsp.2023.10.005] [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: 07/04/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To determine the changes in knee flexion moment (KFM) and knee adduction moment (KAM) during weight-bearing activities following meniscectomy. DESIGN Meta-Analysis. SETTING Laboratory. PARTICIPANTS 332 meniscectomy patients and 137 healthy controls (from 13 qualified studies) MAIN OUTCOME MEASURES: Cohen's d effect sizes (ESs) were calculated to compare KAM and KFM values of the surgical legs to the non-surgical and to healthy control legs. RESULTS When compared to healthy controls, meniscectomy patients' surgical legs demonstrated a significantly greater KAM (ES = 0.310; P = 0.002) but no significant difference in KFM (ES = -0.182; P = 0.051). When compared to the patients' non-surgical legs, however, the surgical legs showed no difference in KAM (ES = -0.024; P = 0.716) but a significantly lower KFM (ES = -0.422; P < 0.001). High heterogeneity among study ESs was observed in patients' between-limb comparison for KAM (Q-value = 20.08, P = 0.005; I2 = 65.1%) and KFM (Q-value = 43.96, P < 0.001; I2 = 79.5%). However, no significant differences in study ESs (all P > 0.102) of KFM and KAM were identified when comparing studies with various times post-surgery, weight-bearing tasks, walking speeds, or patient demographics. CONCLUSION Elevated KAM and reduced/asymmetrical KFM observed in meniscectomy patients may contribute to the increased risk of knee OA. Rehabilitation should focus on movement education to restore between-limb KFM symmetry and reduce KAM bilaterally post-meniscectomy.
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Affiliation(s)
- Kyle T Falvey
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Chad M Kinshaw
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Gordon L Warren
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA.
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Schache AG, Sritharan P, Crossley KM, Perraton LG, Bryant AL, Morris HG, Whitehead TS, Culvenor AG. Is quadriceps strength associated with patellofemoral joint loading after anterior cruciate ligament reconstruction? Phys Ther Sport 2023; 63:31-37. [PMID: 37478626 DOI: 10.1016/j.ptsp.2023.06.006] [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: 05/09/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To test whether quadriceps strength is associated with measures of patellofemoral (PF) joint loading during running and hopping in people after an anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional study. SETTING Biomechanics laboratory. PARTICIPANTS Sixty-five participants (24 women; 41 men) 1-2 years post-ACLR. MAIN OUTCOME MEASURES Peak isometric quadriceps strength for the surgical limb was measured using a dynamometer. Motion analysis and ground reaction force data were combined with musculoskeletal modelling to measure PF joint loading variables for the reconstructed knee (peak knee flexion angle; peak/impulse of the PF joint contact force; time to peak PF joint contact force) during the stance phase of running and during the landing phase of a standardised forward hop. Linear regression analysis (adjusting for age and sex) assessed the association between quadriceps strength and PF joint loading variables. RESULTS Two significant, albeit modest, associations were revealed. Quadriceps strength was associated with the time to peak PF joint contact force during running (β = -0.001; 95%CI -0.002 to -0.000; R2 = 0.179) and the impulse of the PF joint contact force during hopping (β = 0.014; 95%CI 0.003 to 0.024; R2 = 0.159). CONCLUSIONS A strong link between quadriceps strength and PF joint loading was not evident in people 1-2 years post-ACLR.
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Affiliation(s)
- Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - Prasanna Sritharan
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Luke G Perraton
- Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Australia
| | - Adam L Bryant
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | | | | | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Ishida T, Samukawa M, Koshino Y, Ino T, Kasahara S, Tohyama H. Interlimb Asymmetry in Knee Extension Moment During Double-Leg Squatting Is Associated With Persistent Quadriceps Weakness After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231182105. [PMID: 37441507 PMCID: PMC10334007 DOI: 10.1177/23259671231182105] [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: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 07/15/2023] Open
Abstract
Background Although double-leg squatting is less dynamic and places less demand on the quadriceps compared with landing tasks, the relationship between double-leg squatting biomechanics and persistent quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) is unknown. Purpose To clarify the relationships between asymmetries in quadriceps strength and lower limb biomechanics during double-leg squatting >1 year after ACLR. Study Design Controlled laboratory study. Methods A total of 26 participants (5.5 ± 3.8 years after ACLR) were enrolled. The limb symmetry index (LSI) of isokinetic quadriceps strength was used to divide participants into the high-quadriceps (HQ) group (LSI ≥90%; n = 18) and the low-quadriceps (LQ) group (LSI <90%; n = 8). The knee, hip, and ankle extension moment (relative to body weight and support moment [sum of knee, hip, and ankle moments]) and vertical ground-reaction force during double-leg squatting were analyzed using 3-dimensional motion analysis. The association of quadriceps strength and biomechanical variables was tested using 2-way analysis of variance and univariate regression analysis. Results A significant group-by-limb interaction was found for the peak knee extension moment and the ratios of knee and hip extension moment to support moment (P < .001, P = .015 and P < .001, respectively). The LQ group showed a significantly smaller peak knee extension moment and knee to support moment ratio but a larger hip to support moment ratio in the involved limb than in the uninvolved limb (95% CIs: knee extension moment, -0.273 to -0.088 N·m/kg; knee to support moment ratio, -10.7% to -2.2%; hip to support moment ratio, 3.2% to 8.5%). No interlimb difference was found for the HQ group. The LSI of quadriceps strength was significantly associated with the LSI of peak knee extension moment (R2 = 0.183), knee to support moment ratio (R2 = 0.256), and hip to support moment ratio (R2 = 0.233). The mean maximum isokinetic quadriceps strength and peak knee extension moment during squatting on the involved limb of the LQ group were 2.40 ± 0.39 and 0.90 ± 0.16 N·m/kg, respectively. Conclusion Asymmetrical biomechanics during double-leg squatting was associated with persistent quadriceps weakness after ACLR. The LQ group had reduced knee extensor moment on the involved side during squatting despite loading at approximately half the maximum strength. Clinical Relevance Quadriceps strengthening exercises, together with interventions to improve neuromuscular control, may reduce asymmetrical biomechanics during double-leg squatting.
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Affiliation(s)
- Tomoya Ishida
- Faculty of Health Sciences, Hokkaido
University, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido
University, Sapporo, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido
University, Sapporo, Japan
| | - Takumi Ino
- Faculty of Health Sciences, Hokkaido
University of Science, Sapporo, Japan
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Li H, Hu S, Zhao R, Zhang Y, Huang L, Shi J, Li P, Wei X. Gait Analysis of Bilateral Knee Osteoarthritis and Its Correlation with Western Ontario and McMaster University Osteoarthritis Index Assessment. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101419. [PMID: 36295577 PMCID: PMC9610794 DOI: 10.3390/medicina58101419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 12/02/2022]
Abstract
Background and objectives: Objective, accurate, and intuitive evaluation of knee joint function in patients with knee osteoarthritis (KOA) is important. This study aimed to clarify the gait characteristics of patients with bilateral KOA and their correlation with Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Materials and Methods: 20 patients with bilateral KOA and 20 conditionally matched healthy individuals were enrolled in the experimental and control groups, respectively. Footscan and CODA motion gait analysis systems were used to analyse the gait parameters. Gait spatiotemporal parameters and knee joint motion parameters were collected. Weight-bearing balance and walking stability were assessed using discrete trends of relevant gait indicators. Patients in the experimental group were evaluated using WOMAC. Pearson’s correlation analysis was performed on the gait data and WOMAC score data of the experimental group. Results: Velocity, cadence, step length, and stride length of the experimental group were significantly lower than those of the control group (p < 0.01). Step time and gait cycle were significantly greater in the experimental group than in the control group (p < 0.01). Total stance and double-stance times of the experimental group were significantly greater than those of the control group (p < 0.01), whereas the single-stance time was shorter than that of the control group (p < 0.01). The range of motion and maximum flexion angle in the experimental group were significantly lower than those in the control group (p < 0.01), and the minimum angle of knee extension was greater than that in the control group (p < 0.01). The discrete trend of weight-bearing balance and walking stability gait index in the experimental group was greater than that in the control group. The WOMAC score and gait analysis were significantly correlated (p < 0.05). Conclusions: The gait function of patients with KOA is significantly worse than that of normal people. The WOMAC scale and gait analysis can be used to assess KOA severity from different perspectives with good consistency.
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Affiliation(s)
- Haoqian Li
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Department of Orthopaedics, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan 030001, China
| | - Shuai Hu
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Department of Orthopaedics, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan 030001, China
| | - Ruipeng Zhao
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Department of Orthopaedics, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan 030001, China
| | - Yixuan Zhang
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Department of Orthopaedics, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan 030001, China
| | - Lingan Huang
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Department of Orthopaedics, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan 030001, China
- Department of Pain Medicine, Sanya Central Hospital of Hainan Medical College, 1154 Jiefang Road, Sanya 572000, China
| | - Junjun Shi
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Department of Orthopaedics, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan 030001, China
| | - Pengcui Li
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Department of Orthopaedics, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan 030001, China
| | - Xiaochun Wei
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Department of Orthopaedics, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan 030001, China
- Correspondence:
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