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Migel KG, Blackburn JT, Gross MT, Pietrosimone B, Thoma LM, Wikstrom EA. Effect of sensor location for modifying center of pressure during gait using haptic feedback in people with chronic ankle instability. Gait Posture 2024; 110:71-76. [PMID: 38537341 DOI: 10.1016/j.gaitpost.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/23/2024] [Accepted: 03/14/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Gait retraining using haptic biofeedback medially shifts the center of pressure (COP) while walking in orthopedic populations. However, the ideal sensor location needed to effectively shift COP medially has not been identified in people with chronic ankle instability (CAI). RESEARCH QUESTIONS Can a heel sensor location feasibly be employed in people with CAI without negatively altering kinematics? Does a heel sensor placement relative to the 5th metatarsal head (5MH) impact COP location while walking in people with CAI? METHODS In this exploratory crossover study, 10 participants with CAI walked on a treadmill with vibration feedback for 10 minutes with a plantar pressure sensor under the heel and 5MH. Separate 2×2 repeated measures analyses of covariances (rmANCOVAs) were used to compare the averaged COP location and 3-D lower extremity kinematics from the first 10% of stance before and after training and between sensor locations. Baseline measures served as covariates to adjust for baseline differences. RESULTS Feedback triggered by a heel sensor resulted in 40% of participants avoiding a heel strike. There were no significant main effects or interactions between time and sensor location on COP location when controlling for baseline COP (p>0.05). However, with the 5MH placement, participants displayed less ankle internal rotation(IR) (5MH/Heel: -4.12±0.00º/ -6.43±0.62º), less forefoot abduction (-4.29±0.00º/ -5.14±1.01º), more knee flexion (3.40±0.32º/ 0.14±0.57º), less knee external rotation (-10.95±0.00º/-11.24±1.48º), less hip extension (-0.20±0.00º/-1.42±1.05º), and less hip external rotation (3.12±0.00º/3.75±1.98º). SIGNIFICANCE A 5MH location may be more feasible based on difficulties maintaining heel strike when the sensor was under the heel. While no sensor location was statistically better at changing the COP, the 5MH location decreased proximal transverse plane motions making participants' gait more like controls. Individual response variations support comprehensive lower extremity assessments and the need to identify responder profiles using sensory feedback in people with CAI.
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Affiliation(s)
- Kimmery G Migel
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC 27268, USA.
| | - J Troy Blackburn
- MOTION Science Institute, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA
| | - Michael T Gross
- Division of Physical Therapy, Bondurant Hall CB 7135, Chapel Hill, NC 27599, USA
| | - Brian Pietrosimone
- MOTION Science Institute, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA
| | - Louise M Thoma
- Division of Physical Therapy, Bondurant Hall CB 7135, Chapel Hill, NC 27599, USA
| | - Erik A Wikstrom
- MOTION Science Institute, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA
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Bjornsen E, Berkoff D, Blackburn JT, Davis-Wilson H, Evans-Pickett A, Franz JR, Harkey MS, Horton WZ, Lisee C, Luc-Harkey B, Munsch AE, Nissman D, Pfeiffer S, Pietrosimone B. Sustained Limb-Level Loading: A Ground Reaction Force Phenotype Common to Individuals at High Risk for and Those With Knee Osteoarthritis. Arthritis Rheumatol 2024; 76:566-576. [PMID: 37961759 DOI: 10.1002/art.42744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/08/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The objective of this study was to compare the vertical (vGRF), anterior-posterior (apGRF), and medial-lateral (mlGRF) ground reaction force (GRF) profiles throughout the stance phase of gait (1) between individuals 6 to 12 months post-anterior cruciate ligament reconstruction (ACLR) and uninjured matched controls and (2) between ACLR and individuals with differing radiographic severities of knee osteoarthritis (KOA), defined as Kellgren and Lawrence (KL) grades KL2, KL3, and KL4. METHODS A total of 196 participants were included in this retrospective cross-sectional analysis. Gait biomechanics were collected from individuals 6 to 12 months post-ACLR (n = 36), uninjured controls matched to the ACLR group (n = 36), and individuals with KL2 (n = 31), KL3 (n = 67), and KL4 osteoarthritis (OA) (n = 26). Between-group differences in vGRF, apGRF, and mlGRF were assessed in reference to the ACLR group throughout each percentage of stance phase using a functional linear model. RESULTS The ACLR group demonstrated lower vGRF and apGRF in early and late stance compared to the uninjured controls, with large effects (Cohen's d range: 1.35-1.66). Conversely, the ACLR group exhibited greater vGRF (87%-90%; 4.88% body weight [BW]; d = 0.75) and apGRF (84%-94%; 2.41% BW; d = 0.79) than the KL2 group in a small portion of late stance. No differences in mlGRF profiles were observed between the ACLR and either the uninjured controls or the KL2 group. The magnitude of difference in GRF profiles between the ACLR and OA groups increased with OA disease severity. CONCLUSION Individuals 6 to 12 months post-ACLR exhibit strikingly similar GRF profiles as individuals with KL2 KOA, suggesting both patient groups may benefit from targeted interventions to address aberrant GRF profiles.
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Affiliation(s)
| | - David Berkoff
- University of North Carolina at Chapel Hill, Chapel Hill
| | | | | | | | - Jason R Franz
- University of North Carolina at Chapel Hill, Chapel Hill, and North Carolina State University, Raleigh
| | | | | | - Caroline Lisee
- University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Amanda E Munsch
- University of North Carolina at Chapel Hill, Chapel Hill, and North Carolina State University, Raleigh
| | - Daniel Nissman
- University of North Carolina at Chapel Hill, Chapel Hill
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Giuliani-Dewig HK, Gerstner GR, Register-Mihalik JK, Blackburn JT, Padua DA, Staley JA, Ryan ED. The feasibility of workload monitoring among law enforcement officers: A multi-methodological approach. Appl Ergon 2024; 116:104212. [PMID: 38154228 DOI: 10.1016/j.apergo.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/30/2023]
Abstract
This study examined the feasibility of workload monitoring to assess internal workload in law enforcement officers (LEO) using a multi-methodological approach. Fifty front-line LEO completed workload surveys on workdays for eight weeks. Retention and adherence were assessed across the survey period. LEO completed usability and likelihood to continue questionnaires, while departmental administrators (n = 8) received workload reports and completed utility and sustainability questionnaires. A subsample of LEO and administrators participated in semi-structured interviews, following consensual qualitative research design. LEO retention (96%), survey adherence (94%), and usability scores (88.3/100) were high, with a moderate likelihood to continue to use the survey. Administration reported high utility and sustainability. The high adherence rates and usability scores, coupled with strong administrative support, suggest that workload monitoring may be a feasible strategy among LEO to monitor occupational workloads. The LEO and administration feedback highlight areas of improvement (e.g., data transparency, departmental collaboration) to inform future implementation.
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Affiliation(s)
- Hayden K Giuliani-Dewig
- Human Performance Innovation Center, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA; MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gena R Gerstner
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Center for Healthy Work Design and Worker Well-Being, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Johna K Register-Mihalik
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Darin A Padua
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John A Staley
- Carolina Center for Healthy Work Design and Worker Well-Being, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; North Carolina Occupational Safety and Health Education and Research Center, Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric D Ryan
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Center for Healthy Work Design and Worker Well-Being, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Nilius A, Dewig DR, Johnston CD, Pietrosimone BG, Blackburn JT. Quadriceps composition and function influence downhill gait biomechanics >1 year following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 114:106229. [PMID: 38490072 DOI: 10.1016/j.clinbiomech.2024.106229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Quadriceps dysfunction is common following anterior cruciate ligament reconstruction and contributes to aberrant gait biomechanics. Changes in quadriceps composition also occur in these patients including greater concentrations of non-contractile tissue. The purpose of this study was to evaluate associations between quadriceps composition, function, and gait biomechanics in individuals with anterior cruciate ligament reconstruction. METHODS Forty-eight volunteers with anterior cruciate ligament reconstruction completed gait biomechanics and quadriceps function and composition assessments. Gait biomechanics were sampled during downhill walking (-10° slope) on an instrumented treadmill. Quadriceps function (peak torque and rate of torque development) was assessed via maximal isometric contractions, while composition was evaluated via ultrasound echo intensity. FINDINGS Greater quadriceps peak torque was associated with a greater peak knee extension moment (r = 0.365, p = 0.015). Greater vastus lateralis echo intensity (i.e. poorer muscle quality) was associated with less knee flexion displacement (r = -0.316, p = 0.032). Greater echo intensity of the vastus lateralis (r = -0.298, p = 0.044) and rectus femoris (r = -0.322, p = 0.029) was associated with a more abducted knee angle at heel strike. Quadriceps peak torque explained 11-16% of the variance in echo intensity. INTERPRETATION Both quadriceps function and composition influence aberrant gait biomechanics following anterior cruciate ligament reconstruction. Quadriceps composition appears to provide insight into quadriceps dysfunction independent of muscle strength, as they associated with different gait biomechanics outcomes and shared minimal variance. Future research is necessary to determine the influence of changes in quadriceps composition on joint health outcomes.
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Affiliation(s)
- Alex Nilius
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA
| | - Derek R Dewig
- College of Education, Health & Human Performance, Fairmont State University, USA
| | | | - Brian G Pietrosimone
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA
| | - J Troy Blackburn
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA.
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Buck AN, Lisee CM, Bjornsen ES, Schwartz TA, Spang JT, Franz JR, Blackburn JT, Pietrosimone BG. Biomechanical Threshold Values for Identifying Clinically Significant Knee-Related Symptoms Six Months Following Anterior Cruciate Ligament Reconstruction. J Athl Train 2024:499456. [PMID: 38477136 DOI: 10.4085/1062-6050-0562.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
CONTEXT Slower habitual walking speed and aberrant gait biomechanics are linked to clinically significant knee-related symptoms and articular cartilage composition changes linked to posttraumatic osteoarthritis (PTOA) following anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To determine specific gait biomechanical variables that can accurately identify individuals with clinically significant knee-related symptoms post-ACLR, and the corresponding threshold values, sensitivity, specificity, and odds ratios for each biomechanical variable. DESIGN Cross-sectional analysis. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Seventy-one individuals (n=38 female; age=21±4 years; height=1.76±0.11 m; mass=75.38±13.79 kg) who were 6 months post-primary unilateral ACLR (6.2±0.4 months). MAIN OUTCOME MEASURES 3D motion capture of 5 overground walking trials was used to calculate discrete gait biomechanical variables of interest during stance phase (1st and 2nd peak vertical ground reaction force [vGRF]; midstance minimum vGRF; peak internal knee abduction and extension moments; and peak knee flexion angle), along with habitual walking speed. Knee Injury and Osteoarthritis Outcome Scores (KOOS) was used to dichotomize patients as symptomatic (n=51) or asymptomatic (n=20) using the Englund et al. 2003 KOOS guidelines for defining clinically significant knee-related symptoms. Separate receiver operating characteristic (ROC) curves and respective areas under the curve (AUC) were used to evaluate the capability of each biomechanical variable of interest for identifying individuals with clinically significant knee-related symptoms. RESULTS Habitual walking speed (AUC=0.66), vGRF at midstance (AUC=0.69), and 2nd peak vGRF (AUC=0.76), demonstrated low-to-moderate accuracy for identifying individuals with clinically significant knee-related symptoms. Individuals who exhibited habitual walking speeds ≤1.27 m/s, midstance vGRF ≥0.82 BW, and 2nd peak vGRF ≤1.11 BW, demonstrated 3.13, 6.36, and 9.57 times higher odds of experiencing clinically significant knee-related symptoms, respectively. CONCLUSIONS Critical thresholds for gait variables may be utilized to identify individuals with increased odds of clinically significant knee-related symptoms and potential targets for future interventions.
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Affiliation(s)
- Ashley N Buck
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline M Lisee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth S Bjornsen
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd A Schwartz
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey T Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason R Franz
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - J Troy Blackburn
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian G Pietrosimone
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Davis-Wilson HC, Thoma LM, Franz JR, Blackburn JT, Longobardi L, Schwartz TA, Hackney AC, Pietrosimone B. Physical Activity Associates with T1rho MRI of Femoral Cartilage After Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:411-417. [PMID: 37796166 PMCID: PMC10922225 DOI: 10.1249/mss.0000000000003318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE Less physical activity has been associated with systemic biomarkers of cartilage breakdown after anterior cruciate ligament reconstruction (ACLR). However, previous research lacks analysis of deleterious cartilage compositional changes and objective physical activity after ACLR. The purpose of this study was to determine the association between physical activity quantified via accelerometer-based measures of daily steps and time in moderate-to-vigorous physical activity (MVPA), and T1rho magnetic resonance imaging (MRI) of the femoral articular cartilage, a marker of proteoglycan density in individuals with ACLR. METHODS Daily steps and MVPA were assessed over 7 d using an accelerometer worn on the hip in 26 individuals between 6 and 12 months after primary unilateral ACLR. Resting T1rho MRI was collected bilaterally, and T1rho MRI interlimb ratios (ILR: ACLR limb/contralateral limb) were calculated for lateral and medial femoral condyle regions of interest. We conducted univariate linear regression analyses to determine associations between T1rho MRI ILRs and daily steps and MVPA with and without controlling for sex. RESULTS Greater T1rho MRI ILR of the central lateral femoral condyle, indicative of less proteoglycan density in the ACLR limb, was associated with greater time in MVPA ( R2 = 0.178, P = 0.032). Sex-adjusted models showed significant interaction terms between daily steps and sex in the anterior ( P = 0.025), central ( P = 0.002), and posterior ( P = 0.002) medial femoral condyle. CONCLUSIONS Lesser physical activity may be a risk factor for maintaining cartilage health after ACLR; additionally, the relationship between physical activity and cartilage health may be different between males and females.
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Affiliation(s)
- Hope C. Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Louise M. Thoma
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lara Longobardi
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Todd A. Schwartz
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anthony C. Hackney
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Evans-Pickett A, Davis-Wilson HC, Johnston CD, Blackburn JT, Hackney AC, Pietrosimone B. Immediate Effects of Walking With a Knee Brace After Anterior Cruciate Ligament Reconstruction: A Biomechanical, Biochemical, and Structural Approach. J Athl Train 2023; 58:542-553. [PMID: 35119477 PMCID: PMC10496450 DOI: 10.4085/1062-6050-0700.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals who undergo anterior cruciate ligament reconstruction (ACLR) are at higher risk of posttraumatic osteoarthritis. Altered joint tissue loading caused by aberrant gait biomechanics leads to deleterious changes in joint health linked to the onset of posttraumatic osteoarthritis. Knee braces have been used to modify joint tissue loading in individuals with joint injury, yet the effects of walking with a brace after ACLR on biomechanical, biochemical, and structural cartilage outcomes are unknown. OBJECTIVE To compare biomechanical, biochemical, and structural outcomes between braced and nonbraced walking in individuals with ACLR. DESIGN Crossover study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 34 individuals with unilateral ACLR (18 females, 16 males; time since ACLR = 50.1 ± 36.8 months). INTERVENTION(S) Gait biomechanics were assessed during braced and unbraced conditions on separate days. MAIN OUTCOME MEASURE(S) Vertical ground reaction force, knee-flexion angle, and internal knee-extension moment waveforms were evaluated throughout the stance phase and compared between conditions. Percentage changes in serum cartilage oligomeric matrix protein (%ΔCOMP) and femoral cartilage cross-sectional area (%ΔCSA) measured via ultrasound were calculated after a 3000-step walking protocol. RESULTS Braced walking increased the knee-flexion angle (largest difference = 3.56°; Cohen d effect size = 1.72) and knee-extension moment (largest difference = -0.48% body weight × height; Cohen d effect size = -1.14) compared with nonbraced walking but did not influence vertical ground reaction force. Whereas no difference (P = .20) in %ΔCOMP existed between the braced and nonbraced conditions in the entire cohort (n = 30 with complete blood data), a larger increase (P = .04) in %ΔCOMP was seen during nonbraced than braced walking in individuals who demonstrated increased COMP during nonbraced walking. No difference (P = .86) in %ΔCSA was present between the braced and nonbraced conditions. CONCLUSIONS Braced walking may improve sagittal-plane gait biomechanics and %ΔCOMP in a subset of individuals who demonstrate a typical increased COMP response to load (ie, increase in COMP) after nonbraced walking.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Hope C. Davis-Wilson
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Physical Therapy Department, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Christopher D. Johnston
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Athletic Training, High Point University, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Anthony C. Hackney
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
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Bjornsen E, Davis-Wilson H, Evans-Picket A, Horton WZ, Lisee C, Munsch AE, Nissman D, Blackburn JT, Franz JR, Pietrosimone B. Knee kinetics and the medial femoral cartilage cross-sectional area response to loading in indviduals with anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2023; 105:105979. [PMID: 37148613 PMCID: PMC10278237 DOI: 10.1016/j.clinbiomech.2023.105979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Ultrasonography is capable of detecting morphological changes in femoral articular cartilage cross-sectional area in response to an acute bout of walking; yet, the response of femoral cartilage cross-sectional area varies between individuals. It is hypothesized that differences in joint kinetics may influence the response of cartilage to a standardized walking protocol. Therefore, the study purpose was to compare internal knee abduction and extension moments between individuals with anterior cruciate ligament reconstruction who demonstrate an acute increase, decrease, or unchanged medial femoral cross-sectional area response following 3000 steps. METHODS The medial femoral cartilage in the anterior cruciate ligament reconstructed limb was assessed with ultrasonography before and immediately following 3000 steps of treadmill walking. Knee joint moments were calculated in the anterior cruciate ligament reconstructed limb and compared between groups throughout the stance phase of gait using linear regression and functional, mixed effects waveform analyses. FINDINGS No associations between peak knee joint moments and the cross-sectional area response were observed. The group that demonstrated an acute cross-sectional area increase exhibited 1) lower knee abduction moments in early stance in comparison to the group that exhibited a decreased cross-sectional area response; and 2) greater knee extension moments in early stance in comparison to the group with an unchanged cross-sectional area response. INTERPRETATION The propensity of femoral cartilage to acutely increase cross-sectional area in response to walking is consistent with less-dynamic knee abduction and knee extension moment profiles.
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Affiliation(s)
- Elizabeth Bjornsen
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Hope Davis-Wilson
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Alyssa Evans-Picket
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - W Zachary Horton
- Department of Statistics, University of California, Santa Cruz, CA, United States.
| | - Caroline Lisee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Amanda E Munsch
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill and Raleigh, NC, United States.
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill and Raleigh, NC, United States.
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Song K, Pietrosimone B, Blackburn JT, Padua DA, Tennant JN, Wikstrom EA. Mechanical and Sensorimotor Outcomes Associated With Talar Cartilage Deformation After Static Loading in Those With Chronic Ankle Instability. J Athl Train 2023; 58:136-142. [PMID: 35476021 PMCID: PMC10072092 DOI: 10.4085/1062-6050-0520.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Those with chronic ankle instability (CAI) demonstrate deleterious changes in talar cartilage composition, resulting in alterations of talar cartilage loading behavior. Common impairments associated with CAI may play a role in cartilage behavior in response to mechanical loading. OBJECTIVE To identify mechanical and sensorimotor outcomes that are linked with the magnitude of talar cartilage deformation after a static loading protocol in patients with and those without CAI. DESIGN Cross-sectional study. SETTING Laboratory setting. PATIENTS OR OTHER PARTICIPANTS Thirty individuals with CAI and 30 healthy individuals. MAIN OUTCOME MEASURES(S) After a 60-minute off-loading period, ultrasonographic images of the talar cartilage were acquired immediately before and after a 2-minute static loading protocol (single-legged stance). Talar cartilage images were obtained and manually segmented to enable calculation of medial, lateral, and overall average talar thickness. The percentage change, relative to the average baseline thickness, was used for further analysis. Mechanical (ankle joint laxity) and sensorimotor (static balance and Star Excursion Balance Test) outcomes were captured. Partial correlations were computed to determine associations between cartilage deformation magnitude and the mechanical and sensorimotor outcomes after accounting for body weight. RESULTS In the CAI group, greater inversion laxity was associated with greater overall (r = -0.42, P = .03) and medial (r = -0.48, P = .01) talar cartilage deformation after a 2-minute static loading protocol. Similarly, poorer medial-lateral static balance was linked with greater overall (r = 0.47, P = .01) and lateral (r = 0.50, P = .01) talar cartilage deformation. In the control group, shorter posterolateral Star Excursion Balance Test reach distance was associated with greater lateral cartilage deformation (r = 0.42, P = .03). No other significant associations were observed. CONCLUSIONS In those with CAI, inversion laxity and poor static postural control were moderately associated with greater talar cartilage deformation after a 2-minute static loading protocol. These results suggest that targeting mechanical instability and poor balance in those with CAI via intervention strategies may improve how the talar cartilage responds to static loading conditions.
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Affiliation(s)
- Kyeongtak Song
- Department of Physical Education, Yonsei University, Seoul, Republic of Korea
- MOTION Science Institute, Department of Exercise and Sport Science
| | | | | | - Darin A. Padua
- MOTION Science Institute, Department of Exercise and Sport Science
| | - Joshua N. Tennant
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - Erik A. Wikstrom
- MOTION Science Institute, Department of Exercise and Sport Science
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10
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Dewig DR, Evans-Pickett A, Pietrosimone BG, Blackburn JT. Comparison of discrete and continuous analysis approaches for evaluating gait biomechanics in individuals with anterior cruciate ligament reconstruction. Gait Posture 2023; 100:261-267. [PMID: 36682319 DOI: 10.1016/j.gaitpost.2023.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/19/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Aberrant gait biomechanics contribute to post-traumatic knee osteoarthritis development following anterior cruciate ligament reconstruction (ACLR). Walking gait biomechanics are typically evaluated post-ACLR by identifying discrete, peak values in the load acceptance phase of gait (i.e. first 50 %). As these approaches evaluate a single time instant during the gait cycle, functional data analysis (FDA) techniques that evaluate the entire stance phase waveform are becoming more common in the literature. However, it is unclear if these analysis approaches identify the same biomechanical phenomena. RESEARCH QUESTION The purpose of this study was to determine whether four gait biomechanics analysis approaches identify the same aberrant gait characteristics in individuals with ACLR. METHODS Twenty-four individuals with ACLR and 24 healthy controls completed gait analyses on an instrumented treadmill. Four analysis approaches were employed to compare the vertical ground reaction force and sagittal knee angles and moments during the first 50 % of the stance phase between groups and between limbs in the ACLR cohort: 1) comparison of peak values from individual trials (Peak), 2) comparison of peak values from time-normalized ensemble waveforms (Ensemble Peak), 3) FDA via functional ANCOVA (FANCOVA), and 4) FDA evaluating overlap of the 95 % confidence intervals for each waveform (FDA-CI). RESULTS The Peak, Ensemble Peak, and FANCOVA approaches identified highly similar group and limb differences in the biomechanics outcomes with respect to both magnitude and temporal location. However, the FANCOVA approach indicated that these differences were distributed across large portions of the load acceptance phase and that differences existed outside the first 50 % of stance. The FDA-CI approach was generally not effective for identifying aberrant gait biomechanics. SIGNIFICANCE Peak and FANCOVA approaches to gait analysis provide similar findings. Future research is necessary to determine if the additional information afforded by FANCOVA provides insight regarding the mechanical pathogenesis of post-traumatic knee osteoarthritis.
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Affiliation(s)
- Derek R Dewig
- Rockefeller Neuroscience Institute, West Virginia University, USA
| | - Alyssa Evans-Pickett
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA
| | - Brian G Pietrosimone
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA
| | - J Troy Blackburn
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA.
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11
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Evans-Pickett A, Lisee C, Zachary Horton W, Lalush D, Nissman D, Troy Blackburn J, Spang JT, Pietrosimone B. Worse Tibiofemoral Cartilage Composition Is Associated with Insufficient Gait Kinetics After ACL Reconstruction. Med Sci Sports Exerc 2022; 54:1771-1781. [PMID: 35700436 PMCID: PMC9481723 DOI: 10.1249/mss.0000000000002969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Greater articular cartilage T1ρ magnetic resonance imaging relaxation times indicate less proteoglycan density and are linked to posttraumatic osteoarthritis development after anterior cruciate ligament reconstruction (ACLR). Although changes in T1ρ relaxation times are associated with gait biomechanics, it is unclear if excessive or insufficient knee joint loading is linked to greater T1ρ relaxation times 12 months post-ACLR. The purpose of this study was to compare external knee adduction (KAM) and flexion (KFM) moments in individuals after ACLR with high versus low tibiofemoral T1ρ relaxation profiles and uninjured controls. METHODS Gait biomechanics were collected in 26 uninjured controls (50% females; age, 22 ± 4 yr; body mass index, 23.9 ± 2.8 kg·m -2 ) and 26 individuals after ACLR (50% females; age, 22 ± 4 yr; body mass index, 24.2 ± 3.5 kg·m -2 ) at 6 and 12 months post-ACLR. ACLR-T1ρ High ( n = 9) and ACLR-T1ρ Low ( n = 17) groups were created based on 12-month post-ACLR T1ρ relaxation times using a k-means cluster analysis. Functional analyses of variance were used to compare KAM and KFM. RESULTS ACLR-T1ρ High exhibited lesser KAM than ACLR-T1ρ Low and uninjured controls 6 months post-ACLR. ACLR-T1ρ Low exhibited greater KAM than uninjured controls 6 and 12 months post-ACLR. KAM increased in ACLR-T1ρ High and decreased in ACLR-T1ρ Low between 6 and 12 months, both groups becoming more similar to uninjured controls. There were scant differences in KFM between ACLR-T1ρ High and ACLR-T1ρ Low 6 or 12 months post-ACLR, but both groups demonstrated lesser KFM compared with uninjured controls. CONCLUSIONS Associations between worse T1ρ profiles and increases in KAM may be driven by the normalization of KAM in individuals who initially exhibit insufficient KAM 6 months post-ACLR.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Lisee
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - W. Zachary Horton
- Department of Statistics, University of California at Santa Cruz, Santa Cruz, CA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, NC
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
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12
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Davis-Wilson HC, Thoma LM, Johnston CD, Young E, Evans-Pickett A, Spang JT, Blackburn JT, Hackney AC, Pietrosimone B. Fewer daily steps are associated with greater cartilage oligomeric matrix protein response to loading post-ACL reconstruction. J Orthop Res 2022; 40:2248-2257. [PMID: 35060165 DOI: 10.1002/jor.25268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/19/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Aberrant joint loading contributes to the development of posttraumatic knee osteoarthritis (PTOA) following anterior cruciate ligament reconstruction (ACLR); yet little is known about the association between joint loading due to daily walking and cartilage health post-ACLR. Accelerometer-based measures of daily steps and cadence (i.e., rate of steps/min) provide information regarding daily walking in a real-world setting. The purpose of this study was to determine the association between changes in serum cartilage oligomeric matrix protein (COMP; %∆COMP), a mechanosensitive biomarker that is associated with osteoarthritis progression, following a standardized walking protocol and daily walking in individuals with ACLR and uninjured controls. Daily walking was assessed over 7 days using an accelerometer worn on the right hip in 31 individuals with ACLR and 21 controls and quantified as mean steps/day and time spent in ≥100 steps/min. Serum COMP was measured before and following a 3000-step walking protocol at a preferred speed. %∆COMP was calculated as a change in COMP relative to the prewalking value. Linear regressions were used to examine associations between daily walking and %∆COMP after adjusting for preferred speed. Fewer daily steps (ΔR2 = 0.18, p = 0.02) and fewer minutes spent in ≥100 steps/min (ΔR2 = 0.16, p = 0.03) were associated with greater %∆COMP following walking in individuals with ACLR; no statistically significant associations existed in controls (daily steps: ΔR2 = 0.03, p = 0.47; time ≥100 steps/min: ΔR2 < 0.01, p = 0.81). Clinical significance: Individuals with ACLR who engage in less daily walking undergo greater %ΔCOMP, which may represent greater cartilage degradation or turnover in response to walking.
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Affiliation(s)
- Hope C Davis-Wilson
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Louise M Thoma
- Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher D Johnston
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emma Young
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Athletic Training Program, The Steadman Clinic, Vail, Colorado, USA
| | - Alyssa Evans-Pickett
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J Troy Blackburn
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anthony C Hackney
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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13
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Lisee CM, Bjornsen E, Horton WZ, Davis-Wilson H, Blackburn JT, Fisher MB, Pietrosimone B. Differences in Gait Biomechanics Between Adolescents and Young Adults With Anterior Cruciate Ligament Reconstruction. J Athl Train 2022; 57:921-928. [PMID: 36638344 PMCID: PMC9842117 DOI: 10.4085/1062-6050-0052.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Adolescents and adults are treated similarly in rehabilitation and research despite differences in clinical recovery after anterior cruciate ligament reconstruction (ACLR). Aberrant gait is a clinical outcome associated with poor long-term health post-ACLR but has not been compared between adolescents and adults. OBJECTIVE To compare gait biomechanical waveforms throughout stance between adolescents (<18 years old) and young adults (≥18 years old) post-ACLR. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Adolescents (n = 13, girls = 77%, age = 16.7 ± 0.6 years, height = 1.7 ± 0.1 m, weight = 22.2 ± 3.7 kg/m2) were identified from a cross-sectional cohort assessing clinical outcomes 6 to 12 months post-ACLR. Young adults (n = 13, women = 77%, age = 22.3 ± 4.0 years, height = 1.7 ± 0.1 m, weight = 22.9 ± 3.3 kg/m2) were matched based on sex, time since surgery (±2 months), and body mass index (±3 kg/m2). INTERVENTION(S) Participants performed 5 gait trials at their habitual speed. MAIN OUTCOME MEASURE(S) Three-dimensional gait biomechanics and forces were collected. Vertical ground reaction force normalized to body weight (xBW), knee-flexion angle (°), knee-abduction moment (xBW × height), and knee-extension moment (BW × height) waveforms were calculated during the stance phase of gait (0%-100%). Habitual walking speed was compared using independent t tests. We used functional waveforms to compare gait biomechanics throughout stance with and without controlling for habitual walking speed by calculating mean differences between groups with 95% CIs. RESULTS Adolescents walked with slower habitual speeds compared with adults (adolescents = 1.1 ± 0.1 m/s, adults = 1.3 ± 0.1 m/s, P < .001). When gait speed was not controlled, adolescents walked with less vertical ground reaction force (9%-15% of stance) and knee-abduction moment (12%-25% of stance) during early stance and less knee-extension moment during late stance (80%-99% of stance). Regardless of their habitual walking speed, adolescents walked with greater knee-flexion angle throughout most stances (0%-21% and 29%-100% of stance). CONCLUSIONS Adolescents and adults demonstrated different gait patterns post-ACLR, suggesting that age may play a role in altered gait biomechanics.
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Affiliation(s)
| | - Elizabeth Bjornsen
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | | | - Hope Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
| | - J. Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, and North Carolina State University, Raleigh
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
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14
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Evans-Pickett A, Davis-Wilson H, Munsch A, Blackburn JT, Franz JR, Pietrosimone B. Real-time Biofeedback Elicits Bilateral Changes In Gait Biomechanics In Patients With Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000877632.86774.b8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Song K, Pietrosimone B, Blackburn JT, Padua DA, Tennant JN, Wikstrom EA. Dorsiflexion and Hop Biomechanics Associate with Greater Talar Cartilage Deformation in Those with Chronic Ankle Instability. Med Sci Sports Exerc 2022; 54:1176-1182. [PMID: 35389946 DOI: 10.1249/mss.0000000000002902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to identify associations between dorsiflexion range of motion (DFROM), functional hop test performance, and hopping biomechanics with the magnitude of talar cartilage deformation after a standardized hopping protocol in individuals with and without chronic ankle instability (CAI). METHODS Thirty CAI and 30 healthy individuals participated. Ankle DFROM was assessed using the weight-bearing lunge test. Four different functional hop tests were assessed. Three-dimensional kinematics and kinetics were sampled during a 60-cm single-leg hop. We calculated cartilage deformation after a dynamic loading protocol consisting of sixty 60-cm single-leg forward hops by assessing the change in average thickness for the overall, medial, and lateral talar cartilage. Linear regressions examined the associations between cartilage deformation magnitude and DFROM, functional hop tests, and hop biomechanical variables after accounting for body weight and time since the initial ankle sprain. RESULTS In CAI group, lesser static DFROM (ΔR2 = 0.22) and smaller peak ankle dorsiflexion angle (ΔR2 = 0.17) was associated with greater medial deformation. Greater peak vertical ground reaction force (vGRF) (ΔR2 = 0.26-0.28) was associated with greater medial and overall deformation. Greater vGRF loading rate (ΔR2 = 0.23-0.35) was associated with greater lateral and overall deformation. Greater side hop test times (ΔR2 = 0.31-0.36) and ankle plantarflexion at initial contact (ΔR2 = 0.23-0.38) were associated with greater medial, lateral, and overall deformation. In the control group, lesser side hop test times (ΔR2 = 0.14), greater crossover hop distances (ΔR2 = 0.14), and greater single-hop distances (ΔR2 = 0.21) were associated with greater overall deformation. CONCLUSIONS Our results indicate that lesser static DFROM, poorer functional hop test performance, and hop biomechanics associate with greater talar cartilage deformation after a dynamic loading protocol in those with CAI. These factors may represent targets for therapeutic interventions within this population to slow ankle posttraumatic osteoarthritis progression.
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Affiliation(s)
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J Troy Blackburn
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Darin A Padua
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joshua N Tennant
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
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16
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Harkey MS, Blackburn JT, Hackney AC, Lewek MD, Schmitz RJ, Pietrosimone B. Sex-Specific Associations between Cartilage Structure and Metabolism at Rest and Acutely Following Walking and Drop-Landing. Cartilage 2021; 13:1772S-1781S. [PMID: 32954820 PMCID: PMC8808927 DOI: 10.1177/1947603520959386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Cartilage health is thought to be dependent on the relationship between mechanics, structure, and metabolism, rather than these individual components in isolation. Due to sex differences in cartilage health, there is need to determine if the relationships between these cartilage components separately for males and females. Therefore, we sought to determine the sex-specific associations between cartilage structure and metabolism at rest and their acute response following walking and drop-landing in healthy individuals. DESIGN A cartilage ultrasound assessment and an ante-cubital blood draw were performed before and after walking and drop-landing conditions in 20 males and 20 females. Cartilage structure was assessed via medial and lateral femoral cartilage cross-sectional area. Cartilage metabolism was quantified with serum cartilage oligomeric matrix protein (COMP) concentration. Percent change scores from pre- to postloading were used to calculate acute alterations in cross-sectional area and COMP. Correlational analyses were used to assess the association between cartilage structure and metabolism measures separately for males and females. RESULTS In females, greater resting COMP concentration was associated with less cartilage cross-sectional area in the medial(ρ = -0.50, P = 0.03) and lateral (ρ = -0.69, P = 0.001) femur. Resting cartilage measures were not associated among males. Following walking and drop-landing, percent change scores in cartilage structure and metabolism were not associated. CONCLUSIONS This study highlights that, in females, thinner anterior femoral cartilage is associated with greater resting serum COMP concentrations, a biomarker often linked to cartilage breakdown. Future studies into the relationships between various cartilage components should consider sex-specific analyses as these relationships are sex dependent.
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Affiliation(s)
- Matthew S. Harkey
- Department of Kinesiology, Michigan
State University, East Lansing, MI, USA,Matthew S. Harkey, Department of
Kinesiology, Michigan State University, 308 W. Circle Drive #112, East Lansing,
MI 48824, USA.
| | - J. Troy Blackburn
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony C. Hackney
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Nutrition, School of
Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
| | - Michael D. Lewek
- Division of Physical Therapy, University
of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Randy J. Schmitz
- Department of Kinesiology, University of
North Carolina at Greensboro, Greensboro, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Wallace KG, Pfeiffer SJ, Pietrosimone LS, Harkey MS, Zong X, Nissman D, Kamath GM, Creighton RA, Spang JT, Blackburn JT, Pietrosimone B. Changes in Infrapatellar Fat Pad Volume 6 to 12 Months After Anterior Cruciate Ligament Reconstruction and Associations With Patient-Reported Knee Function. J Athl Train 2021; 56:1173-1179. [PMID: 33787883 PMCID: PMC8582630 DOI: 10.4085/1062-6050-0458.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Hypertrophy of the infrapatellar fat pad (IFP) in idiopathic knee osteoarthritis has been linked to deleterious synovial changes and joint pain related to mechanical tissue impingement. Yet little is known regarding the IFP's volumetric changes after anterior cruciate ligament reconstruction (ACLR). OBJECTIVES To examine changes in IFP volume between 6 and 12 months after ACLR and determine associations between patient-reported outcomes and IFP volume at each time point as well as the volume change over time. In a subset of individuals, we examined interlimb IFP volume differences 12 months post-ACLR. STUDY DESIGN Prospective cohort study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS We studied 26 participants (13 women, 13 men, age = 21.88 ± 3.58 years, body mass index = 23.82 ± 2.21 kg/m2) for our primary aims and 13 of those participants (8 women, 5 men, age = 21.15 ± 3.85 years, body mass index = 23.01 ± 2.01 kg/m2) for our exploratory aim. MAIN OUTCOME MEASURE(S) Using magnetic resonance imaging, we evaluated the IFP volume change between 6 and 12 months post-ACLR in the ACLR limb and between-limbs differences at 12 months in a subset of participants. International Knee Documentation Committee subjective knee evaluation (IKDC) scores were collected at 6-month and 12-month follow-ups, and associations between IFP volume and patient-reported outcomes were determined. RESULTS The IFP volume in the ACLR limb increased from 6 months (19.67 ± 6.30 cm3) to 12 months (21.26 ± 6.91 cm3) post-ACLR. Greater increases of IFP volume between 6 and 12 months were significantly associated with better 6-month IKDC scores (r = .44, P = .03). The IFP volume was greater in the uninjured limb (22.71 ± 7.87 cm3) than in the ACLR limb (20.75 ± 9.03 cm3) 12 months post-ACLR. CONCLUSIONS The IFP volume increased between 6 and 12 months post-ACLR; however, the IFP volume of the ACLR limb remained smaller than that of the uninjured limb at 12 months. In addition, those with better knee function 6 months post-ACLR demonstrated greater increases in IFP volume between 6 and 12 months post-ACLR. This suggests that greater IFP volumes may play a role in long-term joint health after ACLR.
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Affiliation(s)
- Kyle G Wallace
- Georgetown University School of Medicine, Washington, DC
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Steven J Pfeiffer
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens
- School of Applied Health Sciences and Wellness, Ohio University, Athens
| | - Laura S Pietrosimone
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC
| | - Matthew S Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | - Xiaopeng Zong
- Department of Radiology, University of North Carolina at Chapel Hill
- Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill
| | - Ganesh M Kamath
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | | | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - J Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
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Davis-Wilson H, Pfeiffer SJ, Evans-Pickett A, Franz J, Blackburn JT, Pietrosimone B. Femoral Cartilage Ultrasound Outcomes Associate With T1rho Magnetic Resonance Outcomes Following Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000761108.62603.3d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Davis-Wilson HC, Thoma LM, Longobardi L, Franz JR, Blackburn JT, Hackney AC, Pietrosimone B. Quality of Life Associates With Moderate to Vigorous Physical Activity Following Anterior Cruciate Ligament Reconstruction. J Athl Train 2021; 57:532-539. [PMID: 34329413 DOI: 10.4085/1062-6050-0670.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Higher knee function is linked to psychological readiness to return to sport following anterior cruciate ligament reconstruction (ACLR). Individuals with ACLR participate in less physical activity compared to matched uninjured controls, yet the association between knee function and physical activity following ACLR remains unclear. OBJECTIVE To determine the association between patient-reported knee function measured with the Knee Injury and Osteoarthritis Outcomes Score Quality of Life (KOOS-QOL), daily steps, and minutes spent in moderate to vigorous physical activity (MVPA) in individuals with ACLR. Secondarily, we determined associations between KOOS-QOL, daily steps, and MVPA in individuals with ACLR who presented with (symptomatic) and without (asymptomatic) clinically meaningful knee related symptoms. DESIGN Cross-sectional study. SETTING Laboratory, Free-living conditions. PATIENTS OR OTHER PARTICIPANTS Sixty-six individuals with primary unilateral ACLR (55% female, 22±4 years, 28±33 months post-ACLR, BMI: 24.2±2.9 kg/m2). OUTCOME MEASURE(S) We collected KOOS and retrospectively stratified participants into those with (symptomatic [n=30]) or without (asymptomatic [n=36]) clinically meaningful knee related symptoms based on previously defined KOOS cutoffs. We assessed daily steps and MVPA from ActiGraph GT9X Link accelerometers which each participant wore on the right hip for 7 days. We conducted linear regressions to determine associations between KOOS-QOL, daily steps, and MVPA. RESULTS No significant associations existed in the entire sample between KOOS-QOL and daily steps (ΔR2=0.01, P=0.50) or MVPA (ΔR2=0.01, P=0.36). In symptomatic individuals, greater KOOS-QOL associated with greater MVPA (ΔR2=0.12, P=0.05,). No significant associations existed between KOOS-QOL, daily steps, and MVPA in the asymptomatic group. CONCLUSIONS Symptomatic individuals with ACLR who spent more time in MVPA reported higher quality of life.
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Affiliation(s)
- Hope C Davis-Wilson
- 1Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Louise M Thoma
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,3Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lara Longobardi
- 4Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason R Franz
- 5Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - J Troy Blackburn
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,6MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,7Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A C Hackney
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,8Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian Pietrosimone
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,6MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,7Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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20
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Evans-Pickett A, Longobardi L, Spang JT, Creighton RA, Kamath G, Davis-Wilson HC, Loeser R, Blackburn JT, Pietrosimone B. Synovial fluid concentrations of matrix Metalloproteinase-3 and Interluekin-6 following anterior cruciate ligament injury associate with gait biomechanics 6 months following reconstruction. Osteoarthritis Cartilage 2021; 29:1006-1019. [PMID: 33781899 PMCID: PMC8658576 DOI: 10.1016/j.joca.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare gait biomechanics 6 months following anterior cruciate ligament (ACL) reconstruction (ACLR) between patients with the highest and lowest concentrations of synovial fluid (SF) interleukin-6 (IL-6) and matrix metalloproteinase-3 (MMP-3), as well as compared to uninjured controls. DESIGN SF concentrations of IL-6 and MMP-3 were collected 7 ± 4 days post injury in 38 ACL injured patients (55% female, 21±4yrs, 25.3 ± 5.2BMI). ACL injured individuals were stratified into the lowest and highest quartiles based on IL-6 (IL-6Lowest and IL-6Highest) and MMP-3 (MMP-3Lowest and MMP-3Highest) concentrations. Gait biomechanics were collected on the injured limb 6 months post-ACLR and in 38 uninjured controls (50% female, 21±3yrs, 23.8 ± 2.8BMI). Functional analyses of variance were used to compare vertical ground reaction force (vGRF), knee flexion angle (KFA), and internal knee extension moment (KEM) waveforms throughout stance phase of gait to determine the proportions of stance differing between limbs and groups. RESULTS Compared to uninjured controls, IL-6High and MMP-3High ACL subgroups demonstrated lesser vGRF (largest differences: IL-6, 7.88%BW; MMP-3, 11.05%BW) during early-stance and greater vGRF (largest differences: IL-6, 6.21%BW; MMP-3, 5.85%BW) in mid-stance, lesser KFA (largest differences: IL-6, 3.11°; MMP-3, 3.72°) and lesser KEM (largest differences: IL-6, 0.96%BW•m; MMP-3, 1.07%BW•m) in early-stance, as well as greater KFA in mid-stance (largest differences: IL-6, 1.5°; MMP-3, 2.95°). CONCLUSIONS High SF concentrations of a proinflammatory cytokine and a degradative enzyme early post-ACL injury are associated with aberrant gait biomechanics in the injured limb at 6 months post-ACLR (i.e., lesser vGRF, KFA and KEM) linked to posttraumatic osteoarthritis development.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States,Corresponding Author: Alyssa Evans-Pickett, Ph.D.
Student, Department of Exercise and Sport Science, University of North Carolina
at Chapel Hill, 210 South Road Fetzer Hall, Chapel Hill, NC, 27599, United
States,
| | - Lara Longobardi
- Thurston Arthritis Research Center, University of
North Carolina at Chapel Hill, 27599, United States
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - R. Alexander Creighton
- Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - Ganesh Kamath
- Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - Hope C. Davis-Wilson
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Richard Loeser
- Thurston Arthritis Research Center, University of
North Carolina at Chapel Hill, 27599, United States
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States,Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and
Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States,Human Movement Science Curriculum, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States,Department of Orthopaedics, School of Medicine,
University of North Carolina at Chapel Hill, 27599, NC, United States
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21
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Song K, Pietrosimone B, Blackburn JT, Padua DA, Tennant JN, Wikstrom EA. Acute Talar Cartilage Deformation in Those with and without Chronic Ankle Instability. Med Sci Sports Exerc 2021; 53:1228-1234. [PMID: 33986229 DOI: 10.1249/mss.0000000000002572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed 1) to determine whether talar cartilage deformation measured via ultrasonography (US) after standing and hopping loading protocols differs between chronic ankle instability (CAI) patients and healthy controls and 2) to determine whether the US measurement of cartilage deformation reflects viscoelasticity between standing and hopping protocols. METHODS A total of 30 CAI and 30 controls participated. After a 60-min off-loading period, US images of the talar cartilage were acquired before and after static (2-min single-leg standing) and dynamic (60 single-leg forward hops) loading conditions. We calculated cartilage deformation by assessing the change in average thickness (mm) for overall, medial, and lateral talar cartilage. The independent variables include time (Pre60 and postloading), condition (standing and dynamic loading), and group (CAI and control). A three-way mixed-model repeated-measures ANCOVA and appropriate post hoc tests were used to compare cartilage deformation between the groups after static and dynamic loading. RESULTS After the static loading condition, those with CAI had greater talar cartilage deformation compared with healthy individuals for overall (-10.87% vs -6.84%, P = 0.032) and medial (-12.98% vs -5.80%, P = 0.006) talar cartilage. Similarly, the CAI group had greater deformation relative to the control group for overall (-8.59% vs -3.46%, P = 0.038) and medial (-8.51% vs -3.31%, P = 0.043) talar cartilage after the dynamic loading condition. In the combined cohort, cartilage deformation was greater after static loading compared with dynamic in overall (-8.85% vs -6.03%, P = 0.003), medial (-9.38% vs -5.91%, P = 0.043), and lateral (-7.90% vs -5.65%, P = 0.009) cartilage. CONCLUSION US is capable of detecting differences in cartilage deformation between those with CAI and uninjured controls after standardized physiologic loads. Across both groups, our results demonstrate that static loading results in greater cartilage deformation compared with dynamic loading.
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Affiliation(s)
- Kyeongtak Song
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Darin A Padua
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joshua N Tennant
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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22
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Pietrosimone LS, Blackburn JT, Wikstrom EA, Berkoff DJ, Docking SI, Cook J, Padua DA. Differences in Biomechanical Loading Magnitude During a Landing Task in Male Athletes with and without Patellar Tendinopathy. J Athl Train 2021; 57:464343. [PMID: 33887762 PMCID: PMC9875712 DOI: 10.4085/1062-6050-0548.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared to healthy athletes. OBJECTIVE The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy. DESIGN Cross-sectional study Setting: Laboratory Patients or Other Participants: 43 males were grouped based on patellar tendon pain & ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM-PTA; n=13; 20±2yrs; 1.8±0.1m; 84±5kg), asymptomatic with PTA (ASYM-PTA; n=15; 21±2yrs; 1.8±0.1m; 82±13kg), and healthy control (CON; n=15; 20±2yrs; 1.8±0.1m; 79±12kg). MAIN OUTCOME MEASURES 3D biomechanics were collected during double-limb jump-landing. Kinematic (knee flexion angle (KF)) and kinetic (vertical ground reaction force (VGRF); internal knee extension moment (KEM); patellar tendon force (FPT)) variables were analyzed as continuous waveforms during the stance phase for the involved limb. Mean values were calculated for each 1% of stance, normalized over 202 data points (0-100%), and plotted with 95% confidence intervals. Statistical significance was defined as a lack of 95% CI overlap for ≥ 6 consecutive data points. RESULTS SYM-PTA had lesser KF than CON throughout the stance phase. ASYM-PTA had lesser KF than CON in the early and late stance phase. SYM-PTA group had lesser KEM and FPT than CON in early stance, as well as ASYM-PTA in mid-stance. CONCLUSIONS Male athletes with SYM-PTA demonstrated a patellar tendon load-avoidance profile compared to ASYM-PTA and CON athletes. ASYM-PTA did not show evidence of overloading compared to CON. Our findings support the need for individualized treatments for athletes with tendinopathy to maximize load-capacity. TRIAL REGISTRY ClinicalTrials.gov (#XXX).
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Affiliation(s)
| | - J. Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - Erik A. Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - David J. Berkoff
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - Sean I. Docking
- La Trobe Sports and Exercise Research Centre, La Trobe University, Bundoora, Australia
| | - Jill Cook
- La Trobe Sports and Exercise Research Centre, La Trobe University, Bundoora, Australia
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
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23
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Pexa B, Ryan ED, Blackburn JT, Padua DA, Garrison JC, Myers JB. Influence of Baseball Training Load on Clinical Reach Tests and Grip Strength in Collegiate Baseball Players. J Athl Train 2021; 55:984-993. [PMID: 32857132 DOI: 10.4085/1062-6050-0456.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT A baseball-specific training load may influence strength or glenohumeral range of motion, which are related to baseball injuries. Glenohumeral reach tests and grip strength are clinical assessments of shoulder range of motion and upper extremity strength, respectively. OBJECTIVE To examine changes in glenohumeral reach test performance and grip strength between dominant and nondominant limbs and high, moderate, and low baseball-specific training-load groups. DESIGN Repeated-measures study. SETTING University laboratory and satellite clinic. PATIENTS OR OTHER PARTICIPANTS Collegiate baseball athletes (n = 18, age = 20.1 ± 1.3 years, height = 185.0 ± 6.5 cm, mass = 90.9 ± 10.2 kg). MAIN OUTCOME MEASURE(S) Participants performed overhead reach tests (OHRTs), behind-the-back reach tests (BBRTs), and grip strength assessments using the dominant and nondominant limbs every 4 weeks for 16 weeks. Percentage change scores were calculated between testing times. After each training session, participants provided their duration of baseball activity, throw count, and body-specific and arm-specific ratings of perceived exertion. We classified them in the high, moderate, or low training-load group based on each training-load variable: body-specific acute:chronic workload ratio (ACWR), arm-specific ACWR, body-specific cumulative load, and arm-specific cumulative load. Mixed models were used to compare training-load groups and limbs. RESULTS The arm-specific ACWR group demonstrated as main effect for OHRT (F = 7.70, P = .001), BBRT (F = 4.01, P = .029), and grip strength (F = 8.89, P < .001). For the OHRT, the moderate training-load group demonstrated a 10.8% greater increase than the high group (P = .004) and a 13.2% greater increase than the low group (P < .001). For the BBRT, the low training-load group had a 10.1% greater increase than the moderate group (P = .011). For grip strength, the low training-load group demonstrated a 12.1% greater increase than the high group (P = .006) and a 17.7% greater increase than the moderate group (P < .001). CONCLUSIONS Arm-specific ACWR was related to changes in clinical assessments of range of motion and strength. Clinicians may use arm-specific ACWR to indicate when a baseball athlete's physical health is changing.
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Pietrosimone B, Davis-Wilson HC, Seeley MK, Johnston C, Spang JT, Creighton RA, Kamath GM, Blackburn JT. Gait Biomechanics in Individuals Meeting Sufficient Quadriceps Strength Cutoffs Following Anterior Cruciate Ligament Reconstruction. J Athl Train 2021; 56:960-966. [PMID: 33481020 DOI: 10.4085/425-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Quadriceps weakness is associated with disability and aberrant gait biomechanics following anterior cruciate ligament reconstruction (ACLR). Strength sufficiency cutoff scores, that normalize quadriceps strength to the mass of an individual, are capable of predicting individuals who will report better function following ACLR. Yet, it remains unknown if gait biomechanics differ between individuals who meet a strength sufficiency cutoff (strong) compared to those who do not (weak). OBJECTIVE Determine if vertical ground reaction force (vGRF), knee flexion angle (KFA) and internal knee extension moment (KEM) differ between strong and weak individuals with an ACLR throughout stance phase of walking. DESIGN Comparison-control. SETTING Laboratory Participants: Individuals who received unilateral ACLR ≥12 months prior to testing were dichotomized into strong (n=31) and weak groups (n=116). MAIN OUTCOME MEASURES Maximal isometric quadriceps strength was collected at 90° of knee flexion using an isokinetic dynamometer and normalized to body mass. Individuals demonstrating ≥3.0Nm/kg were considered strong. Three-dimensional gait biomechanics were collected at a self-selected walking speed. Biomechanical data were time-normalized to 100% of stance phase. vGRF were normalized to body weight (BW), and KEM was normalized to BW*height. Pairwise comparison functions were calculated for each outcome to identify between-group differences for each percentile of stance. RESULTS vGRF was significantly greater in weak participants for the first 22% of stance (average difference of 6.2% BW) and lesser in weak participants between 36-43% of stance (1.4% BW). KFA was significantly greater (i.e., more flexion) in strong participants between 6-62% of stance (2.3°) and lesser (i.e., less flexion) between 68-79% of stance (1.0°). KEM was significantly greater in strong participants between 7-62% of stance (0.007 BW*height). CONCLUSIONS ACLR individuals able to generate knee extension torque ≥3.0Nm/kg exhibit different biomechanical gait profiles compared to weak individuals, which may allow for better energy attenuation following ACLR.
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Affiliation(s)
- Brian Pietrosimone
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Hope C Davis-Wilson
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Matthew K Seeley
- 4Department of Exercise Sciences, Brigham Young University, Provo, Utah, United States
| | - Christopher Johnston
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Jeffrey T Spang
- 3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - R Alexander Creighton
- 3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Ganesh M Kamath
- 3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - J Troy Blackburn
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
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Davis-Wilson HC, Johnston CD, Young E, Song K, Wikstrom EA, Blackburn JT, Pietrosimone B. Effects of BMI on Walking Speed and Gait Biomechanics after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2021; 53:108-114. [PMID: 32826633 DOI: 10.1249/mss.0000000000002460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE History of an anterior cruciate ligament reconstruction (ACLR) and high body mass index (BMI) are strong independent risk factors for knee osteoarthritis (KOA) onset. The combination of these risk factors may further negatively affect joint loading and KOA risk. We sought to determine the combined influence of BMI and ACLR on walking speed and gait biomechanics that are hypothesized to influence KOA onset. METHODS Walking speed and gait biomechanics (peak vertical ground reaction force [vGRF], peak vGRF instantaneous loading rate [vGRF-LR], peak knee flexion angle, knee flexion excursion [KFE], peak internal knee extension moment [KEM], and peak internal knee abduction moment [KAM]) were collected in 196 individuals with unilateral ACLR and 106 uninjured controls. KFE was measured throughout stance phase, whereas all other gait biomechanics were analyzed during the first 50% of stance phase. A 2 × 2 ANOVA was performed to evaluate the interaction between BMI and ACLR and main effects for both BMI and ACLR on walking speed and gait biomechanics between four cohorts (high BMI ACLR, normal BMI ACLR, high BMI controls, and normal BMI controls). RESULTS History of an ACLR and high BMI influenced slower walking speed (F1,298 = 7.34, P = 0.007), and history of an ACLR and normal BMI influenced greater peak vGRF-LR (F1,298 = 6.56, P = 0.011). When evaluating main effects, individuals with an ACLR demonstrated lesser KFE (F1,298 = 7.85, P = 0.005) and lesser peak KEM (F1,298 = 6.31, P = 0.013), and individuals with high BMI demonstrated lesser peak KAM (F1,297 = 5.83, P = 0.016). CONCLUSION BMI and history of ACLR together influence walking speed and peak vGRF-LR. History of an ACLR influences KFE and peak KEM, whereas BMI influences peak KAM. BMI may need to be considered when designing interventions aimed at restoring gait biomechanics post-ACLR.
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Affiliation(s)
| | | | - Emma Young
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
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26
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Dewig DR, Goodwin JS, Pietrosimone BG, Blackburn JT. Associations Among Eccentric Hamstrings Strength, Hamstrings Stiffness, and Jump-Landing Biomechanics. J Athl Train 2020; 55:717-723. [PMID: 32432902 DOI: 10.4085/1062-6050-151-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Anterior cruciate ligament (ACL) injury risk can be assessed from landing biomechanics. Greater hamstrings stiffness is associated with a landing-biomechanics profile consistent with less ACL loading but is difficult to assess in the clinical setting. Eccentric hamstrings strength can be easily evaluated by clinicians and may provide a surrogate measure for hamstrings stiffness. OBJECTIVE To examine associations among eccentric hamstrings strength, hamstrings stiffness, and landing biomechanics linked to ACL injury risk. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 34 uninjured, physically active participants (22 women, 12 men; age = 20.2 ± 1.6 years, height = 171.5 ± 9.7 cm, mass = 67.1 ± 12.7 kg). INTERVENTION(S) We collected eccentric hamstrings strength, active hamstrings stiffness, and double- and single-legged landing biomechanics during a single session. MAIN OUTCOME MEASURE(S) Bivariate associations were conducted between eccentric hamstrings strength and hamstrings stiffness, vertical ground reaction force, internal knee-extension moment, internal knee-varus moment, anterior tibial shear force, knee sagittal-plane angle at initial ground contact, peak knee-flexion angle, knee frontal-plane angle at initial ground contact, peak knee-valgus angle, and knee-flexion displacement using Pearson product moment correlations or Spearman rank-order correlations. RESULTS We observed no association between hamstrings stiffness and eccentric hamstrings strength (r = 0.029, P = .44). We also found no association between hamstrings stiffness and landing biomechanics. However, greater peak eccentric strength was associated with less vertical ground reaction force in both the double-legged (r = -0.331, P = .03) and single-legged (r = -0.418, P = .01) landing conditions and with less internal knee-varus moment in the single-legged landing condition (r = -0.326, P = .04). CONCLUSIONS Eccentric hamstrings strength was associated with less vertical ground reaction force during both landing tasks and less internal knee-varus moment during the single-legged landing but was not an acceptable clinical estimate of active hamstrings stiffness.
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Affiliation(s)
- Derek R Dewig
- MOTION Science Institute, University of North Carolina at Chapel Hill
| | | | | | - J Troy Blackburn
- MOTION Science Institute, University of North Carolina at Chapel Hill
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27
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Davis-Wilson HC, Pfeiffer SJ, Johnston CD, Seeley MK, Harkey MS, Blackburn JT, Fockler RP, Spang JT, Pietrosimone B. Bilateral Gait 6 and 12 Months Post-Anterior Cruciate Ligament Reconstruction Compared with Controls. Med Sci Sports Exerc 2020; 52:785-794. [PMID: 31809411 DOI: 10.1249/mss.0000000000002208] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare gait biomechanics throughout stance phase 6 and 12 months after unilateral anterior cruciate ligament reconstruction (ACLR) between ACLR and contralateral limbs and compared with controls. METHODS Vertical ground reaction force (vGRF), knee flexion angle (KFA), and internal knee extension moment (KEM) were collected bilaterally 6 and 12 months post-ACLR in 30 individuals (50% female, 22 ± 3 yr, body mass index = 23.8 ± 2.2 kg·m) and at a single time point in 30 matched uninjured controls (50% female, 22 ± 4 yr, body mass index = 23.6 ± 2.1 kg·m). Functional analyses of variance were used to evaluate the effects of limb (ACLR, contralateral, and control) and time (6 and 12 months) on biomechanical outcomes throughout stance. RESULTS Compared with the uninjured controls, the ACLR group demonstrated bilaterally lesser vGRF (ACLR, 9% body weight [BW]; contralateral, 4%BW) during early stance and greater vGRF during midstance (ACLR, 5%BW; contralateral, 4%BW) 6 months post-ACLR. Compared to the uninjured controls, the ACLR group demonstrated bilaterally lesser vGRF (ACLR, 10%BW; contralateral, 8%BW) during early stance and greater vGRF during midstance (ACLR, 5%BW; contralateral, 5%BW) 12 months post-ACLR. Compared with controls, the ACLR limb demonstrated lesser KFA during early stance at 6 (2.3°) and 12 months post-ACLR (2.0°), and the contralateral limb demonstrated lesser KFA during early stance at 12 months post-ACLR (2.8°). Compared with controls, the ACLR limb demonstrated lesser KEM during early stance at both 6 months (0.011BW × height) and 12 months (0.007BW × height) post-ACLR, and the contralateral limb demonstrated lesser KEM during early stance only at 12 months (0.006BW × height). CONCLUSIONS Walking biomechanics are altered bilaterally after ACLR. During the first 12 months post-ACLR, both the ACLR and contralateral limbs demonstrate biomechanical differences compared with control limbs. Differences between the contralateral and control limbs increase from 6 to 12 months post-ACLR.
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Affiliation(s)
| | | | | | - Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | | | | | - Ryan P Fockler
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey T Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
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Troy Blackburn J, Dewig DR, Johnston CD. Time course of the effects of vibration on quadriceps function in individuals with anterior cruciate ligament reconstruction. J Electromyogr Kinesiol 2020; 56:102508. [PMID: 33302006 DOI: 10.1016/j.jelekin.2020.102508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022] Open
Abstract
Quadriceps dysfunction is a common, chronic complication following anterior cruciate ligament reconstruction (ACLR) that contributes to aberrant gait biomechanics and poor joint health. Vibration enhances quadriceps function in individuals with ACLR, but the duration of these effects is unknown. This study evaluated the time course of the effects of whole body vibration (WBV) and local muscle vibration (LMV) on quadriceps function. Twenty-four volunteers with ACLR completed 3 testing sessions during which quadriceps isometric peak torque, rate of torque development, and EMG amplitude were assessed prior to and immediately, 10, 20, 30, 45, and 60 min following a WBV, LMV, or control intervention. WBV and LMV (30 Hz, 2g) were applied during six one-minute bouts. WBV increased peak torque 5-11% relative to baseline and control at all post-intervention time points. LMV increased peak torque 6% relative to baseline at 10 min post-intervention and 4-6% relative to control immediately, 10 min, and 20 min post-intervention. The interventions did not influence EMG amplitudes or rate of torque development. The sustained improvements in quadriceps following vibration, especially WBV, suggest that it could be applied at the beginning of rehabilitation sessions to "prime" the central nervous system, potentially improving the efficacy of ACLR rehabilitative exercise.
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Affiliation(s)
- J Troy Blackburn
- Department of Exercise and Sport Science, High Point University, USA; Program in Human Movement Science, High Point University, USA.
| | - Derek R Dewig
- Program in Human Movement Science, High Point University, USA
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Luc-Harkey BA, Franz J, Hackney AC, Blackburn JT, Padua DA, Schwartz T, Davis-Wilson H, Spang J, Pietrosimone B. Immediate Biochemical Changes After Gait Biofeedback in Individuals With Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:1106-1115. [PMID: 32966563 DOI: 10.4085/1062-6050-0372.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Gait biomechanics are linked to biochemical changes that contribute to the development of posttraumatic knee osteoarthritis in individuals with anterior cruciate ligament reconstruction (ACLR). It remains unknown if modifying peak loading during gait using real-time biofeedback will result in acute biochemical changes related to cartilage metabolism. OBJECTIVE To determine if acutely manipulating peak vertical ground reaction force (vGRF) during gait influences acute changes in serum cartilage oligomeric matrix protein concentration (sCOMP) among individuals with ACLR. DESIGN Crossover study. PATIENTS OR OTHER PARTICIPANTS Thirty individuals with unilateral ACLR participated (70% female, age = 20.43 ± 2.91 years old, body mass index = 24.42 ± 4.25, months post-ACLR = 47.83 ± 26.97). Additionally, we identified a subgroup of participants who demonstrated an increase in sCOMP after the control or natural loading condition (sCOMPCHANGE > 0 ng/mL, n = 22, 70% female, age = 20.32 ± 3.00 years old, body mass index = 24.73 ± 4.33, months post-ACLR = 47.27 ± 29.32). MAIN OUTCOME MEASURE(S) Serum was collected both prior to and immediately after each condition to determine sCOMPchange. INTERVENTION(S) All participants attended 4 sessions that involved 20 minutes of walking on a force-measuring treadmill consisting of a control condition (natural loading) followed by random ordering of 3 loading conditions with real-time biofeedback: (1) symmetric vGRF between limbs, (2) a 5% increase in vGRF (high loading) and (3) a 5% decrease in vGRF (low loading). A general linear mixed model was used to determine differences in sCOMPCHANGE between altered loading conditions and the control group in the entire cohort and the subgroup. RESULTS The sCOMPCHANGE was not different across loading conditions for the entire cohort (F3,29 = 1.34, P = .282). Within the subgroup, sCOMPCHANGE was less during high loading (1.95 ± 24.22 ng/mL, t21 = -3.53, P = .005) and symmetric loading (9.93 ± 21.45 ng/mL, t21 = -2.86, P = .025) compared with the control condition (25.79 ± 21.40 ng/mL). CONCLUSIONS Increasing peak vGRF during gait decreased sCOMP in individuals with ACLR who naturally demonstrated an increase in sCOMP after 20 minutes of walking. TRIAL REGISTRY ClinicalTrials.gov (NCT03035994).
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Affiliation(s)
| | - Jason Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh
| | - Anthony C Hackney
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Todd Schwartz
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Hope Davis-Wilson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Jeffrey Spang
- Department of Orthopaedics, MOTION Science Institute, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Pietrosimone LS, Blackburn JT, Wikstrom EA, Berkoff DJ, Docking SI, Cook J, Padua DA. Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial. Phys Ther Sport 2020; 46:177-185. [PMID: 32957034 DOI: 10.1016/j.ptsp.2020.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To a) determine the acute effects of a single-dose patellar tendon isometric exercise protocol on involved limb landing biomechanics in individuals with patellar tendinopathy and asymptomatic patellar tendon pathology, and b) determine if individuals with patellar tendinopathy demonstrated changes in pain following a single-dose patellar tendon isometric exercise protocol. DESIGN Single-blinded randomized cross-over trial. SETTING Laboratory; PARTICIPANTS: 28 young male athletes with symptomatic (n = 13, age: 19.62 ± 1.61) and asymptomatic (n = 15, age: 21.13 ± 1.88) patellar tendinopathy. MAIN OUTCOME MEASURES Participants completed a single-dose patellar tendon isometric exercise protocol and a sham-TENS protocol, randomized and separated by 7-10 days. Pain-levels during a single-limb decline squat (SLDS) and three-dimensional biomechanics were collected during a double-limb jump-landing task before and after each intervention protocol. A mixed-model repeated measures ANOVA was conducted to compare change scores for all dependent variables. RESULTS There were no group × intervention interactions for change in pain (F(1, 26) = 0.555, p = 0.463). There was one significant group × intervention interaction for vertical ground reaction force (VGRF) (F(1, 26) = 5.33, p = 0.029). However, post-hoc testing with Bonferroni correction demonstrated no statistical significance for group (SYM: t = -1.679, p = 0.119; ASYM: t = -1.7, p = 0.107) or intervention condition (isometric: t = -2.58, p = 0.016; sham-TENS: 0.72, p = 0.460). There were no further significant group × intervention interactions (p > 0.05). CONCLUSIONS A single-dose patellar tendon isometric exercise protocol did not have acute effects on landing biomechanics or pain levels in male athletes with patellar tendinopathy or asymptomatic patellar tendon pathology.
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Affiliation(s)
- Laura S Pietrosimone
- Doctor of Physical Therapy Division, Department of Orthopedic Surgery, School of Medicine, Duke University, Durham, NC, USA.
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David J Berkoff
- Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sean I Docking
- La Trobe Sports and Exercise Research Centre, LaTrobe University, Bundooram, Australia
| | - Jill Cook
- La Trobe Sports and Exercise Research Centre, LaTrobe University, Bundooram, Australia
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Giuliani HK, Shea NW, Gerstner GR, Mota JA, Blackburn JT, Ryan ED. The Influence of Age and Obesity-Altered Muscle Tissue Composition on Muscular Dimensional Changes: Impact on Strength and Function. J Gerontol A Biol Sci Med Sci 2020; 75:2286-2294. [DOI: 10.1093/gerona/glaa206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
The purpose of this study was to determine if muscular dimensional changes with increases in torque production are influenced by age- and obesity-related increases in intramuscular fat, and its relationship to percent body fat (%BF), echo intensity (EI), strength, and maximum walking speed. Sixty-six healthy men were categorized into 3 groups based on age and body mass index status (young normal weight [YNW], older normal weight [ONW], and older obese [OB]). Participants underwent %BF assessments, resting ultrasonography to determine muscle size (cross-sectional area [CSA]) and EI of the superficial quadriceps, and a 10-m maximum walking speed assessment. Maximal and submaximal (rest–100% MVC in 10% increments) isometric leg extension strength was assessed while changes in rectus femoris (RF) CSA, width, and depth were obtained with ultrasonography. Echo intensity and %BF were different among all groups (p ≤ .007), with the YNW and OB groups exhibiting the lowest and highest %BF and EI values, respectively. The RF increased in depth and decreased in width with increases in torque intensity for all groups. The ONW group demonstrated no change (−0.08%) in RF CSA across torque intensities, whereas the YNW group (−11.5%) showed the greatest decrease in CSA, and the OB group showed a more subtle decrease (−4.6%). Among older men, a greater change in RF CSA was related to poorer EI (r = −0.355) and higher %BF (r = −0.346), while a greater decrease in RF width was associated with faster walking speeds (r = −0.431). Examining muscular dimensional changes during contraction is a unique model to investigate the influence of muscle composition on functional performance.
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Affiliation(s)
- Hayden K Giuliani
- Neuromuscular Assessment Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Nic W Shea
- School of Biological Sciences, Georgia Institute of Technology, Atlanta
| | - Gena R Gerstner
- Department of Human Movement Sciences, Old Dominion University, Norfolk, Virginia
| | - Jacob A Mota
- Neuromuscular Assessment Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - J Troy Blackburn
- Neuromuscular Assessment Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Eric D Ryan
- Neuromuscular Assessment Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
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Davis-Wilson HC, Johnston CD, Evans-Pickett A, Hackney A, Blackburn JT, Thoma L, Longobardi L, Franz J, Pietrosimone B. Fewer Steps Per Day Associates With Greater Cartilage Breakdown Biomarkers Post Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676256.25165.8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Evans-Pickett A, Davis-Wilson HC, Luc-Harkey BA, Blackburn JT, Franz JR, Padua DA, Seeley MK, Pietrosimone B. Biomechanical effects of manipulating peak vertical ground reaction force throughout gait in individuals 6-12 months after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2020; 76:105014. [PMID: 32388079 PMCID: PMC8658526 DOI: 10.1016/j.clinbiomech.2020.105014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/15/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to determine the effect of cueing an increase or decrease in the vertical ground reaction force impact peak (peak in the first 50% of stance) on vertical ground reaction force, knee flexion angle, internal knee extension moment, and internal knee abduction moment waveforms throughout stance in individuals 6-12 months after an anterior cruciate ligament reconstruction. METHODS Twelve individuals completed 3 conditions (High, Low, and Control) where High and Low Conditions cue a 5% body weight increase or decrease, respectively, in the vertical ground reaction force impact peak compared to usual walking. Biomechanics during High and Low Conditions were compared to the Control Condition throughout stance. FINDINGS The High Condition resulted in: (a) increased vertical ground reaction forces at each peak and decreased during mid-stance, (b) greater knee excursion (i.e., greater knee flexion angle in early stance and a more extended knee in late stance), (c) greater internal extension moment for the majority of stance, and (d) lesser second internal knee abduction moment peak. The Low Condition resulted in: (a) vertical ground reaction forces decreased during early stance and increased during mid-stance, (b) decreased knee excursion, (c) increased internal extension moment throughout stance, and (d) decreased internal knee abduction moment peaks. INTERPRETATION Cueing a 5% body weight increase in vertical ground reaction force impact peak resulted in a more dynamic vertical ground reaction force loading pattern, increased knee excursion, and a greater internal extension moment during stance which may be useful in restoring gait patterns following anterior cruciate ligament reconstruction.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Hope C Davis-Wilson
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Brittney A Luc-Harkey
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - J Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, NC, United States
| | - Darin A Padua
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Pfeiffer SJ, Davis-Wilson HC, Pexa B, Szymczak J, Wistreich C, Sorensen R, Wikstrom EA, Blackburn JT, Pietrosimone B. Assessing Step Count-Dependent Changes in Femoral Articular Cartilage Using Ultrasound. J Ultrasound Med 2020; 39:957-965. [PMID: 31763713 DOI: 10.1002/jum.15180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate changes in the femoral cartilage cross-sectional area (CSA) measured with ultrasound (US) between baseline and 1000, 2000, 3000, 4000, and 5000 steps of walking on a treadmill. METHODS Forty-one healthy individuals completed a single testing session. Participants rested with their knees extended on a plinth for 45 minutes to unload the femoral cartilage. Ultrasound was used to acquire images of the femoral cartilage before the treadmill-walking protocol. After the baseline US acquisition, participants walked on a treadmill at their preferred overground walking speed for 1000 steps, after which additional US images of the femoral cartilage were acquired. This process was repeated after 2000, 3000, 4000, and 5000 steps. A 1-way repeated-measures analysis of variance compared the CSA across the 6 step counts. An analysis of variance with repeated measures on time and Bonferroni corrected planned comparisons (.05/5) were used to evaluate differences in the femoral cartilage at each step count compared to baseline. RESULTS The study included 20 male and 21 female participants (mean age ± SD, 21.5 ± 2.8 years; mean body mass index, 24.3 ± 3.4 kg/m 2 ). The CSAs were significantly greater at the 2000-step (1.27 ± 1.75 mm 2 ; P < .001), 4000-step (0.89 ± 1.17 mm2; P < .001), and 5000-step (2.10 ± 1.73 mm 2 ; P < .001) points compared to baseline. The CSA was significantly less at the 3000-step point (1.05 ± 1.29 mm 2 ; P < .001) compared to baseline. CONCLUSIONS Changes in the CSA after walking may be dependent on the number of steps. The participants had a significant decrease in the CSA after 3000 steps of normal walking and a significant increase in the CSA after 2000, 4000, and 5000 steps of normal walking.
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Affiliation(s)
- Steven J Pfeiffer
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hope C Davis-Wilson
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brett Pexa
- Department of Athletic Training, High Point University, High Point, NC, USA
| | - Jessica Szymczak
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine Wistreich
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rachel Sorensen
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
| | - J Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, North Carolina, USA
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Pietrosimone B, Luc-Harkey BA, Harkey MS, Davis-Wilson HC, Pfeiffer SJ, Schwartz TA, Nissman D, Padua DA, Blackburn JT, Spang JT. Using TENS to Enhance Therapeutic Exercise in Individuals with Knee Osteoarthritis. Med Sci Sports Exerc 2020; 52:2086-2095. [PMID: 32251254 DOI: 10.1249/mss.0000000000002353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Transcutaneous electrical nerve stimulation (TENS) facilitates quadriceps voluntary activation in experimental settings. Augmenting therapeutic exercise (TE) with TENS may enhance the benefits of TE in individuals with knee osteoarthritis (KOA) and quadriceps voluntary activation failure (QVAF). PURPOSE This study aimed to determine the effect of TENS + TE on patient-reported function, quadriceps strength, and voluntary activation, as well as physical performance compared with sham TENS + TE (Sham) and TE alone in individuals with symptomatic KOA and QVAF. METHODS Ninety individuals participated in a double-blinded randomized controlled trial. Everyone received 10 standardized TE sessions of physical therapy. TENS + TE and Sham groups applied the respective devices during all TE sessions and throughout activities of daily living over 4 wk. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), quadriceps strength, and voluntary activation, as well as a 20-m walk test, chair-stand test, and stair-climb test were performed at baseline, after the 4-wk intervention (post 1) and at 8 wk after the start of the intervention (post 2). Mixed-effects models were used to determine between-group differences between baseline and post 1, as well as baseline and post 2. RESULTS Improvements in WOMAC subscales, quadriceps strength, and voluntary activation, 20-m walk times, chair-stand repetitions, and stair-climb time were found at post 1 and post 2 compared with baseline for all groups (P < 0.05). WOMAC Pain and Stiffness improved in the TENS + TE group compared with TE alone at post 1 (P < 0.05); yet, no other between-group differences were found. CONCLUSIONS TE effectively improved patient-reported function, quadriceps strength, and voluntary activation, as well as physical performance in individuals with symptomatic KOA and QVAF, but augmenting TE with TENS did not improve the benefits of TE.
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Affiliation(s)
| | - Brittney A Luc-Harkey
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston, MA
| | | | | | | | - Todd A Schwartz
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Jeffery T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lynall RC, Campbell KR, Mauntel TC, Blackburn JT, Mihalik JP. Single-Legged Hop and Single-Legged Squat Balance Performance in Recreational Athletes With a History of Concussion. J Athl Train 2020; 55:488-493. [PMID: 32216655 DOI: 10.4085/1062-6050-185-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Researchers have suggested that balance deficiencies may linger during functional activities after concussion recovery. OBJECTIVE To determine whether participants with a history of concussion demonstrated dynamic balance deficits as compared with control participants during single-legged hops and single-legged squats. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 15 previously concussed participants (6 men, 9 women; age = 19.7 ± 0.9 years, height = 169.2 ± 9.4 cm, mass = 66.0 ± 12.8 kg, median time since concussion = 126 days [range = 28-432 days]) were matched with 15 control participants (6 men, 9 women; age = 19.7 ± 1.6 years, height = 172.3 ± 10.8 cm, mass = 71.0 ± 10.4 kg). INTERVENTION(S) During single-legged hops, participants jumped off a 30-cm box placed at 50% of their height behind a force plate, landed on a single limb, and attempted to achieve a stable position as quickly as possible. Participants performed single-legged squats while standing on a force plate. MAIN OUTCOME MEASURE(S) Time to stabilization (TTS; time for the normalized ground reaction force to stabilize after landing) was calculated during the single-legged hop, and center-of-pressure path and speed were calculated during single-legged squats. Groups were compared using analysis of covariance, controlling for average days since concussion. RESULTS The concussion group demonstrated a longer TTS than the control group during the single-legged hop on the nondominant leg (mean difference = 0.35 seconds [95% confidence interval = 0.04, 0.64]; F2,27 = 5.69, P = .02). No TTS differences were observed for the dominant leg (F2,27 = 0.64, P = .43). No group differences were present for the single-legged squat on either leg (P ≥ .11). CONCLUSIONS Dynamic balance-control deficits after concussion may contribute to an increased musculoskeletal injury risk. Given our findings, we suggest that neuromuscular deficits currently not assessed after concussion may linger. Time to stabilization is a clinically applicable measure that has been used to distinguish patients with various pathologic conditions, such as chronic ankle instability and anterior cruciate ligament reconstruction, from healthy control participants. Whereas the single-legged squat may not sufficiently challenge balance control, future study of the more dynamic single-legged hop is needed to determine its potential diagnostic and prognostic value after concussion.
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Affiliation(s)
- Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Kody R Campbell
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill
| | - Timothy C Mauntel
- US Department of Defense-Veterans Affairs Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - J Troy Blackburn
- Human Movement Science Curriculum, Division of Allied Health Sciences, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill
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Pietrosimone B, Pfeiffer SJ, Harkey MS, Wallace K, Hunt C, Blackburn JT, Schmitz R, Lalush D, Nissman D, Spang JT. Quadriceps weakness associates with greater T1ρ relaxation time in the medial femoral articular cartilage 6 months following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:2632-2642. [PMID: 30560446 DOI: 10.1007/s00167-018-5290-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/09/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Quadriceps weakness following anterior cruciate ligament reconstruction (ACLR) is linked to decreased patient-reported function, altered lower extremity biomechanics and tibiofemoral joint space narrowing. It remains unknown if quadriceps weakness is associated with early deleterious changes to femoral cartilage composition that are suggestive of posttraumatic osteoarthritis development. The purpose of the cross-sectional study was to determine if quadriceps strength was associated with T1ρ relaxation times, a marker of proteoglycan density, of the articular cartilage in the medial and lateral femoral condyles 6 months following ACLR. It is hypothesized that individuals with weaker quadriceps would demonstrate lesser proteoglycan density. METHODS Twenty-seven individuals (15 females, 12 males) with a patellar tendon autograft ACLR underwent isometric quadriceps strength assessments in 90°of knee flexion during a 6-month follow-up exam. Magnetic resonance images (MRI) were collected bilaterally and voxel by voxel T1ρ relaxation times were calculated using a five-image sequence and a monoexponential equation. Following image registration, the articular cartilage for the weight-bearing surfaces of the medial and lateral femoral condyles (MFC and LFC) were manually segmented and further sub-sectioned into posterior, central and anterior regions of interest (ROI) based on the corresponding meniscal anatomy viewed in the sagittal plane. Univariate linear regression models were used to determine the association between quadriceps strength and T1ρ relaxation times in the entire weight-bearing MFC and LFC, as well as the ROI in each respective limb. RESULTS Lesser quadriceps strength was significantly associated with greater T1ρ relaxation times in the entire weight-bearing MFC (R2 = 0.14, P = 0.05) and the anterior-MFC ROI (R2 = 0.22, P = 0.02) of the ACLR limb. A post hoc analysis found lesser strength and greater T1ρ relaxation times were significantly associated in a subsection of participants (n = 18) without a concomitant medial tibiofemoral compartment meniscal or chondral injury in the entire weight-bearing MFC, as well as anterior-MFC and central-MFC ROI of the ACLR and uninjured limb. CONCLUSIONS The association between weaker quadriceps and greater T1ρ relaxation times in the MFC suggests deficits in lower extremity muscle strength may be related to cartilage composition as early as 6 months following ACLR. Maximizing quadriceps strength in the first 6 months following ACLR may be critical for promoting cartilage health early following ACLR. LEVEL OF EVIDENCE Prognostic level 1.
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Affiliation(s)
- Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA. .,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Fetzer Hall 209 South Road, Chapel Hill, NC, 27599, USA. .,Department of Orthopaedics, University of North Carolina at Chapel Hill, 102 Mason Farm Rd # 2, Chapel Hill, NC, 27599, USA.
| | - Steven J Pfeiffer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Fetzer Hall 209 South Road, Chapel Hill, NC, 27599, USA
| | - Matthew S Harkey
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, South Building, 3rd Floor, Boston, MA, 02111, USA
| | - Kyle Wallace
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA
| | - Christian Hunt
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Fetzer Hall 209 South Road, Chapel Hill, NC, 27599, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, 102 Mason Farm Rd # 2, Chapel Hill, NC, 27599, USA
| | - Randy Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Coleman Building, 1408 Walker Avenue, Greensboro, NC, 27402, USA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 333 S Columbia St, Raleigh, NC, 27514, USA
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Dr # 2, Chapel Hill, NC, 27599, USA
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, 102 Mason Farm Rd # 2, Chapel Hill, NC, 27599, USA
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Pietrosimone LS, Blackburn JT, Wikstrom E, Berkoff D, Docking S, Cook J, Padua D. Biomechanical Loading Magnitude Differences During Landing in Male Athletes with and without Patellar Tendinopathy. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562327.24618.ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Davis HC, Pfeiffer SJ, Johnston CD, Seeley MK, Harkey MS, Blackburn JT, Fockler RP, Spang JT, Pietrosimone B. Walking Biomechanics Six and Twelve Months Following Anterior Cruciate Ligament Reconstruction Compared to Healthy Controls. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561300.58804.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Evans A, Luc-Harkey BA, Davis HC, Troy Blackburn J, Seeley MK, Franz JR, Pietrosimone B. Manipulating Initial Peak vGRF During Walking Affects Loading Throughout Stance in Individuals with ACL Reconstruction. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561289.20686.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pietrosimone B, Seeley MK, Johnston C, Pfeiffer SJ, Spang JT, Blackburn JT. Walking Ground Reaction Force Post-ACL Reconstruction: Analysis of Time and Symptoms. Med Sci Sports Exerc 2019; 51:246-254. [PMID: 30157111 DOI: 10.1249/mss.0000000000001776] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The association between lower-extremity loading and clinically relevant knee symptoms at different time points after anterior cruciate ligament reconstruction (ACLR) is unclear. Vertical ground reaction force (vGRF) from walking was compared between individuals with and without clinically relevant knee symptoms in three cohorts: <12 months post-ACLR, 12-24 months post-ACLR, and >24 months post-ACLR. METHODS One hundred twenty-eight individuals with unilateral ACLR were classified as symptomatic or asymptomatic, based on previously defined cutoff values for the Knee Osteoarthritis and Injury Outcome Score (<12 months post-ACLR [symptomatic n = 28, asymptomatic n = 24]; 12-24 months post-ACLR [symptomatic n = 15, asymptomatic n = 15], and >24 months post-ACLR [symptomatic, n = 13; asymptomatic, n = 33]). Vertical ground reaction force exerted on the ACLR limb was collected during walking gait, and functional analyses of variance were used to evaluate the effects of symptoms and time post-ACLR on vGRF throughout stance phase (α = 0.05). RESULTS Symptomatic individuals, <12 months post-ACLR, demonstrated less vGRF during both vGRF peaks (i.e., weight acceptance and propulsion) and greater vGRF during midstance, compared to asymptomatic individuals. Vertical ground reaction force characteristics were not different between symptomatic and asymptomatic individuals for most of stance in individuals between 12 and 24 months post-ACLR. Symptomatic individuals who were >24 months post-ACLR, exhibited greater vGRF during both peaks, but lesser vGRF during midstance, compared to asymptomatic individuals. CONCLUSION Relative to asymptomatic individuals, symptomatic individuals are more likely to underload the ACLR limb early after ACLR (i.e., <12 months) during both vGRF peaks, but overload the ACLR limb, during both vGRF peaks, at later time points (i.e., >24 months). We propose these differences in lower-extremity loading during walking might have implications for long-term knee health, and should be considered when designing therapeutic interventions for individuals with an ACLR.
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Affiliation(s)
- Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - Christopher Johnston
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Steven J Pfeiffer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffery T Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lynall RC, Blackburn JT, Guskiewicz KM, Marshall SW, Plummer P, Mihalik JP. Functional balance assessment in recreational college-aged individuals with a concussion history. J Sci Med Sport 2019; 22:503-508. [DOI: 10.1016/j.jsams.2018.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/25/2018] [Accepted: 10/21/2018] [Indexed: 10/27/2022]
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Lane AR, Harkey MS, Davis HC, Luc-Harkey BA, Stanley L, Hackney AC, Blackburn JT, Pietrosimone B. Body Mass Index and Type 2 Collagen Turnover in Individuals After Anterior Cruciate Ligament Reconstruction. J Athl Train 2019; 54:270-275. [PMID: 30829538 DOI: 10.4085/1062-6050-525-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals with an anterior cruciate ligament reconstruction (ACLR) are at an increased risk of developing posttraumatic osteoarthritis. How osteoarthritis risk factors, such as increased body mass index (BMI), may influence early changes in joint tissue metabolism is unknown. OBJECTIVE To determine the association between BMI and type 2 cartilage turnover in individuals with an ACLR. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Forty-five individuals (31 women, 14 men) with unilateral ACLR at least 6 months earlier who were cleared for unrestricted physical activity. MAIN OUTCOME MEASURE(S) Body mass index (kg/m2) and type 2 collagen turnover were the primary outcomes. Body mass index was calculated from objectively measured height and mass. Serum was obtained to measure type 2 collagen turnover, quantified as the ratio of degradation (collagen type 2 cleavage product [C2C]) to synthesis (collagen type 2 C-propeptide [CP2]; C2C : CP2). Covariate measures were physical activity level before ACLR (Tegner score) and current level of disability (International Knee Documentation Committee Index score). Associations of primary outcomes were analyzed for the group as a whole and then separately for males and females. RESULTS Overall, greater BMI was associated with greater C2C : CP2 (r = 0.32, P = .030). After controlling for covariates (Tegner and International Knee Documentation Committee Index scores), we identified a similar association between BMI and C2C : CP2 (partial r = 0.42, P = .009). Among women, greater BMI was associated with greater C2C : CP2 before (r = 0.47, P = .008) and after (partial r = 0.50, P = .008) controlling for covariates. No such association occurred in men. CONCLUSIONS Greater BMI may influence greater type 2 collagen turnover in those with ACLR. Individuals, especially women, who maintain or reduce BMI may be less likely to demonstrate greater type 2 collagen turnover ratios after ACLR.
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Affiliation(s)
- Amy R Lane
- Human Movement Science Curriculum, Department of Allied Health Sciences
| | - Matthew S Harkey
- Human Movement Science Curriculum, Department of Allied Health Sciences
| | - Hope C Davis
- Human Movement Science Curriculum, Department of Allied Health Sciences
| | | | - Laura Stanley
- Human Movement Science Curriculum, Department of Allied Health Sciences
| | - Anthony C Hackney
- Human Movement Science Curriculum, Department of Allied Health Sciences.,Department of Exercise and Sport Science, Gillings School of Public Health, University of North Carolina at Chapel Hill.,Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill
| | - J Troy Blackburn
- Human Movement Science Curriculum, Department of Allied Health Sciences.,Department of Exercise and Sport Science, Gillings School of Public Health, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Human Movement Science Curriculum, Department of Allied Health Sciences.,Department of Exercise and Sport Science, Gillings School of Public Health, University of North Carolina at Chapel Hill
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Harkey MS, Blackburn JT, Nissman D, Davis H, Durrington I, Rizk C, Kuismanen A, Pietrosimone B. Ultrasonographic Assessment of Femoral Cartilage in Individuals With Anterior Cruciate Ligament Reconstruction: A Case-Control Study. J Athl Train 2019; 53:1082-1088. [PMID: 30615493 DOI: 10.4085/1062-6050-376-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Developing osteoarthritis is common after anterior cruciate ligament reconstruction (ACLR). Monitoring changes in femoral cartilage size after ACLR may be a way to detect the earliest structural alterations before the radiographic onset of osteoarthritis. Diagnostic ultrasonography (US) offers a clinically accessible and valid method for evaluating anterior femoral cartilage size. OBJECTIVE To compare the US measurements of anterior femoral cross-sectional area and cartilage thickness between limbs in individuals with a unilateral ACLR and between the ACLR limbs of these individuals and the limbs of uninjured control participants. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 20 volunteers with an ACLR (37.0 ± 26.6 months after surgery) and 28 uninjured volunteers. MAIN OUTCOME MEASURE(S) We used US to assess anterior femoral cartilage cross-sectional area and thickness (ie, medial, lateral, and intercondylar) in the ACLR and contralateral limbs of participants with ACLR and unilaterally in the reference limbs of uninjured participants. RESULTS The ACLR limb presented with greater anterior femoral cartilage cross-sectional area (96.68 ± 22.68 mm2) than both the contralateral (85.69 ± 17.57 mm2, t19 = 4.47; P < .001) and uninjured (84.62 ± 15.89 mm2, t46 = 2.17; P = .04) limbs. The ACLR limb presented with greater medial condyle thickness (2.61 ± 0.61 mm) than both the contralateral (2.36 ± 0.47 mm, t19 = 2.78; P = .01) and uninjured limbs (2.22 ± 0.40 mm, t46 = 2.69; P = .01) and greater lateral condyle thickness (2.46 ± 0.65 mm) than the uninjured limb (2.12 ± 0.41 mm, t46 = 2.20; P = .03). CONCLUSIONS Anterior femoral cartilage cross-sectional area and thickness assessed via US were greater in the ACLR limb than in the contralateral and uninjured limbs. Greater thickness and cross-sectional area may have been due to cartilage swelling or hypertrophy after ACLR, which may affect the long-term health of the joint.
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Affiliation(s)
- Matthew S Harkey
- Division of Rheumatology, Tufts Medical Center, Boston, MA, and Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester
| | - J Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill
| | - Hope Davis
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | | | - Christina Rizk
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | | | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
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Johnston CD, Goodwin JS, Spang JT, Pietrosimone B, Blackburn JT. Gait biomechanics in individuals with patellar tendon and hamstring tendon anterior cruciate ligament reconstruction grafts. J Biomech 2019; 82:103-108. [DOI: 10.1016/j.jbiomech.2018.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
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Luc-Harkey BA, Franz JR, Hackney AC, Blackburn JT, Padua DA, Pietrosimone B. Lesser lower extremity mechanical loading associates with a greater increase in serum cartilage oligomeric matrix protein following walking in individuals with anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2018; 60:13-19. [PMID: 30292062 DOI: 10.1016/j.clinbiomech.2018.09.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aberrant mechanical loading during gait is hypothesized to contribute to the development of posttraumatic osteoarthritis following anterior cruciate ligament reconstruction. Our purpose was to determine if peak vertical ground reaction force and instantaneous vertical ground reaction force loading rate associate with the acute change in serum cartilage oligomeric matrix protein following a 20-minute bout of walking. METHODS We enrolled thirty individuals with a unilateral anterior cruciate ligament reconstruction. Peak vertical ground reaction force and instantaneous vertical ground reaction force loading rate were extracted from the first 50% of the stance phase of gait during a 60-second trial. Blood samples were collected immediately before and after 20 min of treadmill walking at self-selected speed. The change in serum cartilage oligomeric matrix protein from pre- to post-walking was calculated. Stepwise linear regression models were used to determine the association between each outcome of loading and the change in serum cartilage oligomeric matrix protein after accounting for sex, gait speed, time since anterior cruciate ligament reconstruction, graft type, and history of concomitant meniscal procedure (ΔR2). FINDINGS Lesser peak vertical ground reaction force (ΔR2 = 0.208; β = -0.561; P = 0.019) and instantaneous vertical ground reaction force loading rate (ΔR2 = 0.168; β = -0.519; P = 0.037) on the anterior cruciate ligament reconstructed limb associated with a greater increase in serum cartilage oligomeric matrix protein following 20 min of walking. INTERPRETATION Mechanical loading may be a future therapeutic target for altering the acute biochemical response to walking in individuals with an anterior cruciate ligament reconstruction.
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Affiliation(s)
- Brittney A Luc-Harkey
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
| | - Anthony C Hackney
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - J Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Darin A Padua
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Pietrosimone B, Blackburn JT, Padua DA, Pfeiffer SJ, Davis HC, Luc-Harkey BA, Harkey MS, Stanley Pietrosimone L, Frank BS, Creighton RA, Kamath GM, Spang JT. Walking gait asymmetries 6 months following anterior cruciate ligament reconstruction predict 12-month patient-reported outcomes. J Orthop Res 2018; 36:2932-2940. [PMID: 29781550 DOI: 10.1002/jor.24056] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/15/2018] [Indexed: 02/04/2023]
Abstract
The study sought to determine the association between gait biomechanics (vertical ground reaction force [vGRF], vGRF loading rate [vGRF-LR]) collected 6 months following anterior cruciate ligament reconstruction (ACLR) with patient-reported outcomes at 12 months following ACLR. Walking gait biomechanics and all subsections of the Knee Injury and Osteoarthritis Outcomes Score (KOOS) were collected at 6 and 12 months following ACLR, respectively, in 25 individuals with a unilateral ACLR. Peak vGRF and peak instantaneous vGRF-LR were extracted from the first 50% of the stance phase. Limb symmetry indices (LSI) were used to normalize outcomes in the ACLR limb to that of the uninjured limb (ACLR/uninjured). Linear regression analyses were used to determine associations between biomechanical outcomes and KOOS while accounting for walking speed. Receiver operator characteristic curves were used to determine the accuracy of 6-month biomechanical outcomes for identifying individuals with acceptable patient-reported outcomes, using previously defined KOOS cut-off scores, 12 months post-ACLR. Individuals with lower peak vGRF LSI 6 months post-ACLR demonstrated worse patient-reported outcomes (KOOS Pain, Activities of Daily life, Sport and Recreation, Quality of Life) at the 12-month exam. A peak vGRF LSI ≥0.99 6 months following ACLR associated with 13.33× higher odds of reporting acceptable patient-reported outcomes 12 months post-ACLR. Lesser peak vGRF LSI during walking at 6-months post-ACLR may be a critical indicator of worse future patient-reported outcomes. Clinical significance achieving early symmetrical lower extremity loading and minimizing under-loading of the ACLR limb during walking may be a potential therapeutic target for improving patient-reported outcomes post-ACLR. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2932-2940, 2018.
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Affiliation(s)
- Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steven J Pfeiffer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hope C Davis
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brittney A Luc-Harkey
- Department of Orthopedic Surgery, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew S Harkey
- Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts
| | - Laura Stanley Pietrosimone
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barnett S Frank
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert Alexander Creighton
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ganesh M Kamath
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffery T Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Stanley LE, Harkey M, Luc-Harkey B, Frank BS, Pietrosimone B, Blackburn JT, Padua DA. Ankle Dorsiflexion displacement is associated with hip and knee kinematics in females following anterior cruciate ligament reconstruction. Res Sports Med 2018; 27:21-33. [DOI: 10.1080/15438627.2018.1502180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Laura E. Stanley
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew Harkey
- Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Brittney Luc-Harkey
- Department of Orthopedic Surgery, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Barnett S. Frank
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J. Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Pfeiffer S, Harkey MS, Stanley LE, Blackburn JT, Padua DA, Spang JT, Marshall SW, Jordan JM, Schmitz R, Nissman D, Pietrosimone B. Associations Between Slower Walking Speed and T1ρ Magnetic Resonance Imaging of Femoral Cartilage Following Anterior Cruciate Ligament Reconstruction. Arthritis Care Res (Hoboken) 2018; 70:1132-1140. [PMID: 29193888 DOI: 10.1002/acr.23477] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/21/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine whether walking speed, collected at 6 and 12 months following anterior cruciate ligament reconstruction (ACLR), is associated with inter-extremity differences in proteoglycan density, measured via T1ρ magnetic resonance imaging, in tibiofemoral articular cartilage 12 months following ACLR. METHODS Twenty-one individuals with a unilateral patellar-tendon autograft ACLR (10 women and 11 men, mean ± SD age 23.9 ± 2.7 years, mean ± SD body mass index 23.9 ± 2.7 kg/m2 ) were recruited for participation in this study. Walking speed was collected using 3-dimensional motion capture at 6 and 12 months following ACLR. The articular cartilage of the medial femoral condyle (MFC) and lateral femoral condyle and medial and lateral tibial condyles was manually segmented and subsectioned into 3 regions of interest (anterior, central, and posterior) based on the location of the meniscus in the sagittal plane. Inter-extremity mean T1ρ relaxation time ratios (T1ρ ACLR extremity / T1ρ contralateral extremity) were calculated and used for analysis. Pearson product-moment correlations were used to determine associations between walking speed and inter-extremity differences in T1ρ relaxation time ratios. RESULTS Slower walking speed 6 months post-ACLR was significantly associated with higher T1ρ relaxation time ratios in the MFC of the ACLR extremity 12 months following ACLR (posterior MFC, r = -0.51, P = 0.02; central MFC, r = -0.47, P = 0.04). Similarly, slower walking speed at 12 months post-ACLR was significantly associated with higher T1ρ relaxation time ratios in the posterior MFC ACLR extremity (r = -0.47, P = 0.04) 12 months following ACLR. CONCLUSION Slower walking speed at 6 and 12 months following ACLR may be associated with early proteoglycan density changes in medial femoral compartment cartilage health in the first 12 months following ACLR.
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Bell DR, Blackburn JT, Norcross MF, Ondrak KS, Hudson JD, Hackney AC, Padua DA. Correction to: Estrogen and muscle stiffness have a negative relationship in females. Knee Surg Sports Traumatol Arthrosc 2018; 26:2214. [PMID: 29511821 DOI: 10.1007/s00167-018-4892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In the original publication the name of the fourth reviewer was incorrectly published.
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Affiliation(s)
- David R Bell
- Department of Kinesiology, Wisconsin Injury in Sport Laboratory, University of Wisconsin-Madison, 2000 Observatory Drive, Madison, WI, 53706, USA.
| | - J Troy Blackburn
- Department of Exercise and Sport Science, Neuromuscular Research Laboratory, University of North Carolina at Chapel Hill, Fetzer Hall, CB#8700, Chapel Hill, NC, 27599, USA
| | - Marc F Norcross
- Department of Exercise and Sport Science, Neuromuscular Research Laboratory, University of North Carolina at Chapel Hill, Fetzer Hall, CB#8700, Chapel Hill, NC, 27599, USA
| | - Kristin S Ondrak
- Department of Exercise and Sport Science, Applied Physiology Laboratory, University of North Carolina at Chapel Hill, Fetzer Hall, CB#8700, Chapel Hill, NC, 27599, USA
| | - Jeffery D Hudson
- Department of Exercise and Sport Science, Sports Medicine Research Laboratory, University of North Carolina at Chapel Hill, Fetzer Hall, CB#8700, Chapel Hill, NC, 27599, USA
| | - A C Hackney
- Department of Exercise and Sport Science, Applied Physiology Laboratory, University of North Carolina at Chapel Hill, Fetzer Hall, CB#8700, Chapel Hill, NC, 27599, USA
| | - Darin A Padua
- Department of Exercise and Sport Science, Sports Medicine Research Laboratory, University of North Carolina at Chapel Hill, Fetzer Hall, CB#8700, Chapel Hill, NC, 27599, USA
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