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Wheatley MGA, Pearle AD, Shamritsky DZ, Hirth JM, Nawabi DH, Wickiewicz TL, Beynnon BD, Imhauser CW. Statistical shape analysis and computational modeling reveal novel relationships between tibiofemoral bony geometry and knee mechanics in young, female athletes. J Biomech 2024; 167:112030. [PMID: 38583375 DOI: 10.1016/j.jbiomech.2024.112030] [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] [Received: 01/23/2023] [Revised: 12/30/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
Young female athletes participating in sports requiring rapid changes of direction are at heightened risk of suffering traumatic knee injury, especially noncontact rupture of the anterior cruciate ligament (ACL). Clinical studies have revealed that geometric features of the tibiofemoral joint are associated with increased risk of suffering noncontact ACL injury. However, the relationship between three-dimensional (3D) tibiofemoral geometry and knee mechanics in young female athletes is not well understood. We developed a statistically augmented computational modeling workflow to determine relationships between 3D geometry of the knee and tibiofemoral kinematics and ACL force in response to an applied loading sequence of compression, valgus, and anterior force, which is known to load the ACL. This workflow included 3D characterization of tibiofemoral bony geometry via principal component analysis and multibody dynamics models incorporating subject-specific knee geometries. A combination of geometric features of both the tibia and the femur that spanned all three anatomical planes was related to increased ACL force and to increased kinematic coupling (i.e., anterior, medial, and distal tibial translations and internal tibial rotation) in response to the applied loads. In contrast, a uniplanar measure of tibiofemoral geometry that is associated with ACL injury risk, sagittal plane slope of the lateral tibial plateau subchondral bone, was not related to ACL force. Thus, our workflow may aid in developing mechanics-based ACL injury screening tools for young, active females based on a unique combination of bony geometric features that are related to increased ACL loading.
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Affiliation(s)
| | - Andrew D Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - David Z Shamritsky
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Jacob M Hirth
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | | | - Bruce D Beynnon
- Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA.
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Hafer JF, Kent JA, Boyer KA. Physical activity and age-related biomechanical risk factors for knee osteoarthritis. Gait Posture 2019; 70:24-29. [PMID: 30784958 DOI: 10.1016/j.gaitpost.2019.02.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/15/2019] [Accepted: 02/12/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a highly prevalent disease leading to mobility disability in the aged that could, in part, be initiated by age-related alterations in knee mechanics. However, if and how knee mechanics change with age remains unclear. RESEARCH QUESTION What are the impacts of age and physical activity (PA) on biomechanical characteristics that can affect the loading environment in the knee during gait? METHODS Three groups (n = 20 each, 10 male and 10 female) of healthy adults were recruited: young (Y, 21-35 years), mid-life highly active (MHi, 55-70 years, runners), and mid-life less active (MLo, 55-70 years, low PA). Outcome measures included knee kinematics and kinetics and co-activation during gait, and knee extensor muscle torque and power collected at baseline and after a 30-minute treadmill trial to determine the impact of prolonged walking on knee function. RESULTS At baseline, high-velocity concentric knee extensor power was lower for MLo and MHi compared with Y, and MLo displayed greater early (6.0 ± 5.8 mm) and peak during stance (11.3 ± 7.8 mm) femoral anterior displacement relative to the tibia compared with Y (0.2 ± 5.6 and 4.4 ± 6.8 mm). Also at baseline, MLo showed equal quadriceps:hamstrings activation, while Y showed greater relative hamstrings activation during midstance. The walking bout induced substantial knee extensor fatigue (decrease in maximal torque and power) in Y and MLo, while MHi were fatigue-resistant. SIGNIFICANCE These results indicate that maintenance of PA in mid-life may impart small but measurable effects on knee function and biomechanics that may translate to a more stable loading environment in the knee through mid-life and thus could reduce knee OA risk long-term.
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Affiliation(s)
- Jocelyn F Hafer
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States; Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, United States.
| | - Jane A Kent
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, United States
| | - Katherine A Boyer
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, United States; Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, United States
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Clouthier AL, Smith CR, Vignos MF, Thelen DG, Deluzio KJ, Rainbow MJ. The effect of articular geometry features identified using statistical shape modelling on knee biomechanics. Med Eng Phys 2019; 66:47-55. [PMID: 30850334 DOI: 10.1016/j.medengphy.2019.02.009] [Citation(s) in RCA: 14] [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] [Received: 08/10/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 01/17/2023]
Abstract
Articular geometry in the knee varies widely among people which has implications for risk of injury and pathology. The goals of this work were to develop a framework to systematically vary geometry in a multibody knee model and to use this framework to investigate the effect of morphological features on dynamic knee kinematics and contact mechanics. A statistical shape model of the tibiofemoral and patellofemoral joints was created from magnetic resonance images of 14 asymptomatic knees. The shape model was then used to generate 37 unique multibody knee models based on -3 to +3 standard deviations of the scores for the first six principal components identified. Each multibody model was then incorporated into a lower extremity musculoskeletal model and the Concurrent Optimization of Muscle Activations and Kinematics (COMAK) routine was used to simulate knee mechanics for overground walking. Changes in articular geometry affected knee function, resulting in differences up to 17° in orientation, 8 mm in translation, 0.7 BW in contact force, and 2.0 MPa in mean cartilage contact pressure. Understanding the relationship between shape and function in a joint could provide insight into the mechanisms behind injury and pathology and the variability in response to treatment.
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Affiliation(s)
- Allison L Clouthier
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., McLaughlin Hall, Kingston, ON K7L 3N6, Canada.
| | - Colin R Smith
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI 53706, USA
| | - Michael F Vignos
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI 53706, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI 53706, USA
| | - Kevin J Deluzio
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., McLaughlin Hall, Kingston, ON K7L 3N6, Canada
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., McLaughlin Hall, Kingston, ON K7L 3N6, Canada
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Morgan AM, O'Connor KM. Evaluation of an accelerometer to assess knee mechanics during a drop landing. J Biomech 2019; 86:125-131. [PMID: 30777341 DOI: 10.1016/j.jbiomech.2019.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/31/2022]
Abstract
Non-contact anterior cruciate ligament (ACL) injuries account for 70% of all ACL injuries, and can lead to missed time from activity for athletes and a predisposition for knee osteoarthritis. Prior research has shown that athletes who land in a stiff manner, with larger internal knee adduction and extension moments, are at greater risk for an ACL injury. A three-dimensional accelerometer placed at the tibial tuberosity may prove to be a low-cost means of assessing these risk factors. The primary purpose of this study was to compare tibial accelerations during drop landings with kinematic and kinetic risk factors for ACL injury measured with three-dimensional motion capture. The secondary purpose of this study was to compare these measures between soft and stiff landings. Participants were instructed to land bilaterally in preferred, soft, and stiff manners. Peak knee flexion decreased significantly from soft to stiff landings. Peak internal knee extension moment, peak anterior/posterior knee acceleration, and peak medial knee acceleration all increased significantly from soft to stiff landings. No associations were found between landing condition and either frontal plane knee angle at maximum vertical ground reaction force or peak internal knee adduction moment. Significant positive associations between kinetics and accelerations were found only in the sagittal plane. As such, while a three-dimensional accelerometer could discern between soft and stiff landings in both planes, it may be better suited to predict kinetic risk factors in the sagittal plane.
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Affiliation(s)
- Alexander M Morgan
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | - Kristian M O'Connor
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Burston J, Richards J, Selfe J. The effects of three quarter and full length foot orthoses on knee mechanics in healthy subjects and patellofemoral pain patients when walking and descending stairs. Gait Posture 2018; 62:518-522. [PMID: 29684886 DOI: 10.1016/j.gaitpost.2018.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/18/2017] [Revised: 04/05/2018] [Accepted: 04/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND An increased load of the patellofemoral joint is often attributed to foot function in patients with patellofemoral pain. Foot orthoses are commonly prescribed for this condition; however the mechanisms by which they work are poorly understood. The aim of this study was to investigate the kinematics and kinetics of the knee between patellofemoral pain patients and a group of healthy subjects when using a standardised foot orthosis prescription during walking and step descent. METHOD Fifteen healthy subjects and fifteen patients diagnosed with PFP with a foot posture index greater than 6, had foot orthoses moulded to their feet. They were asked to walk at a self-selected pace and complete a 20 cm step descent using customised orthoses with ¾ and full length wedges. Kinematic and Kinetic data were collected and modelled using Calibrated Anatomical System Technique. RESULTS Significant differences were seen in both the kinematics and kinetics between the healthy group and the PFP patients at the knee. A significant reduction in the knee coronal plane moment was found during the forward continuum phase of step descent when wearing the foot orthoses; this was attributed to a change in the ground reaction force as there were no changes reported in the kinematics of the knee with the orthoses. CONCLUSIONS This study identified potentially clinically important differences in the knee mechanics between the PFP patients and the healthy group during walking and step descent. The foot orthoses reduced the coronal plane knee moment in the PFP patients to a value similar to that of the healthy subjects with no intervention.
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Affiliation(s)
- J Burston
- South West Yorkshire Foundation Trust, Barnsley, UK; Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - J Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK.
| | - J Selfe
- Department of Health Professions, Manchester Metropolitan University, UK
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Brandon SCE, Thelen DG, Smith CR, Novacheck TF, Schwartz MH, Lenhart RL. The coupled effects of crouch gait and patella alta on tibiofemoral and patellofemoral cartilage loading in children. Gait Posture 2018; 60:181-187. [PMID: 29248848 PMCID: PMC5809194 DOI: 10.1016/j.gaitpost.2017.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 07/12/2017] [Revised: 10/03/2017] [Accepted: 12/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Elevated tibiofemoral and patellofemoral loading in children who exhibit crouch gait may contribute to skeletal deformities, pain, and cessation of walking ability. Surgical procedures used to treat crouch frequently correct knee extensor insufficiency by advancing the patella. However, there is little quantitative understanding of how the magnitudes of crouch and patellofemoral correction affect cartilage loading in gait. METHODS We used a computational musculoskeletal model to simulate the gait of twenty typically developing children and fifteen cerebral palsy patients who exhibited mild, moderate, and severe crouch. For each walking posture, we assessed the influence of patella alta and baja on tibiofemoral and patellofemoral cartilage contact. RESULTS Tibiofemoral and patellofemoral contact pressures during the stance phase of normal gait averaged 2.2 and 1.0 MPa. Crouch gait increased pressure in both the tibofemoral (2.6-4.3 MPa) and patellofemoral (1.8-3.3 MPa) joints, while also shifting tibiofemoral contact to the posterior tibial plateau. For extended-knee postures, normal patellar positions (Insall-Salvatti ratio 0.8-1.2) concentrated contact on the middle third of the patellar cartilage. However, in flexed knee postures, both normal and baja patellar positions shifted pressure toward the superior edge of the patella. Moving the patella into alta restored pressure to the middle region of the patellar cartilage as crouch increased. CONCLUSIONS This work illustrates the potential to dramatically reduce tibiofemoral and patellofemoral cartilage loading by surgically correcting crouch gait, and highlights the interaction between patella position and knee posture in modulating the location of patellar contact during functional activities.
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Affiliation(s)
- Scott C E Brandon
- Department of Mechanical Engineering, University of Wisconsin-Madison, USA; School of Engineering, University of Guelph, Canada
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, USA; Department of Biomedical Engineering, University of Wisconsin-Madison, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, USA.
| | - Colin R Smith
- Department of Mechanical Engineering, University of Wisconsin-Madison, USA
| | - Tom F Novacheck
- Gillette Children's Specialty Healthcare, USA; Department of Orthopaedic Surgery, University of Minnesota, Twin Cities, USA
| | - Michael H Schwartz
- Gillette Children's Specialty Healthcare, USA; Department of Orthopaedic Surgery, University of Minnesota, Twin Cities, USA
| | - Rachel L Lenhart
- Department of Mechanical Engineering, University of Wisconsin-Madison, USA; Department of Biomedical Engineering, University of Wisconsin-Madison, USA
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Nesbitt RJ, Bates NA, Rao MB, Schaffner G, Shearn JT. Effects of Population Variability on Knee Loading During Simulated Human Gait. Ann Biomed Eng 2017; 46:284-297. [PMID: 29159731 DOI: 10.1007/s10439-017-1956-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 06/26/2017] [Accepted: 11/03/2017] [Indexed: 01/11/2023]
Abstract
Cadaveric simulation models allow researchers to study native tissues in situ. However, as tests are conducted using donor specimens with unmatched kinematics, techniques that impose population average motions are subject to deviation from true physiologic conditions. This study aimed to identify factors which explain the kinetic variability observed during robotic simulations of a single human gait motion using a sample of human cadaver knees. Twelve human cadaver limbs (58 ± 16 years) were subjected to tibiofemoral geometrical analysis and cyclical stiffness testing in each anatomical degree of freedom. A simulated gait motion was then applied to each specimen. Resulting kinetics, specimen geometries, and various representations of tissue stiffness were reduced to functional attributes using principal component analysis and fit to a generalized linear prediction model. The capacity of knee topography to generate force was the largest contributor to kinetic variation in compression. Overall joint size, femoral notch height, translational laxity, and ad/abduction stiffness significantly contributed to kinetic variation in medial/lateral and anterior/posterior forces and associated torques. Future studies will investigate customizing kinematic paths to better simulate native conditions and reduce sampling variation, improving biomechanical test methods and evaluation strategies for future orthopedic techniques.
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Affiliation(s)
- Rebecca J Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Marepalli B Rao
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Environmental Health-Genomics, University of Cincinnati, Cincinnati, OH, USA
| | - Grant Schaffner
- Department of Aerospace Engineering & Engineering Mechanics, University of Cincinnati, Cincinnati, OH, USA
| | - Jason T Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
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Lenhart RL, Kaiser J, Smith CR, Thelen DG. Prediction and Validation of Load-Dependent Behavior of the Tibiofemoral and Patellofemoral Joints During Movement. Ann Biomed Eng 2015; 43:2675-85. [PMID: 25917122 DOI: 10.1007/s10439-015-1326-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/16/2015] [Indexed: 01/05/2023]
Abstract
The study objective was to construct and validate a subject-specific knee model that can simulate full six degree of freedom tibiofemoral and patellofemoral joint behavior in the context of full body movement. Segmented MR images were used to reconstruct the geometry of 14 ligament bundles and articular cartilage surfaces. The knee was incorporated into a lower extremity musculoskeletal model, which was then used to simulate laxity tests, passive knee flexion, active knee flexion, and human walking. Simulated passive and active knee kinematics were shown to be consistent with subject-specific measures obtained via dynamic MRI. Anterior tibial translation and internal tibial rotation exhibited the greatest variability when uncertainties in ligament properties were considered. When used to simulate walking, the model predicted knee kinematic patterns that differed substantially from passive joint behavior. Predictions of ean knee cartilage contact pressures during normal gait reached 6.2 and 2.8 Pa on the medial tibial plateau and patellar facets, respectively. Thus, the dynamic modeling framework can be used to simulate the interaction of soft tissue loads and cartilage contact during locomotion activities, and therefore provides a basis to simulate the effects of soft tissue injury and surgical treatment on functional knee mechanics.
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Affiliation(s)
- Rachel L Lenhart
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Jarred Kaiser
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Colin R Smith
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Darryl G Thelen
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA. .,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA. .,Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
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Egloff C, Sawatsky A, Leonard T, Fung T, Valderrabano V, Herzog W. Alterations in patellofemoral kinematics following vastus medialis transection in the anterior cruciate ligament deficient rabbit knee. Clin Biomech (Bristol, Avon) 2014; 29:577-82. [PMID: 24703827 DOI: 10.1016/j.clinbiomech.2014.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 08/30/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior cruciate ligament deficiency and quadriceps muscle weakness are considered to be important risk factors for aberrant patellar tracking and subsequent patellofemoral osteoarthritis. However, data from in vivo experiments looking at dynamic patellar joint kinematics and muscle force are scarce. Therefore, the purpose of this study was to evaluate the effects of anterior cruciate ligament transection and loss of vastus medialis force on patellar tracking in the rabbit knee in vivo. METHODS Eight skeletally mature New Zealand White Rabbits, weighing 6.0kg (0.6kg standard deviation) were used. The experimental trials consisted of active, concentric and eccentric movements of the knee joint. Measurements were performed with the intact, the anterior cruciate ligament deficient, and the vastus medialis transected knee. Patellofemoral kinematics (shift, rotation) were quantified from high speed video. FINDINGS Following anterior cruciate ligament transection, patellar tracking occurred more laterally, and caused a significant lateral rotation of the patella. The addition of vastus medialis transection did not alter patellar tracking or rotation significantly for any of the force-matched experimental conditions. INTERPRETATION The loss of the anterior cruciate ligament results in lateral patellar shift and rotation while the loss of vastus medialis muscle force does not affect patellar tracking or rotation in the anterior cruciate ligament deficient knee. We suggest that the current results should be considered carefully in future interpretations of knee extensor imbalance. More research is needed to describe the contribution of vastus medialis muscle strength to medial patellofemoral stability and confirm these results in the human knee.
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Affiliation(s)
- Christian Egloff
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Orthopaedic Department, University Hospital, University of Basel, Basel, Switzerland.
| | - Andrew Sawatsky
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Tim Leonard
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Tak Fung
- Statistics, Information Technologies, University of Calgary, Calgary, Alberta, Canada
| | - Victor Valderrabano
- Orthopaedic Department, University Hospital, University of Basel, Basel, Switzerland
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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