151
|
SAXBY DAVIDJOHN, BRYANT ADAML, MODENESE LUCA, GERUS PAULINE, KILLEN BRYCEA, KONRATH JASON, FORTIN KARINE, WRIGLEY TIMV, BENNELL KIML, CICUTTINI FLAVIAM, VERTULLO CHRISTOPHER, FELLER JULIANA, WHITEHEAD TIM, GALLIE PRICE, LLOYD DAVIDG. Tibiofemoral Contact Forces in the Anterior Cruciate Ligament–Reconstructed Knee. Med Sci Sports Exerc 2016; 48:2195-2206. [DOI: 10.1249/mss.0000000000001021] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
152
|
Characterizing knee loading asymmetry in individuals following anterior cruciate ligament reconstruction using inertial sensors. Gait Posture 2016; 49:114-119. [PMID: 27395452 PMCID: PMC5035204 DOI: 10.1016/j.gaitpost.2016.06.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 02/02/2023]
Abstract
Limitations in the ability to identify knee extensor loading deficits during gait in individuals following anterior cruciate ligament reconstruction (ACLr) may underlie their persistence. A recent study suggested that shank angular velocity, directly output from inertial sensors, differed during gait between individuals post-ACLr and controls. However, it is not clear if this kinematic variable relates to knee moments calculated using joint kinematics and ground reaction forces. Heel rocker mechanics during loading response of gait, characterized by rapid shank rotation, require knee extensor control. Measures of shank angular velocity may be reflective of knee moments. This study investigated the relationship between shank angular velocity and knee extensor moment during gait in individuals (n=19) 96.7±16.8days post-ACLr. Gait was assessed concurrently using inertial sensors and a marker-based motion system with force platforms. Peak shank angular velocity and knee extensor moment were strongly correlated (r=0.75, p<0.001) and between limb ratios of angular velocity predicted between limb ratios of extensor moment (r(2)=0.57, p<0.001) in the absence of between limb differences in spatiotemporal gait parameters. The strength of these relationships indicate that shank kinematic data offer meaningful information regarding knee loading and provide a potential alternative to full motion analysis systems for identification of altered knee loading following ACLr.
Collapse
|
153
|
Bonanzinga T, Signorelli C, Bontempi M, Russo A, Zaffagnini S, Marcacci M, Bragonzoni L. Evaluation of RSA set-up from a clinical biplane fluoroscopy system for 3D joint kinematic analysis. JOINTS 2016; 4:121-5. [PMID: 27602352 DOI: 10.11138/jts/2016.4.2.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE dinamic roentgen stereophotogrammetric analysis (RSA), a technique currently based only on customized radiographic equipment, has been shown to be a very accurate method for detecting three-dimensional (3D) joint motion. The aim of the present work was to evaluate the applicability of an innovative RSA set-up for in vivo knee kinematic analysis, using a biplane fluoroscopic image system. To this end, the Authors describe the set-up as well as a possible protocol for clinical knee joint evaluation. The accuracy of the kinematic measurements is assessed. METHODS the Authors evaluated the accuracy of 3D kinematic analysis of the knee in a new RSA set-up, based on a commercial biplane fluoroscopy system integrated into the clinical environment. The study was organized in three main phases: an in vitro test under static conditions, an in vitro test under dynamic conditions reproducing a flexion-extension range of motion (ROM), and an in vivo analysis of the flexion-extension ROM. For each test, the following were calculated, as an indication of the tracking accuracy: mean, minimum, maximum values and standard deviation of the error of rigid body fitting. RESULTS in terms of rigid body fitting, in vivo test errors were found to be 0.10±0.05 mm. Phantom tests in static and kinematic conditions showed precision levels, for translations and rotations, of below 0.1 mm/0.2° and below 0.5 mm/0.3° respectively for all directions. CONCLUSIONS the results of this study suggest that kinematic RSA can be successfully performed using a standard clinical biplane fluoroscopy system for the acquisition of slow movements of the lower limb. CLINICAL RELEVANCE a kinematic RSA set-up using a clinical biplane fluoroscopy system is potentially applicable and provides a useful method for obtaining better characterization of joint biomechanics.
Collapse
Affiliation(s)
- Tommaso Bonanzinga
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
| | - Cecilia Signorelli
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
| | - Marco Bontempi
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
| | - Alessandro Russo
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
| | - Stefano Zaffagnini
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie, Bologna, Italy
| | - Maurilio Marcacci
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie, Bologna, Italy
| | - Laura Bragonzoni
- Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie, Bologna, Italy
| |
Collapse
|
154
|
Samaan MA, Ringleb SI, Bawab SY, Greska EK, Weinhandl JT. Anterior cruciate ligament (ACL) loading in a collegiate athlete during sidestep cutting after ACL reconstruction: A case study. Knee 2016; 23:744-52. [PMID: 27130728 DOI: 10.1016/j.knee.2016.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/22/2016] [Accepted: 03/26/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Athletes with anterior cruciate ligament (ACL) injuries usually undergo ACL-reconstruction (ACLR) in order to restore joint stability, so that dynamic maneuvers such as the sidestep cut can be performed. Despite restoration of joint stability after ACLR, many athletes do not return to pre-injury levels and may be at a high risk of a second ACL injury. The purpose of this study was to determine whether or not ACL loading, would increase after ACLR. METHODS One female Division I collegiate athlete performed bilateral unanticipated sidestep cuts both before ACL injury and 27months after ACLR. Musculoskeletal simulations were used to calculate ACL loading during the deceleration phase of the sidestep cuts. RESULTS Twenty-seven months after ACLR, the athlete demonstrated higher total ACL loading in the ipsilateral limb as well as altered joint kinematics, moments, and quadriceps muscle force production. In the contralateral limb, there were no increases in total ACL loading or muscle force production yet altered lower extremity joint kinematics and moments were present after ACLR. CONCLUSIONS Higher total ACL loading in the ipsilateral limb of this athlete may suggest an increased risk of second ACL injury. The results of this study provide an initial step in understanding the effects of ACLR on the risk of second ACL injury in an elite athlete and suggest that it is important to develop a better understanding of this surgical intervention on knee joint loading, in order to reduce the risk of second ACL injury while performing dynamic maneuvers.
Collapse
Affiliation(s)
- Michael A Samaan
- Department of Mechanical and Aerospace Engineering, Old Dominion University, 238 Kaufman Hall, Norfolk, VA 23529, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA.
| | - Stacie I Ringleb
- Department of Mechanical and Aerospace Engineering, Old Dominion University, 238 Kaufman Hall, Norfolk, VA 23529, USA
| | - Sebastian Y Bawab
- Department of Mechanical and Aerospace Engineering, Old Dominion University, 238 Kaufman Hall, Norfolk, VA 23529, USA
| | - Eric K Greska
- Department of Exercise Science and Community Health, University of West Florida, 11000 University Pkwy., Bldg. 72, Rm. 216, Pensacola, FL 32514, USA
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation and Sports Studies, The University of Tennessee, 333 HPER Building, 1914 Andy Holt Avenue, Knoxville, TN 37996, USA
| |
Collapse
|
155
|
Hart HF, Collins NJ, Ackland DC, Cowan SM, Crossley KM. Gait Characteristics of People with Lateral Knee Osteoarthritis after ACL Reconstruction. Med Sci Sports Exerc 2016; 47:2406-15. [PMID: 25830360 DOI: 10.1249/mss.0000000000000671] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Lateral knee osteoarthritis (OA) is common after anterior cruciate ligament reconstruction (ACLR), yet gait characteristics associated with lateral knee OA after ACLR are not well understood. This cross-sectional study aimed to compare knee, trunk, pelvis, hip, and ankle kinematics and moments between people with predominant lateral knee OA after ACLR and healthy controls. METHODS Nineteen post-ACLR people with lateral knee OA and 25 healthy controls were recruited. Quantitative gait analysis was conducted during walking, and knee pain, confidence, and kinesiophobia were assessed. Between-group differences in peak kinematics and moments were evaluated, and Pearson correlations evaluated relations between biomechanical and patient-reported measures (P < 0.05). RESULTS Participants with lateral knee OA after ACLR had greater peak knee flexion (mean difference, 3.5°; 95% confidence interval, 0.9-6.1) and lower knee internal rotation angles (-3.3°; -6.2 to -0.5) than the controls. Those with lateral knee OA also had greater peak pelvic anterior tilt (3.1°, 0.4-5.9), hip flexion angles (5.1°, 1.9-8.3), and peak ankle dorsiflexion moment (0.1 N·m·kg(-1), 0.0-0.2). In the lateral knee OA group, worse knee confidence and kinesiophobia were significantly correlated with greater peak trunk flexion angle (r = 0.654 and r = 0.535, respectively) and greater knee pain was significantly correlated with greater peak knee flexion angle (r = 0.535). CONCLUSIONS Gait characteristics associated with lateral knee OA after ACLR differ from those in healthy individuals, predominantly in the sagittal plane. Increased sagittal plane knee and trunk kinematics seem to be related to worse knee pain, confidence, and kinesiophobia. These findings will assist the development of compartment-specific interventions for individuals with posttraumatic lateral knee OA.
Collapse
Affiliation(s)
- Harvi F Hart
- 1Department of Physiotherapy, University of Melbourne, Parkville, Victoria, AUSTRALIA; 2Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, AUSTRALIA; 3Physiotherapy Department, St. Vincent's Hospital, Melbourne, Victoria, AUSTRALIA; and 4School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, AUSTRALIA
| | | | | | | | | |
Collapse
|
156
|
Ismail SA, Button K, Simic M, Van Deursen R, Pappas E. Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knee: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2016; 35:68-80. [PMID: 27132248 DOI: 10.1016/j.clinbiomech.2016.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/23/2016] [Accepted: 04/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered joint motion that occurs in people with an anterior cruciate ligament deficient knee is proposed to play a role in the initiation of knee osteoarthritis, however, the exact mechanism is poorly understood. Although several studies have investigated gait deviations in individuals with chronic anterior cruciate ligament deficient knee in the frontal and transverse planes, no systematic review has summarized the kinematic and kinetic deviations in these two planes. METHODS We searched five electronic databases from inception to 14th October 2013, with key words related to anterior cruciate ligament, biomechanics and gait, and limited to human studies only. Two independent reviewers assessed eligibility based on predetermined inclusion/exclusion criteria and methodological quality was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology statement checklist. FINDINGS We identified 16 studies, totaling 183 subjects with anterior cruciate ligament deficient knee and 211 healthy subjects. Due to the variability in reported outcomes, we could only perform meta-analysis for 13 sagittal plane outcomes. The only significant finding from our meta-analysis showed that individuals with anterior cruciate ligament deficient knee demonstrated a significantly greater external hip flexor angular impulse compared to control (P=0.03). INTERPRETATION No consensus about what constitutes a typical walking pattern in individuals with anterior cruciate ligament deficient knee can be made, nor can conclusions be derived to explain if gait deviations in the frontal and transverse plane contributed to the development of the knee osteoarthritis among this population.
Collapse
Affiliation(s)
- Shiek Abdullah Ismail
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Milena Simic
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Robert Van Deursen
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| |
Collapse
|
157
|
Hajizadeh M, Hashemi Oskouei A, Ghalichi F, Sole G. Knee Kinematics and Joint Moments During Stair Negotiation in Participants With Anterior Cruciate Ligament Deficiency and Reconstruction: A Systematic Review and Meta-Analysis. PM R 2016; 8:563-579.e1. [DOI: 10.1016/j.pmrj.2016.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/24/2016] [Accepted: 01/27/2016] [Indexed: 01/13/2023]
|
158
|
Thomas AC, Hubbard-Turner T, Wikstrom EA, Palmieri-Smith RM. Epidemiology of Posttraumatic Osteoarthritis. J Athl Train 2016; 52:491-496. [PMID: 27145096 DOI: 10.4085/1062-6050-51.5.08] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Osteoarthritis is a leading cause of disability whose prevalence and incidence continue to increase. History of joint injury represents an important risk factor for posttraumatic osteoarthritis and is a significant contributor to the rapidly growing percentage of the population with osteoarthritis. This review will present the epidemiology associated with posttraumatic osteoarthritis, with particular emphasis on the knee and ankle joints. It is important to understand the effect of posttraumatic osteoarthritis on the population so that sufficient resources can be devoted to countering the disease and promoting optimal long-term health for patients after joint injury.
Collapse
Affiliation(s)
- Abbey C Thomas
- Biodynamics Research Laboratory, University of North Carolina at Charlotte
| | | | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | |
Collapse
|
159
|
Kaiser J, Vignos MF, Liu F, Kijowski R, Thelen DG. American Society of Biomechanics Clinical Biomechanics Award 2015: MRI assessments of cartilage mechanics, morphology and composition following reconstruction of the anterior cruciate ligament. Clin Biomech (Bristol, Avon) 2016; 34:38-44. [PMID: 27061359 PMCID: PMC4851865 DOI: 10.1016/j.clinbiomech.2016.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The pathogenesis of osteoarthritis following anterior cruciate ligament (ACL) reconstruction is currently unknown. The study purpose was to leverage recent advances in quantitative and dynamic MRI to test the hypothesis that abnormal joint mechanics within four years of reconstruction is accompanied by evidence of early compositional changes in cartilage. METHODS Static MR imaging was performed bilaterally on eleven subjects with an ACL reconstruction (1-4years post-surgery) and on twelve healthy subjects to obtain tibial cartilage thickness maps. Quantitative imaging (mcDESPOT) was performed unilaterally on all subjects to assess the fraction of bound water in the tibial plateau cartilage. Finally, volumetric dynamic imaging was performed to assess cartilage contact patterns during an active knee flexion-extension task. A repeated-measures ANOVA was used to test for the effects of surgical reconstruction and location on cartilage thickness, bound water fractions, and contact across the medial and lateral tibia plateaus. FINDINGS No significant differences in cartilage thickness were found between groups. However, there was a significant reduction in the fraction of water bound by proteoglycan in the ACL reconstructed knees, most notably along the anterior portion of the medial plateau and the weight-bearing lateral plateau. During movement, reconstructed knees exhibited greater contact along the medial spine in the medial plateau and along the posterior aspect of the lateral plateau, when compared with their healthy contralateral knees and healthy controls. INTERPRETATION This study provides evidence that abnormal mechanics in anterior cruciate ligament reconstructed knees are present coincidently with early biomarkers of cartilage degeneration.
Collapse
Affiliation(s)
- Jarred Kaiser
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, USA
| | - Michael F Vignos
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, USA
| | - Fang Liu
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Richard Kijowski
- Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI 537924, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, USA; Department of Biomedical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 1685 Highland Avenue, Madison, WI 53705, USA.
| |
Collapse
|
160
|
Shi D, Li N, Wang Y, Jiang S, Lin J, Zhu W. Gait modification strategies in trunk over right stance phase in patients with right anterior cruciate ligament deficiency. Gait Posture 2016; 46:63-8. [PMID: 27131179 DOI: 10.1016/j.gaitpost.2016.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 02/02/2023]
Abstract
This study aimed to investigate the gait modification strategies of trunk over right stance phase in patients with right anterior cruciate ligament deficiency (ACL-D). Thirty-six patients with right chronic ACL-D were recruited, as well as 36 controls. A 3D optical video motion capture system was used during gait and stair ambulation. Kinematic variables of the trunk and kinematic and kinetic variables of the knee were calculated. Patients with chronic right ACL-D exhibited many significant abnormalities compared with controls. Trunk rotation with right shoulder trailing over the right stance phase was lower in all five motion patterns (P<0.05). Compared with controls, trunk posterior lean was higher from descending stairs to walking when the knee sagittal plane moment ended (P<0.01). Trunk lateral flexion to the left was higher when ascending stairs at the start of right knee coronal plane moment (P=0.01), when descending stairs at the maximal knee coronal plane moment (P<0.01), and when descending stairs at the end of the knee coronal plane moment (P=0.03). Trunk rotation with right shoulder forward was higher at the minimal knee transverse plane moment (P<0.01) and when the knee transverse plane moment ended (P<0.01); during walking, trunk rotation with right shoulder trailing was lower at other knee moments during other walking patterns (all P<0.01). In conclusion, gait modification strategies of the trunk were apparent in patients with ACL-D. These results provide new insights about diagnosis and rehabilitation of chronic ACL-D (better use of walking and stair tasks as part of a rehabilitation program).
Collapse
Affiliation(s)
- Dongliang Shi
- Department of Pediatric Orthopedic, Xinhua Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200092, China
| | - Nannan Li
- Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yubin Wang
- Department of Pediatric Orthopedic, Xinhua Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200092, China
| | - Shuyun Jiang
- Gait Analysis Laboratory, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai 200437, China
| | - Jianping Lin
- Department of Orthopedic, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
| | - Wenhui Zhu
- Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China.
| |
Collapse
|
161
|
Hart HF, Collins NJ, Ackland DC, Cowan SM, Hunt MA, Crossley KM. Immediate Effects of a Brace on Gait Biomechanics for Predominant Lateral Knee Osteoarthritis and Valgus Malalignment After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2016; 44:865-73. [PMID: 26842310 DOI: 10.1177/0363546515624677] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral knee osteoarthritis is notably common after anterior cruciate ligament reconstruction (ACLR). While valgus bracing has been investigated as an intervention for medial knee osteoarthritis (OA), little is known about the effectiveness of varus bracing for lateral knee OA after ACLR. PURPOSE To determine the immediate effects of a varus unloader knee brace on gait biomechanics in people with lateral knee OA and valgus malalignment after ACLR. STUDY DESIGN Controlled laboratory study. METHODS Nineteen participants who had undergone primary ACLR 5 to 20 years previously and had symptomatic and radiographic lateral knee OA as well as valgus malalignment were included. Three-dimensional gait analyses were conducted during walking under 3 test conditions: (1) no brace, (2) unadjusted brace (sagittal plane support with neutral frontal plane adjustment), and (3) adjusted brace (sagittal plane support with varus adjustment). Knee, pelvis, hip, and ankle kinematics and moments data were statistically analyzed using repeated-measures analysis of variance (α = 0.05). RESULTS Compared with walking with no brace, the adjusted brace significantly increased peak knee flexion angle (mean difference [95% CI]: 3.2° [1.3° to 5.0°]) and adduction angle (1.7° [0.8° to 2.6°]) and reduced peak internal rotation angle (-3.0° [-4.0° to -2.0°]). Significant increases in peak knee flexion moment (0.14 N·m/kg [0.06 to 0.20 N·m/kg]), adduction moment (0.10 N·m/kg [0.07 to 0.14 N·m/kg]), and external rotation moment (0.01 N·m/kg [0.00 to 0.02 N·m/kg]) were observed with the adjusted brace. The adjusted brace also reduced peak hip adduction angle (-1.29° [-2.12 to -0.47]) and increased peak hip adduction (0.17 N·m/kg [0.04 to 0.31 N·m/kg]) and external rotation moments (0.09 N·m/kg [0.03 to 0.14 N·m/kg]). There were no significant differences between the adjusted and unadjusted brace conditions, except for knee internal rotation angle, where the adjusted brace produced significantly greater reductions relative to the unadjusted brace (-1.46° [-1.98 to -0.95]). CONCLUSION Irrespective of frontal plane adjustment, the varus unloader brace produced immediate modulations in sagittal, frontal, and transverse plane joint angles and moments in younger individuals with lateral knee OA and valgus malalignment after ACLR. CLINICAL RELEVANCE The varus unloader brace may have the potential to mitigate abnormal knee joint mechanics associated with the development and progression of lateral knee OA after ACLR.
Collapse
Affiliation(s)
- Harvi F Hart
- Department of Mechanical Engineering, The University of Melbourne, Parkville, Victoria, Australia Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - David C Ackland
- Department of Mechanical Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Sallie M Cowan
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michael A Hunt
- Department of Physical Therapy, The University of British Columbia, British Columbia, Canada
| | - Kay M Crossley
- Department of Mechanical Engineering, The University of Melbourne, Parkville, Victoria, Australia School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
162
|
Schmitt LC, Paterno MV, Ford KR, Myer GD, Hewett TE. Strength Asymmetry and Landing Mechanics at Return to Sport after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2016; 47:1426-34. [PMID: 25373481 DOI: 10.1249/mss.0000000000000560] [Citation(s) in RCA: 238] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport after anterior cruciate ligament (ACL) reconstruction are lacking. This study investigated the effect of QF strength asymmetry on knee landing biomechanics at the time of return to sport after ACL reconstruction. METHODS Seventy-seven individuals (17.4 yr) at the time of return to sport after primary ACL reconstruction (ACLR group) and 47 uninjured control individuals (17.0 yr; CTRL group) participated. QF strength was assessed and quadriceps index was calculated (QI = [involved strength / uninvolved strength] × 100%). The ACLR group was subdivided based on QI: high quadriceps (HQ, QI ≥ 90%) and low quadriceps (LQ, QI < 85%). Knee kinematic and kinetic variables were collected during a drop vertical jump maneuver. Limb symmetry during landing and discrete variables were compared among the groups using multivariate analysis of variance and linear regression analyses. RESULTS The LQ group demonstrated worse asymmetry in all kinetic and ground reaction force variables compared to the HQ and CTRL groups, including reduced involved limb peak knee external flexion moments (P < 0.001), reduced involved limb (P = 0.003) and increased uninvolved limb (P = 0.005) peak vertical ground reaction forces and higher uninvolved limb peak loading rates (P < 0.004). There were no differences in the landing patterns between the HQ and CTRL groups on any variable (P > 0.05). In the ACLR group, QF strength estimated limb symmetry during landing after controlling for graft type, meniscus injury, knee pain, and symptoms. CONCLUSIONS At the time of return to sport, individuals after ACL reconstruction with weaker QF demonstrate altered landing patterns. Conversely, those with nearly symmetrical QF strength demonstrate landing patterns similar to uninjured individuals. Consideration of an objective QF strength measure may aid clinical decision making to optimize sports participation after ACL reconstruction.
Collapse
Affiliation(s)
- Laura C Schmitt
- 1Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH; 2Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 3Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 4Division of Occupational Therapy and Physical Therapy Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 5Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; 6Department of Physical Therapy, High Point University, High Point, NC; 7Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH; 8Sports Health & Performance Institute, Ohio State University, Columbus, OH; 9Department of Physiology and Cell Biology, Ohio State University, Columbus, OH; 10Department of Orthopaedic Surgery, Ohio State University, Columbus, OH; 11Department of Family Medicine, Ohio State University, Columbus, OH; 12Department of Biomedical Engineering, Ohio State University, Columbus, OH; and 13School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, OH
| | | | | | | | | |
Collapse
|
163
|
Papathanasiou I, Michalitsis S, Hantes ME, Vlychou M, Anastasopoulou L, Malizos KN, Tsezou A. Molecular changes indicative of cartilage degeneration and osteoarthritis development in patients with anterior cruciate ligament injury. BMC Musculoskelet Disord 2016; 17:21. [PMID: 26762166 PMCID: PMC4712525 DOI: 10.1186/s12891-016-0871-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/05/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tear is considered a risk factor for osteoarthritis development. The purpose of our study was to investigate the expression levels of the apoptotic enzyme caspase 3, pro-inflammatory cytokines interleukin-1β (IL-1β) and interleukin-6 (IL-6) and degrading enzyme matrix metalloproteinase 13 (MMP-13), all indicative of cartilage degeneration and osteoarthritis development in patients' chondrocytes after ACL rupture. METHODS We investigated the correlation between grade of cartilage degradation and time from injury or patients' age. IL-1β, IL-6 and MMP-13 mRNA expression levels were investigated in normal (n = 4) and chondrocytes from patients with ACL rupture (n = 33) using real-time polymerase chain reaction (PCR). Moreover, MMP-13 and caspase-3 protein expression levels were evaluated by western blot analysis. Trend analysis and correlation coefficient were performed to derive the relations between gene expression (MMP13, IL-6, IL-1β) and grading of cartilage defects and between gene expression (MMP13, IL-6, IL-1β) and patients' age, respectively. RESULTS Correlations were established between grade of cartilage degradation and time from injury. MMP-13, IL-6, IL-1β and caspase 3 expression levels were significantly upregulated in chondrocytes from ACL-deficient knee compared to normal. Among the patients with ACL-deficient knees, a significant upregulation of MMP-13 was observed in patients with ACL-rupture > 18 months from the time of injury to arthroscopy compared to patients with ACL-injury up to 18 months, whereas IL-6 and IL-1β expression was higher in chondrocytes from patients with more than 10 months ACL injury compared to those that underwent surgery within the first 10 months after injury. Νο association was observed between IL-1β, IL-6 and MMP-13 expression levels and cartilage defects or patients' age. CONCLUSION Our results showed that increased levels of apoptotic, inflammatory and catabolic factors in chondrocytes are associated with time from injury and could contribute to cartilage degradation and osteoarthritis development after ACL rupture.
Collapse
Affiliation(s)
- Ioanna Papathanasiou
- Laboratory of Cytogenetics and Molecular Genetics, University of Thessaly, Faculty of Medicine, Biopolis, 41500, Larissa, Greece.
| | - Sotirios Michalitsis
- Department of Orthopaedic Surgery, University of Thessaly, Faculty of Medicine, Biopolis, 41500, Larissa, Greece.
| | - Michael E Hantes
- Department of Orthopaedic Surgery, University of Thessaly, Faculty of Medicine, Biopolis, 41500, Larissa, Greece.
| | - Marianna Vlychou
- Department of Radiology, University of Thessaly, Faculty of Medicine, Biopolis, 41500, Larissa, Greece.
| | - Lydia Anastasopoulou
- Laboratory of Cytogenetics and Molecular Genetics, University of Thessaly, Faculty of Medicine, Biopolis, 41500, Larissa, Greece.
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery, University of Thessaly, Faculty of Medicine, Biopolis, 41500, Larissa, Greece.
| | - Aspasia Tsezou
- Laboratory of Cytogenetics and Molecular Genetics, University of Thessaly, Faculty of Medicine, Biopolis, 41500, Larissa, Greece. .,Department of Biology, University of Thessaly, Faculty of Medicine, Biopolis, 41500, Larissa, Greece.
| |
Collapse
|
164
|
LEPLEY ADAMS, GRIBBLE PHILLIPA, THOMAS ABBEYC, TEVALD MICHAELA, SOHN DAVIDH, PIETROSIMONE BRIANG. Longitudinal Evaluation of Stair Walking Biomechanics in Patients with ACL Injury. Med Sci Sports Exerc 2016. [DOI: 10.1249/mss.0000000000000741] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
165
|
Steadman JR, Briggs KK, Pomeroy SM, Wijdicks CA. Current state of unloading braces for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:42-50. [PMID: 25236680 DOI: 10.1007/s00167-014-3305-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/03/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Unicompartmental knee osteoarthritis (OA) is often treated with the prescription of an unloading knee brace to decrease pain and stiffness. Braces have been shown to improve the quality of life by applying an external moment to offset increased compressive tibiofemoral contact loads, but evidence regarding mechanical efficacy at the joint is controversial. Thus, the purpose of this study was to review the current state of unloading braces on knee mechanics, clinical impact, and long-term disease progression. METHODS A literature search was performed through the PubMed MEDLINE database for the search terms "osteoarthritis," "knee," "brace," and derivatives of the keyword "unload." Articles published since January 1, 1980 were reviewed for their relevance. Evidence for the effectiveness of unloading braces for disease management both biomechanically and clinically was considered. RESULTS While significant research has been done to show improvement in OA symptoms with the use of an unloading brace, current literature suggests a debate regarding the effectiveness of these braces for biomechanical change. Clinical findings reveal overall improvements in parameters such as pain, instability, and quality of life. CONCLUSION Although clinical evidence supports brace use to improve pain and functional ability, current biomechanical evidence suggests that unloading of the affected knee compartment does not significantly hinder disease progression. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- J Richard Steadman
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Karen K Briggs
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA.
| | - Shannon M Pomeroy
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Coen A Wijdicks
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| |
Collapse
|
166
|
Farrokhi S, Voycheck CA, Gustafson JA, Fitzgerald GK, Tashman S. Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis. Knee 2016; 23:49-56. [PMID: 27030846 PMCID: PMC4817272 DOI: 10.1016/j.knee.2015.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). METHODS Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. RESULTS Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p < 0.02) and greater heel-strike joint contact point velocities (p < 0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p = 0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p < 0.01) and greater quadriceps and hip abductor muscle weakness (p = 0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p < 0.04) but not with quadriceps or hip abductor strength. CONCLUSION Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.
Collapse
Affiliation(s)
- Shawn Farrokhi
- Assistant Professor & Co-director of the Human Movement Research Laboratory, Department of Physical Therapy, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carrie A. Voycheck
- Posdoctoral Fellow, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan A. Gustafson
- Doctoral Student, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - G. Kelley Fitzgerald
- Professor & Director of the Physical Therapy Clinical and Translational Research Center, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Associate Professor & Director of Biodynamics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, PA, USA
| |
Collapse
|
167
|
Heard BJ, Barton KI, Chung M, Achari Y, Shrive NG, Frank CB, Hart DA. Single intra-articular dexamethasone injection immediately post-surgery in a rabbit model mitigates early inflammatory responses and post-traumatic osteoarthritis-like alterations. J Orthop Res 2015; 33:1826-34. [PMID: 26135713 DOI: 10.1002/jor.22972] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/24/2015] [Indexed: 02/04/2023]
Abstract
Despite surgical reconstruction of the anterior cruciate ligament, a significant number of patients will still develop post-traumatic osteoarthritis (PTOA). Our objective was to determine if mitigating aspects of the acute phase of inflammation following a defined knee surgery with a single administration of a glucocorticoid could prevent the development of PTOA-like changes within an established rabbit model of surgically induced PTOA. An early and late post-surgical time-point was investigated in this study (48 h and 9 weeks post-surgery) in which the following groups were repeated (each n=6, for a total of 24 rabbits per time-point, and 48 rabbits used in the study): control (age/sex matched), sham (arthrotomy), drill injury (arthrotomy+two drill holes to a non-cartilaginous area of the femoral notch), and drill injury+single intra-articular (IA) injection of dexamethasone (DEX). At 48 h post-surgery, DEX treatment significantly lowered the mRNA levels for a subset of pro-inflammatory mediators, and significantly lowered the histological grade. Nine weeks post surgery, DEX treatment significantly lowered the histological scores (presented as effect size) for synovium (3.8), lateral femoral condyle (3.9), and lateral tibial cartilage (5.1) samples. Thus, DEX likely acts to prevent injury induced inflammation that could contribute to subsequent joint damage.
Collapse
Affiliation(s)
- Bryan J Heard
- Department of Surgery, University of Calgary, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kristen I Barton
- Department of Surgery, University of Calgary, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, Calgary, Alberta, Canada
| | - May Chung
- Department of Surgery, University of Calgary, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Yamini Achari
- Department of Surgery, University of Calgary, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nigel G Shrive
- Department of Surgery, University of Calgary, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Civil Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Cyril B Frank
- Department of Surgery, University of Calgary, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, Calgary, Alberta, Canada
| | - David A Hart
- Department of Surgery, University of Calgary, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|
168
|
Static and dynamic tibial translation before, 5 weeks after, and 5 years after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:3691-7. [PMID: 25261221 DOI: 10.1007/s00167-014-3279-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/26/2014] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate static and dynamic tibial translation before, 5 weeks after, and 5 years after anterior cruciate ligament (ACL) reconstruction. To explore whether static and dynamic tibial translation are correlated. METHODS Ten patients undergoing quadruple hamstring tendon graft ACL reconstruction were evaluated before, 5 weeks after, and 5 years after ACL reconstruction. Sagittal tibial translation was measured during the Lachman test (static translation) and during gait (dynamic translation) using a CA-4000 electrogoniometer. RESULTS Five years after ACL reconstruction, static tibial translation did not differ between knees (Lachman test 90 N and 134 N n.s.). In contrast, there was greater maximal anterior tibial translation during gait in ACL-reconstructed knees than in uninjured knees (5.5 ± 1.4 vs. 4.5 ± 1.6 mm, P = 0.028). There were no differences in static or dynamic tibial translation between the 5-year follow-up and before ACL reconstruction or between the 5-year follow-up and the 5-week follow-up. There were no correlations between static and dynamic tibial translation. CONCLUSION Although static tibial translation did not differ between knees 5 years after ACL reconstruction, dynamic tibial translation during gait was greater in ACL-reconstructed knees than in uninjured knees. Neither static nor dynamic tibial translation changed 5 years after ACL reconstruction as compared to before surgery and 5 weeks after surgery. Static tibial translation did not correlate with dynamic tibial translation. CLINICAL RELEVANCE This study indicates that although the knee is stable during static measurements, kinematics during gait is impaired 5 years after ACL reconstruction. This may affect the return to sport and risk of osteoarthritis. LEVEL OF EVIDENCE Case series, Level IV.
Collapse
|
169
|
Beckwée D, Vaes P, Shahabpour M, Muyldermans R, Rommers N, Bautmans I. The Influence of Joint Loading on Bone Marrow Lesions in the Knee: A Systematic Review With Meta-analysis. Am J Sports Med 2015; 43:3093-107. [PMID: 25634907 DOI: 10.1177/0363546514565092] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone marrow lesions (BMLs) are considered as predictors of pain, disability, and structural progression of knee osteoarthritis. The relationship between knee loading and BMLs is not yet completely understood. PURPOSE To summarize the available evidence regarding the relationship between joint loading and the prevalence and progression of BMLs in the tibiofemoral joint. STUDY DESIGN Meta-analysis. METHODS Three databases (PubMed, Web of Science, and The Cochrane Library) were systematically screened for studies encompassing BMLs and changes in knee loading. A methodological quality assessment was conducted, and a meta-analysis computing overall odds ratios (ORs) was performed where possible. RESULTS A total of 29 studies involving 7641 participants were included. Mechanical loading was categorized as body weight and composition, compartmental load, structural lesion, and physical activity. High compartmental loads and structural lesions increased the risk for BMLs (overall ORs ranging from 1.56 [95% CI, 1.13-2.15] to 8.2 [95% CI, 4.4-15.1]; P = .006). Body weight increased the risk for BMLs to a lesser extent (overall OR, 1.03; 95% CI, 1.01-1.05; P = .007). Contradictory results for the effect of physical activity on BMLs were found. CONCLUSION Augmented compartmental loads and structural lesions increased the risk of the presence or progression of BMLs. Body weight increased the risk for BMLs to a lesser extent. Contradictory results for the effect of physical activity on BMLs may be explained by a dose-response relationship, knee alignment, and structural lesions. CLINICAL RELEVANCE It has been shown that unloading the knee temporarily may induce beneficial effects on osteoarthritis-related structural changes. Therefore, an early recognition of BMLs in the aging athlete's knee may provide information to counter the onset and aggravation of symptomatic knee osteoarthritis by reducing the knee load.
Collapse
Affiliation(s)
- David Beckwée
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Peter Vaes
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ronald Muyldermans
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nikki Rommers
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Bautmans
- Department of Frailty in Ageing Research, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
170
|
Jalali M, Farahmand F, Mousavi SME, Golestanha SA, Rezaeian T, Shirvani Broujeni S, Rahgozar M, Esfandiarpour F. Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e17832. [PMID: 26557277 PMCID: PMC4632562 DOI: 10.5812/iranjradiol.17832v2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 02/27/2014] [Accepted: 03/15/2014] [Indexed: 11/22/2022]
Abstract
Background: Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. Objectives: In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients. Patients and Methods: For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results: Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Conclusion: Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient patients during lunge exercise.
Collapse
Affiliation(s)
- Maryam Jalali
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Iran Helal Institute of Applied Sciences and Technology, Tehran, Iran
- Corresponding author: Maryam Jalali, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Tel: +98-9125040255, E-mail:
| | - Farzam Farahmand
- University of Leeds, Leeds, UK
- Research Center of Biomedical Technologies and Robotics (RCBTR), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Ali Golestanha
- Department of Radiology, Mostafa Khomeini Hospital, Shahed University, Tehran, Iran
| | | | | | - Mehdi Rahgozar
- Department of Biostatistics and Computer, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fateme Esfandiarpour
- Department of Physical Therapy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
171
|
Schroeder MJ, Krishnan C, Dhaher YY. The influence of task complexity on knee joint kinetics following ACL reconstruction. Clin Biomech (Bristol, Avon) 2015; 30:852-9. [PMID: 26101055 PMCID: PMC4568131 DOI: 10.1016/j.clinbiomech.2015.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/02/2015] [Accepted: 06/04/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous research indicates that subjects with anterior cruciate ligament reconstruction exhibit abnormal knee joint movement patterns during functional activities like walking. While the sagittal plane mechanics have been studied extensively, less is known about the secondary planes, specifically with regard to more demanding tasks. This study explored the influence of task complexity on functional joint mechanics in the context of graft-specific surgeries. METHODS In 25 participants (10 hamstring tendon graft, 6 patellar tendon graft, 9 matched controls), three-dimensional joint torques were calculated using a standard inverse dynamics approach during level walking and stair descent. The stair descent task was separated into two functionally different sub-tasks-step-to-floor and step-to-step. The differences in external knee moment profiles were compared between groups; paired differences between the reconstructed and non-reconstructed knees were also assessed. FINDINGS The reconstructed knees, irrespective of graft type, typically exhibited significantly lower peak knee flexion moments compared to control knees during stair descent, with the differences more pronounced in the step-to-step task. Frontal plane adduction torque deficits were graft specific and limited to the hamstring tendon knees during the step-to-step task. Internal rotation torque deficits were also primarily limited to the hamstring tendon graft group during stair descent. Collectively, these results suggest that task complexity was a primary driver of differences in joint mechanics between anterior cruciate ligament reconstructed individuals and controls, and such differences were more pronounced in individuals with hamstring tendon grafts. INTERPRETATION The mechanical environment experienced in the cartilage during repetitive, cyclical tasks such as walking and other activities of daily living has been argued to contribute to the development of degenerative changes to the joint and ultimately osteoarthritis. Given the task-specific and graft-specific differences in joint mechanics detected in this study, care should be taken during the rehabilitation process to mitigate these changes.
Collapse
Affiliation(s)
- Megan J. Schroeder
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL 60611, USA,Correspondence: Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Suite 1406, Chicago, IL 60611, USA. Tel.: +1 (312) 238-1408; Fax: +1 (312) 238-2208.
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, Chicago, IL 60611, USA,Department of Physical Medicine and Rehabilitation, University of Michigan, 325 East Eisenhower Parkway, Ann Arbor, MI 48108, USA
| | - Yasin Y. Dhaher
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL 60611, USA,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, Chicago, IL 60611, USA
| |
Collapse
|
172
|
Marriott K, Birmingham TB, Kean CO, Hui C, Jenkyn TR, Giffin JR. Five-year changes in gait biomechanics after concomitant high tibial osteotomy and ACL reconstruction in patients with medial knee osteoarthritis. Am J Sports Med 2015; 43:2277-85. [PMID: 26264767 DOI: 10.1177/0363546515591995] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concomitant high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction is a combined surgical procedure intended to improve kinematics and kinetics in the unstable ACL-deficient knee with varus malalignment and medial compartment knee osteoarthritis (OA). PURPOSE To investigate 5-year changes in gait biomechanics as well as radiographic and patient-reported outcomes bilaterally after unilateral, concomitant medial opening wedge HTO and ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS A total of 33 patients (mean ± SD age, 40 ± 9 years) with varus malalignment (mean mechanical axis angle, -5.9° ± 2.9°), medial compartment knee OA, and ACL deficiency completed 3-dimensional gait analysis preoperatively and 2 and 5 years postoperatively. Primary outcomes were the peak external knee adduction (first peak) and flexion moments. Secondary outcomes were the peak external knee extension and transverse plane moments, peak knee angles in all 3 planes, radiographic static knee alignment measures (mechanical axis angle and posterior tibial slope), and the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS There was a substantial decrease in the knee adduction moment in the surgical limb (%BW × H, -1.49; 95% CI, -1.75 to -1.22) and a slight increase in the nonsurgical limb (%BW × H, 0.16; 95% CI, 0.03 to 0.30) from preoperatively to 5 years postoperatively. There was also a decrease in the knee flexion moment for both the surgical (%BW × H, -0.67; 95% CI, -1.19 to -0.15) and nonsurgical limbs (%BW × H, -1.06; 95% CI, -1.49 to -0.64). Secondary outcomes suggested that substantial improvements were maintained at 5 years, although smaller declines were observed in several measures and in both limbs from 2 to 5 years. CONCLUSION Changes in the peak external moments about the knee in all 3 planes during walking were observed 5 years after concomitant medial opening wedge HTO and ACL reconstruction. These findings are consistent with an intended, sustained shift in the mediolateral distribution of knee loads. CLINICAL RELEVANCE These findings suggest that concomitant HTO and ACL reconstruction results in substantial changes in gait biomechanics. Future clinical research comparing treatment strategies is both warranted and required for this relatively uncommon but seemingly biomechanically efficacious procedure.
Collapse
Affiliation(s)
- Kendal Marriott
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Crystal O Kean
- School of Medical and Applied Science, Central Queensland University, Rockhampton, Queensland, Australia
| | - Catherine Hui
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas R Jenkyn
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada Department of Mechanical and Materials Engineering, Faculty of Engineering, University of Western Ontario, London, Ontario, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
173
|
Kwee RM, Ahlawat S, Kompel AJ, Morelli JN, Fayad LM, Zikria BA, Demehri S. Association of mucoid degeneration of anterior cruciate ligament with knee meniscal and cartilage damage. Osteoarthritis Cartilage 2015; 23:1543-50. [PMID: 25907861 DOI: 10.1016/j.joca.2015.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the prevalence of anterior cruciate ligament (ACL) mucoid degeneration in patients referred for routine knee magnetic resonance (MR) imaging, and its association with age and structural joint damage. METHOD Four independent radiologists assessed 413 consecutive knee MR examinations for the presence of a normal or ruptured ACL, or ACL mucoid degeneration. Knees with ACL mucoid degeneration were frequency matched by age, sex, and MR field strength with consecutive control knees with a normal ACL (1:2 ratio). Differences in meniscal and cartilage damage of the tibiofemoral compartments, as determined by the Whole-Organ MR Imaging Score (WORMS) system, were compared by Mann-Whitney U tests. Multivariable logistic regression analysis identified the association of ACL mucoid degeneration with severe MTFC cartilage damage (WORMS≥5). RESULTS Patients with ACL mucoid degeneration (n = 36; 36% males; median age 55.5 years, range: 26-81) were older than patients with a normal (P < 0.001) or ruptured ACL (P < 0.001), without sex predilection (P = 0.76), and were more frequently diagnosed at 3 T (12%) compared to 1.5 T (2%). Knees with ACL mucoid degeneration had statistically significantly more medial meniscal (P < 0.001) and central and posterior medial tibiofemoral compartment (MTFC) cartilage (P < 0.001) damage compared with control knees (n = 72), but there were no differences in patients ≤50 years (P = 0.09 and 0.32, respectively). In multivariable logistic regression, severe MTFC cartilage damage (WORMS≥5) was significantly associated with ACL mucoid degeneration (odds ratio 4.09, 95% confidence interval 1.29-12.94, P = 0.016). CONCLUSION There is a strong association between ACL mucoid degeneration and cartilage damage in the central and posterior MTFC, especially in patients >50 years.
Collapse
Affiliation(s)
- R M Kwee
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Ahlawat
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - A J Kompel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - J N Morelli
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - L M Fayad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - B A Zikria
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| |
Collapse
|
174
|
Thorhauer E, Tashman S. Validation of a method for combining biplanar radiography and magnetic resonance imaging to estimate knee cartilage contact. Med Eng Phys 2015; 37:937-47. [PMID: 26304232 DOI: 10.1016/j.medengphy.2015.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 02/07/2023]
Abstract
Combining accurate bone kinematics data from biplane radiography with cartilage models from magnetic resonance imaging, it is possible to estimate tibiofemoral cartilage contact area and centroid location. Proper validation of such estimates, however, has not been performed under loading conditions approximating functional tasks, such as gait, squatting, and stair descent. The goal of this study was to perform an in vitro validation to resolve the accuracy of cartilage contact estimations in comparison to a laser scanning gold standard. Results demonstrated acceptable reliability and accuracy for both contact area and centroid location estimates. Root mean square errors in contact area averaged 8.4% and 4.4% of the medial and lateral compartmental areas, respectively. Modified Sorensen-Dice agreement scores of contact regions averaged 0.81 ± 0.07 for medial and 0.83 ± 0.07 for lateral compartments. These validated methods have applications for in vivo assessment of a variety of patient populations and physical activities, and may lead to greater understanding of the relationships between knee cartilage function, effects of joint injury and treatment, and the development of osteoarthritis.
Collapse
Affiliation(s)
- Eric Thorhauer
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203, United States of America
| | - Scott Tashman
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203, United States of America.
| |
Collapse
|
175
|
Hart HF, Culvenor AG, Collins NJ, Ackland DC, Cowan SM, Machotka Z, Crossley KM. Knee kinematics and joint moments during gait following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Br J Sports Med 2015; 50:597-612. [DOI: 10.1136/bjsports-2015-094797] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 02/07/2023]
|
176
|
Chu CR, Andriacchi TP. Dance between biology, mechanics, and structure: A systems-based approach to developing osteoarthritis prevention strategies. J Orthop Res 2015; 33:939-47. [PMID: 25639920 PMCID: PMC5823013 DOI: 10.1002/jor.22817] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/19/2014] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a leading cause of human suffering and disability for which disease-modifying treatments are lacking. OA occurs through complex and dynamic interplays between diverse factors over long periods of time. The traditional research and clinical focus on OA, the end stage disease, obscured understanding pathogenesis prior to reaching a common pathway defined by pain and functional deficits, joint deformity, and radiographic changes. To emphasize disease modification and prevention, we describe a multi-disciplinary systems-based approach encompassing biology, mechanics, and structure to define pre-osteoarthritic disease processes. Central to application of this model is the concept of "pre-osteoarthritis," conditions where clinical OA has not yet developed. Rather, joint homeostasis has been compromised and there are potentially reversible markers for heightened OA risk. Key messages from this perspective are (i) to focus research onto defining pre-OA through identifying and validating biological, mechanical, and imaging markers of OA risk, (ii) to emphasize multi-disciplinary approaches, and (iii) to propose that developing personalized interventions to address reversible markers of OA risk in healthy joints may be the key to prevention. Ultimately, a systems-based analysis of OA pathogenesis shows potential to transform clinical practice by facilitating development and testing of new strategies to prevent or delay the onset of osteoarthritis.
Collapse
Affiliation(s)
- Constance R. Chu
- Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Joint Preservation Center, Palo Alto VA, Palo Alto, California
| | - Thomas P. Andriacchi
- Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Joint Preservation Center, Palo Alto VA, Palo Alto, California
- Mechanical Engineering, Stanford University, Stanford, California
| |
Collapse
|
177
|
Zaid M, Lansdown D, Su F, Pedoia V, Tufts L, Rizzo S, Souza RB, Li X, Ma CB. Abnormal tibial position is correlated to early degenerative changes one year following ACL reconstruction. J Orthop Res 2015; 33:1079-86. [PMID: 25721417 PMCID: PMC7238841 DOI: 10.1002/jor.22867] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 02/08/2015] [Indexed: 02/04/2023]
Abstract
Altered knee kinematics following ACL reconstruction may predispose patients to the development of early onset post-traumatic osteoarthritis. The goal of our study was to examine the longitudinal interrelationship between altered tibial position relative to the femur and cartilage health measured by quantitative T1ρ MRI. Twenty-five patients with isolated unilateral ACL injury underwent kinematic and cartilage T1ρ MRI at baseline prior to ACL reconstruction and then at 1-year post-reconstruction. Tibial position relative to the femur in the anterior-posterior plane was calculated as well as cartilage T1ρ relaxation values in the injured and uninjured knee. At baseline prior to ACL reconstruction, the tibia was in a significantly more anterior position relative to the femur in the ACL deficient knee compared to the healthy contralateral knee. This difference was no longer present at 1-year follow-up. Additionally, the side-side difference in tibial position correlated to increased cartilage T1ρ relaxation values in the medial compartment of the knee 1-year post-reconstruction. Altered tibial position following ACL reconstruction is correlated with detectable cartilage degeneration as soon as 1 year following ACL reconstruction.
Collapse
Affiliation(s)
- Musa Zaid
- University of California San Francisco School of Medicine, San Francisco
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco
| | - Favian Su
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Lauren Tufts
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Sarah Rizzo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Richard B. Souza
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco
| |
Collapse
|
178
|
Palmieri-Smith RM, Lepley LK. Quadriceps Strength Asymmetry After Anterior Cruciate Ligament Reconstruction Alters Knee Joint Biomechanics and Functional Performance at Time of Return to Activity. Am J Sports Med 2015; 43:1662-9. [PMID: 25883169 PMCID: PMC4758854 DOI: 10.1177/0363546515578252] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quadriceps strength deficits are observed clinically after anterior cruciate ligament (ACL) injury and reconstruction and are often not overcome despite rehabilitation. Given that quadriceps strength may be important for achieving symmetrical joint biomechanics and promoting long-term joint health, determining the magnitude of strength deficits that lead to altered mechanics is critical. PURPOSE To determine if the magnitude of quadriceps strength asymmetry alters knee and hip biomechanical symmetry as well as functional performance and self-reported function. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 73 patients were tested at the time they were cleared for return to activity after ACL reconstruction. Quadriceps strength and activation, scores on the International Knee Documentation Committee form, the hop for distance test, and sagittal plane lower extremity biomechanics were recorded while patients completed a single-legged hop. RESULTS Patients with high and moderate quadriceps strength symmetry had larger central activation ratios as well as greater limb symmetry indices on the hop for distance compared with patients with low quadriceps strength symmetry (P < .05). Similarly, knee flexion angle and external moment symmetry were higher in the patients with high and moderate quadriceps symmetry compared with those with low symmetry (P < .05). Quadriceps strength was found to be associated with sagittal plane knee angle and moment symmetry (P < .05). CONCLUSION Patients with low quadriceps strength displayed greater movement asymmetries at the knee in the sagittal plane. Quadriceps strength was related to movement asymmetries and functional performance. Rehabilitation after ACL reconstruction needs to focus on maximizing quadriceps strength, which likely will lead to more symmetrical knee biomechanics.
Collapse
Affiliation(s)
- RM Palmieri-Smith
- School of Kinesiology, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI 48109-2214,Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109
| | - LK Lepley
- School of Kinesiology, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI 48109-2214,Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY 40536
| |
Collapse
|
179
|
Abstract
Anterior cruciate ligament (ACL) rupture is a common and devastating injury with long-term sequelae that include meniscal tears, chondral injury, and an increased risk of knee osteoarthritis (OA). ACL reconstruction is recommended to protect against knee instability, reduce the likelihood of meniscal tears and further surgery, and enable earlier return to sporting activities. ACL reconstruction, however, does not reduce the incidence of early-onset OA. In this review, we discuss the factors before and after surgery that are believed to contribute to the premature development of degenerative joint disease.
Collapse
Affiliation(s)
- David Dare
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA,
| | | |
Collapse
|
180
|
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: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [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.
Collapse
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.
| |
Collapse
|
181
|
van Meer BL, Meuffels DE, van Eijsden WA, Verhaar JAN, Bierma-Zeinstra SMA, Reijman M. Which determinants predict tibiofemoral and patellofemoral osteoarthritis after anterior cruciate ligament injury? A systematic review. Br J Sports Med 2015; 49:975-83. [DOI: 10.1136/bjsports-2013-093258] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 01/12/2023]
|
182
|
Mei K, Peng J, Gao L, Zheng NN, Fan J. Hierarchical classification of large-scale patient records for automatic treatment stratification. IEEE J Biomed Health Inform 2015; 19:1234-45. [PMID: 25807574 DOI: 10.1109/jbhi.2015.2414876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this paper, a hierarchical learning algorithm is developed for classifying large-scale patient records, e.g., categorizing large-scale patient records into large numbers of known patient categories (i.e., thousands of known patient categories) for automatic treatment stratification. Our hierarchical learning algorithm can leverage tree structure to train more discriminative max-margin classifiers for high-level nodes and control interlevel error propagation effectively. By ruling out unlikely groups of patient categories (i.e., irrelevant high-level nodes) at an early stage, our hierarchical approach can achieve log-linear computational complexity, which is very attractive for big data applications. Our experiments on one specific medical domain have demonstrated that our hierarchical approach can achieve very competitive results on both classification accuracy and computational efficiency as compared with other state-of-the-art techniques.
Collapse
|
183
|
Bevill SL, Boyer KA, Andriacchi TP. The regional sensitivity of chondrocyte gene expression to coactive mechanical load and exogenous TNF-α stimuli. J Biomech Eng 2015; 136:091005. [PMID: 24976081 DOI: 10.1115/1.4027937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/02/2014] [Indexed: 11/08/2022]
Abstract
Both mechanical load and elevated levels of proinflammatory cytokines have been associated with the risk for developing osteoarthritis (OA), yet the potential interaction of these mechanical and biological factors is not well understood. The purpose of this study was to evaluate the response of chondrocytes to the effects of dynamic unconfined compression, TNF-α, and the simultaneous effects of dynamic unconfined compression and TNF-α. The response to these three treatments was markedly different and, taken together, the response in the gene expression of chondrocytes to the different treatment conditions suggest a complex interaction between structure, biology, and mechanical loading.
Collapse
|
184
|
McLean SG, Mallett KF, Arruda EM. Deconstructing the Anterior Cruciate Ligament: What We Know and Do Not Know About Function, Material Properties, and Injury Mechanics. J Biomech Eng 2015; 137:020906. [DOI: 10.1115/1.4029278] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 12/20/2022]
Abstract
Anterior cruciate ligament (ACL) injury is a common and potentially catastrophic knee joint injury, afflicting a large number of males and particularly females annually. Apart from the obvious acute injury events, it also presents with significant long-term morbidities, in which osteoarthritis (OA) is a frequent and debilitative outcome. With these facts in mind, a vast amount of research has been undertaken over the past five decades geared toward characterizing the structural and mechanical behaviors of the native ACL tissue under various external load applications. While these efforts have afforded important insights, both in terms of understanding treating and rehabilitating ACL injuries; injury rates, their well-established sex-based disparity, and long-term sequelae have endured. In reviewing the expanse of literature conducted to date in this area, this paper identifies important knowledge gaps that contribute directly to this long-standing clinical dilemma. In particular, the following limitations remain. First, minimal data exist that accurately describe native ACL mechanics under the extreme loading rates synonymous with actual injury. Second, current ACL mechanical data are typically derived from isolated and oversimplified strain estimates that fail to adequately capture the true 3D mechanical response of this anatomically complex structure. Third, graft tissues commonly chosen to reconstruct the ruptured ACL are mechanically suboptimal, being overdesigned for stiffness compared to the native tissue. The net result is an increased risk of rerupture and a modified and potentially hazardous habitual joint contact profile. These major limitations appear to warrant explicit research attention moving forward in order to successfully maintain/restore optimal knee joint function and long-term life quality in a large number of otherwise healthy individuals.
Collapse
Affiliation(s)
- Scott G. McLean
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Kaitlyn F. Mallett
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Ellen M. Arruda
- Department of Mechanical Engineering, Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
| |
Collapse
|
185
|
Yim JH, Seon JK, Kim YK, Jung ST, Shin CS, Yang DH, Rhym IS, Song EK. Anterior translation and rotational stability of anterior cruciate ligament-deficient knees during walking: speed and turning direction. J Orthop Sci 2015; 20:155-62. [PMID: 25395272 DOI: 10.1007/s00776-014-0672-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/22/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is one of the most common injuries associated with the knee. After ACL injury, knee joint stability can be altered, resulting in abnormal loading during functional activities. Since ACL-deficient (ACLD) knees are also vulnerable to translational and rotational instability, patients need to be wary of certain motions encountered in daily life. The present study investigated the effect of walking speed and pivoting directional change during gait on knee joint kinematics of ACLD knees. We hypothesized that faster walking and crossover turning would induce severe kinematic changes. METHODS Thirty-five patients (22 males and 13 females) having a unilateral isolated subacute ACLD knee (from 1 to 3 months after injury) and contralateral intact (CLI) knee participated in this study. Spatiotemporal parameters, three-dimensional (3D) knee joint angles, and anterior-posterior (AP) translation were obtained by a 3D high-speed motion-capturing system. The CLI knee of each patient served as the control. The calculated AP stability and knee joint angles were used to test the research hypothesis. Mixed two-way repeated measures analysis of variance was performed to clarify the effects of walking speed and pivoting direction with a significance of 0.05. When a significance of mean comparison was detected, a post hoc test was performed. RESULTS Significant and consistent increased AP translation of the tibia relative to the femur at the whole stance phase of the gait cycle was evident in ACLD knees compared to CLI knees for normal and faster (20 % greater than normal) walking speeds. Faster walking speed did not induce significantly more anterior location of the tibia. In addition, ACLD knees were significantly less extended than CLI knees during a large portion of midstance. Although there was a consistent varus offset between the curves of ACLD and CLI knees, the difference did not reach statistical significance during the stance phase. Also, ACLD knees did not show any significant difference in tibial rotation compared to CLI knees during the entire stance phase of the gait cycle. For pivoting turns, ACLD knees showed significantly less extended and varus offset than CLI knees only during the cutting turn. ACLD knees exhibited less tibial internal rotation during the crossover turn and less tibial external rotation during the cutting turn than CLI knees. CONCLUSIONS In ACLD knees, the tibia tended to shift more anteriorly and changed with less extension at walking. However, faster walking speed did not induce any significant difference compared with normal-speed walking. In addition, ACLD knees displayed kinematic changes during pivoting, but not the crossover turn.
Collapse
Affiliation(s)
- Ji Hyeon Yim
- Department of Orthopaedic Surgery, Gwangju Hyundae Hospital, Gwangju, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
186
|
Kajaks T, Costigan P. The effect of sustained static kneeling on kinetic and kinematic knee joint gait parameters. APPLIED ERGONOMICS 2015; 46 Pt A:224-230. [PMID: 25172306 DOI: 10.1016/j.apergo.2014.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 08/02/2014] [Accepted: 08/07/2014] [Indexed: 06/03/2023]
Abstract
Despite epidemiological evidence for kneeling as an occupational risk factor for knee osteoarthritis, biomechanical evidence is lacking. Gait knee joint mechanics, a common measure used to study knee osteoarthritis initiation, were used in the present study to investigate the effect of sustained static kneeling on the knee. Ten healthy male subjects (24.1 years ± 3.5) performed ten baseline walking trials, followed by a 30-min kneeling protocol and a second set of walking trials. Knee joint moments and angles were calculated during the stance phase. Within-subject root mean squared differences were compared within and between the pre- and post-kneeling gait trials. Differences were observed between the pre-kneeling and post-kneeling walking trails for flexion and adduction knee moments (0.12 Nm/kg ± 0.03, 0.07 Nm/kg ± 0.02) and angles (3.18° ± 1.22 and 1.64° ± 1.15), indicating that sustained static deep-knee flexion kneeling does acutely alter knee joint gait parameters.
Collapse
Affiliation(s)
- Tara Kajaks
- Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1.
| | - Patrick Costigan
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, Canada K7L 3N6.
| |
Collapse
|
187
|
Gardinier ES, Di Stasi S, Manal K, Buchanan TS, Snyder-Mackler L. Knee contact force asymmetries in patients who failed return-to-sport readiness criteria 6 months after anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42:2917-25. [PMID: 25318940 PMCID: PMC4314107 DOI: 10.1177/0363546514552184] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND After anterior cruciate ligament (ACL) injury, contact forces are decreased in the injured knee when compared with the uninjured knee. The persistence of contact force asymmetries after ACL reconstruction may increase the risk of reinjury and may play an important role in the development of knee osteoarthritis in these patients. Functional performance may also be useful in identifying patients who demonstrate potentially harmful joint contact force asymmetries after ACL reconstruction. HYPOTHESIS Knee joint contact force asymmetries would be present during gait after ACL reconstruction, and performance on a specific set of validated return-to-sport (RTS) readiness criteria would discriminate between those who demonstrated contact force asymmetries and those who did not. STUDY DESIGN Descriptive laboratory study. METHODS A total of 29 patients with ACL ruptures participated in gait analysis and RTS readiness testing 6 months after reconstruction. Muscle and joint contact forces were estimated using an electromyography (EMG)-driven musculoskeletal model of the knee. The magnitude of typical limb asymmetry in uninjured controls was used to define limits of meaningful limb asymmetry in patients after ACL reconstruction. The RTS testing included isometric quadriceps strength testing, 4 unilateral hop tests, and 2 self-report questionnaires. Paired t tests were used to assess limb symmetry for peak medial and tibiofemoral contact forces in all patients, and a mixed-design analysis of variance was used to analyze the effect of passing or failing RTS testing on contact force asymmetry. RESULTS Among all patients, neither statistically significant nor meaningful contact force asymmetries were identified. However, patients who failed RTS testing exhibited meaningful contact force asymmetries, with tibiofemoral contact force being significantly lower for the involved knee. Conversely, patients who passed RTS testing exhibited neither significant nor meaningful contact force asymmetries. CONCLUSION Joint contact force asymmetries during gait are present in some patients 6 months after ACL reconstruction. Patients who demonstrated poor functional performance on RTS readiness testing exhibited significant and meaningful contact force asymmetries. CLINICAL RELEVANCE When assessing all patients together, variability in the functional status obscured significant and meaningful differences in contact force asymmetry in patients 6 months after ACL reconstruction. These specific RTS readiness criteria appear to differentiate between those who demonstrate joint contact force symmetry after ACL reconstruction and those who do not.
Collapse
Affiliation(s)
- Emily S. Gardinier
- Address correspondence to School of Kinesiology, University of Michigan, 104 Washtenaw Avenue, 1206 Central Campus Recreation Building, Ann Arbor, MI 48109, USA ()
| | | | | | | | | |
Collapse
|
188
|
Thorlund JB, Creaby MW, Wrigley TV, Metcalf BR, Bennell KL. Knee joint laxity and passive stiffness in meniscectomized patients compared with healthy controls. Knee 2014; 21:886-90. [PMID: 24993275 DOI: 10.1016/j.knee.2014.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 05/15/2014] [Accepted: 06/02/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Passive mechanical behavior of the knee in the frontal plane, measured as angular laxity and mechanical stiffness, may play an important role in the pathogenesis of knee osteoarthritis (OA). Little is known about knee laxity and stiffness prior to knee OA onset. We investigated knee joint angular laxity and passive stiffness in meniscectomized patients at high risk of knee OA compared with healthy controls. METHODS Sixty patients meniscectomized for a medial meniscal tear (52 men, 41.4 ± 5.5 years, 175.3 ± 7.9 cm, 83.6 ± 12.8 kg, mean ± SD) and 21 healthy controls (18 men, 42.0 ± 6.7 years, 176.8 ± 5.7 cm, 77.8 ± 13.4 kg) had their knee joint angular laxity and passive stiffness assessed twice ~2.3 years apart. Linear regression models including age, sex, height and body mass as covariates in the adjusted model were used to assess differences between groups. RESULTS Greater knee joint varus (-10.1 vs. -7.3°, p<0.001), valgus (7.1 vs. 5.6°, p=0.001) and total (17.2 vs. 12.9°, p<0.001) angular laxity together with reduced midrange passive stiffness (1.71 vs. 2.36 Nm/°, p<0.001) were observed in patients vs. healthy controls. No differences were observed in change in stiffness over time between patients and controls, however a tendency towards increased laxity in patients was seen. CONCLUSIONS Meniscectomized patients showed increased knee joint angular laxity and reduced passive stiffness ~3 months post surgery compared with controls. In addition, the results indicated that knee joint laxity may increase over time in meniscectomized patients.
Collapse
Affiliation(s)
- Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia
| | - Tim V Wrigley
- Centre for Health Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Ben R Metcalf
- Centre for Health Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
189
|
Argentieri EC, Sturnick DR, DeSarno MJ, Gardner-Morse MG, Slauterbeck JR, Johnson RJ, Beynnon BD. Changes to the articular cartilage thickness profile of the tibia following anterior cruciate ligament injury. Osteoarthritis Cartilage 2014; 22:1453-60. [PMID: 25278056 DOI: 10.1016/j.joca.2014.06.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/16/2014] [Accepted: 06/22/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We sought to determine if anterior cruciate ligament (ACL)-injured subjects demonstrated side-to-side differences in tibial cartilage thickness soon after injury, and if uninjured-control subjects displayed side-to-side symmetry in cartilage thickness. Second, we aimed to investigate associations between body mass index (BMI), cross-sectional area (CSA) of the proximal tibia, and articular cartilage thickness differences. METHODS Bilateral Magnetic Resonance Images (MRIs) were obtained on 88 ACL-injured subjects (27 male; 61 female) a mean 27 days post-injury, and 88 matched uninjured control subjects. Within ACL-injured and uninjured control subjects, side-to-side differences in medial and lateral tibial articular cartilage thickness were analyzed with adjustment for tibial position relative to the femur during MRI acquisition. Associations between tibial CSA and cartilage thickness differences were tested within high and low BMI groups. RESULTS Within the medial tibial compartment, ACL-injured females displayed significant increases: mean (confidence interval (CI)) = +0.18 mm (0.17, 0.19) and decreases: mean (CI) = -0.14 mm (-0.13, -0.15) in tibial cartilage thickness within the central and posterior cartilage regions respectively. Adjustment for tibial position revealed a decreased area of significant cartilage thickness differences, though 46% of points maintained significance. In the lateral compartment anterior region, there was a significantly different relationship between cartilage thickness differences and CSA, within high and low BMI groups (BMI group*CSA interaction, P = 0.007). Within the low BMI group, a significant negative correlation between cartilage thickness and CSA was identified (P = 0.03). CONCLUSIONS ACL-injured females displayed cartilage thickness differences in the central, and posterior medial tibial cartilage regions. Tibial position effected thickness differences, but did not account for all significant differences.
Collapse
Affiliation(s)
- E C Argentieri
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - D R Sturnick
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - M J DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.
| | - M G Gardner-Morse
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - J R Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - R J Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - B D Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| |
Collapse
|
190
|
Wang H, Fleischli JE, Hutchinson ID, Zheng NN. Knee moment and shear force are correlated with femoral tunnel orientation after single-bundle anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42:2377-85. [PMID: 25062662 DOI: 10.1177/0363546514541232] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increasing evidence has shown that anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) better restores normal knee kinematics and functionality than nonanatomic ACLR. Whether anatomic reconstruction results in better knee kinetics during daily activities has not been fully investigated. PURPOSE To assess the relationship between femoral tunnel angle and kinetic parameters of the knee joint during walking after single-bundle ACLR and to compare the radiographic and kinetic results of patients who underwent anatomic ACLR with those of patients who underwent nonanatomic ACLR. STUDY DESIGN Controlled laboratory study. METHODS Twenty-one patients who underwent unilateral ACLR were recruited, and 20 healthy subjects from a previous study were used as a control group. All surgical procedures were performed by a single surgeon, 11 using the transtibial (TT) technique and 10 using the anteromedial portal (AMP) technique. Femoral tunnel orientation was measured from posterior-to-anterior radiographs. Dynamic knee joint moments and shear forces during gait were evaluated using 3-dimensional motion analysis and inverse dynamics. Relationships between femoral tunnel angles and kinetic results were evaluated via linear regression. Results were compared between 2 ACLR groups and controls using 1-way analysis of variance. RESULTS Femoral tunnel angle had significant correlations with peak external knee flexion moment and posterior shear force during early stance. The TT group had a significantly smaller (more vertical) mean femoral tunnel angle (19.4° ± 4.1°) than the AMP group (36.4° ± 5.8°). Significant reductions were found in the normalized peak external knee flexion moment (TT, 0.15 ± 0.12 Nm/kg·m; AMP, 0.25 ± 0.12 Nm/kg·m; control, 0.25 ± 0.16 Nm/kg·m) (P = .032) and posterior shear force (TT, 0.64 ± 0.55 N/kg; AMP, 1.10 ± 0.58 N/kg; control, 1.35 ± 0.55 N/kg) (P = .024) in the TT group compared with controls, but not in the AMP group. Moreover, a significantly greater medial shear force was found in the TT group during the late stance phase (TT, 1.08 ± 0.32 N/kg; AMP, 0.89 ± 0.26 N/kg; control, 0.83 ± 0.22 N/kg) (P = .038). A greater peak external knee adduction moment was found in both ACL groups during the early stance phase (TT, 0.25 ± 0.07 Nm/kg·m; AMP, 0.25 ± 0.07 Nm/kg·m; control, 0.19 ± 0.05 Nm/kg·m) (P < .01). CONCLUSION Knee joint kinetic changes are seen within months (~10 months) after ACLR. This study revealed significant relationships between femoral tunnel orientation and postoperative knee joint flexion moment and posterior shear force during walking. The AMP technique provides better restoration of these knee kinetic parameters compared with the TT technique at this postoperative time point. CLINICAL RELEVANCE The femoral tunnel angle measured from plain radiographs can be used as an important metric of postoperative knee joint kinetics. This information provides a better understanding of the knee joint's biomechanical environment after ACLR using commonly used single-bundle techniques.
Collapse
Affiliation(s)
- Hongsheng Wang
- Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - James E Fleischli
- Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina, USA
| | - Ian D Hutchinson
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Naiquan Nigel Zheng
- Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| |
Collapse
|
191
|
Abstract
Osteoarthritis (OA) is a leading cause of disability and its incidence is rising due to increasing obesity and an ageing population. Risk factors can be divided into person-level factors, such as age, sex, obesity, genetics, race/ethnicity and diet, and joint-level factors including injury, malalignment and abnormal loading of the joints. The interaction of these risk factors is complex and provides a challenge to the managing physician. The purpose of this review is to illustrate how each of these factors interact together to instigate incident OA as well as to outline the need for ongoing epidemiologic studies for the future prevention of both incident and progressive OA. It is only by understanding the impact of this disease and the modifiable risk factors that we will be able to truly target public health prevention interventions appropriately.
Collapse
Affiliation(s)
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
192
|
Riordan EA, Little C, Hunter D. Pathogenesis of post-traumatic OA with a view to intervention. Best Pract Res Clin Rheumatol 2014; 28:17-30. [PMID: 24792943 DOI: 10.1016/j.berh.2014.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Post-traumatic osteoarthritis (PTOA) subsequent to joint injury accounts for over 12% of the overall disease burden of OA, and higher in the most at-risk ankle and knee joints. Evidence suggests that the pathogenesis of PTOA may be related to inflammatory processes and alterations to the articular cartilage, menisci, muscle and subchondral bone that are initiated in the acute post-injury phase. Imaging of these early changes, as well as a number of biochemical markers, demonstrates the potential for use as predictors of future disease, and may help stratify patients on the likelihood of their developing clinical disease. This will be important in guiding future interventions, which will likely target elements of the inflammatory response within the joint, molecular abnormalities related to cartilage matrix degradation, chondrocyte function and subchondral bone remodelling. Until significant improvements are made, however, in identifying patients most at risk for developing PTOA--and therefore those who are candidates for therapy--primary prevention programmes will remain the most effective current management tools.
Collapse
Affiliation(s)
- Edward A Riordan
- School of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Christopher Little
- Raymond Purves Bone and Joint Research Laboratories, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Level 10 Kolling Building, St Leonards, NSW, Australia
| | - David Hunter
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, Australia
| |
Collapse
|
193
|
Alexander PG, Gottardi R, Lin H, Lozito TP, Tuan RS. Three-dimensional osteogenic and chondrogenic systems to model osteochondral physiology and degenerative joint diseases. Exp Biol Med (Maywood) 2014; 239:1080-95. [PMID: 24994814 DOI: 10.1177/1535370214539232] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tissue engineered constructs have the potential to function as in vitro pre-clinical models of normal tissue function and disease pathogenesis for drug screening and toxicity assessment. Effective high throughput assays demand minimal systems with clearly defined performance parameters. These systems must accurately model the structure and function of the human organs and their physiological response to different stimuli. Musculoskeletal tissues present unique challenges in this respect, as they are load-bearing, matrix-rich tissues whose functionality is intimately connected to the extracellular matrix and its organization. Of particular clinical importance is the osteochondral junction, the target tissue affected in degenerative joint diseases, such as osteoarthritis (OA), which consists of hyaline articular cartilage in close interaction with subchondral bone. In this review, we present an overview of currently available in vitro three-dimensional systems for bone and cartilage tissue engineering that mimic native physiology, and the utility and limitations of these systems. Specifically, we address the need to combine bone, cartilage and other tissues to form an interactive microphysiological system (MPS) to fully capture the biological complexity and mechanical functions of the osteochondral junction of the articular joint. The potential applications of three-dimensional MPSs for musculoskeletal biology and medicine are highlighted.
Collapse
Affiliation(s)
- Peter G Alexander
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, 15219 USA
| | - Riccardo Gottardi
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, 15219 USA Ri.MED Foundation, Palermo, I-90133 Italy
| | - Hang Lin
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, 15219 USA
| | - Thomas P Lozito
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, 15219 USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, 15219 USA Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15261, USA Department of Mechanical Engineering and Materials Science, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15261, USA
| |
Collapse
|
194
|
Hunter DJ, Lohmander LS, Makovey J, Tamez-Peña J, Totterman S, Schreyer E, Frobell RB. The effect of anterior cruciate ligament injury on bone curvature: exploratory analysis in the KANON trial. Osteoarthritis Cartilage 2014; 22:959-68. [PMID: 24867633 DOI: 10.1016/j.joca.2014.05.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 04/30/2014] [Accepted: 05/14/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Investigate the 5-year longitudinal changes in bone curvature after acute anterior cruciate ligament (ACL) injury, and identify predictors of such changes. METHODS In the KANON-trial (ISRCTN 84752559), 111/121 young active adults with an acute ACL tear to a previously un-injured knee had serial 1.5 T MR images from baseline (within 5 weeks from injury) to 5 years after injury. Of these, 86 had ACL reconstruction (ACLR) performed early or delayed, 25 were treated with rehabilitation alone. Measures of articulating bone curvature were obtained from computer-assisted segmentation of MR images. Curvature (mm(-1)) was determined for femur, tibia, medial/lateral femur, trochlea, medial/lateral tibia. Age, sex, treatment, BMI, meniscal injury, osteochondral fracture on baseline MR images were tested for association. RESULTS Over 5 years, curvature decreased in each region (P < 0.001) suggesting flattening of convex shapes and increased concavity of concave shapes. A higher BMI was associated with flattening of the femur (P = 0.03), trochlea (P = 0.007) and increasing concavity of the lateral tibia (LT) (P = 0.011). ACLR, compared to rehabilitation alone, was associated with flatter curvature in the femur (P < 0.001), medial femoral condyle (P = 0.006) and trochlea (P = 0.003). Any meniscal injury at baseline was associated with a more flattened curvature in the femur (P = 0.038), trochlea (P = 0.039), lateral femoral condyle (P = 0.034) and increasing concavity of the LT (P = 0.048). CONCLUSION ACL injury is associated with significant changes in articulating bone curvature over a 5 year period. Higher BMI, baseline meniscal injury and undergoing ACL reconstruction (as distinct from undergoing rehabilitation alone) are all associated with flattening of the articulating bone.
Collapse
Affiliation(s)
- D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - L S Lohmander
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden; Research Unit for Musculoskeletal Function and Physiotherapy and Department of Orthopaedics and Traumatology, University of Southern Denmark, Odense, Denmark
| | - J Makovey
- Rheumatology Department, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - J Tamez-Peña
- Escuela de Medicina, Tecnológico de Monterrey, Monterrey, NL, México; Qmetrics Technologies, Rochester, NY, USA
| | | | - E Schreyer
- Qmetrics Technologies, Rochester, NY, USA
| | - R B Frobell
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
195
|
Mäkelä JTA, Rezaeian ZS, Mikkonen S, Madden R, Han SK, Jurvelin JS, Herzog W, Korhonen RK. Site-dependent changes in structure and function of lapine articular cartilage 4 weeks after anterior cruciate ligament transection. Osteoarthritis Cartilage 2014; 22:869-78. [PMID: 24769230 DOI: 10.1016/j.joca.2014.04.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 04/04/2014] [Accepted: 04/12/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the site-dependent changes in the structure and function of articular cartilage in the lapine knee joint at a very early stage of osteoarthritis (OA), created experimentally by anterior cruciate ligament transection (ACLT). METHODS Unilateral ACLT was performed in eight mature New Zealand white rabbits. ACL transected and contralateral (C-L) joints were prepared for analysis at 4 weeks after ACLT. Three rabbits with intact joints were used as a control group (CNTRL). Femoral groove, medial and lateral femoral condyles, and tibial plateaus were harvested and used in the analysis. Biomechanical tests, microscopy and spectroscopy were used to determine the biomechanical properties, composition and structure of the samples. A linear mixed model was chosen for statistical comparisons between the groups. RESULTS As a result of ACLT, the equilibrium and dynamic moduli were decreased primarily in the femoral condyle cartilage. Up to three times lower moduli (P < 0.05) were observed in the ACLT group compared to the control group. Significant (P < 0.05) proteoglycan (PG) loss in the ACLT joint cartilage was observed up to a depth of 20-30% from the cartilage surface in femoral condyles, while significant PG loss was confined to more superficial regions in tibial plateaus and femoral groove. The collagen orientation angle was increased (P < 0.05) up to a cartilage depth of 60% by ACLT in the lateral femoral condyle, while smaller effects, but still significant, were observed at other locations. The collagen content was increased (P < 0.05) in the middle and deep zones of the ACLT group compared to the control group samples, especially in the lateral femoral condyle. CONCLUSION Femoral condyle cartilage experienced the greatest structural and mechanical alterations in very early OA, as produced by ACLT. Degenerative alterations were observed especially in the superficial collagen fiber organization and PG content, while the collagen content was increased in the deep tissue of femoral condyle cartilage. The current findings provide novel information of the early stages of OA in different locations of the knee joint.
Collapse
Affiliation(s)
- J T A Mäkelä
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Z S Rezaeian
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Physical Therapy, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - S Mikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - R Madden
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - S-K Han
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Advanced Biomedical and Welfare Technology R&BD Group, Korea Institute of Industrial Technology, Cheonan-si, Chungcheongnam-do, Korea
| | - J S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - W Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
196
|
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: 0.5] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
197
|
Gokeler A, Bisschop M, Benjaminse A, Myer GD, Eppinga P, Otten E. Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices. Knee Surg Sports Traumatol Arthrosc 2014; 22:1163-74. [PMID: 23812438 DOI: 10.1007/s00167-013-2577-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 06/09/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE To determine the most effective practices for quadriceps strengthening after ACL reconstruction. METHODS An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch with unilateral ACL-reconstructed patients older than 13 years, RCT rehabilitation programmes containing muscle strengthening, protocol described in detail and time frame of measurements reported. Quadriceps muscle strength and patient-reported outcomes were the endpoints. Included studies were assessed on their methodological quality using the CONSORT Checklist. RESULTS From 645 identified studies, 10 met the inclusion criteria. Seven studies found an increase in quadriceps strength after intervention programmes regardless of type of training. An eccentric exercise programme showed significantly better values for isometric quadriceps strength compared to a concentric exercise programme. The Tegner activity scale showed a significant increase in activity level for all training programmes. The Cincinnati Knee Rating System showed significant improvements in particular for the neuromuscular training group. CONCLUSIONS The evidence from this review indicates that eccentric training may be most effective to restore quadriceps strength, but full recovery may not be achieved with current rehabilitation practices. Neuromuscular training incorporating motor learning principles should be added to strengthening training to optimise outcome measurements. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Alli Gokeler
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,
| | | | | | | | | | | |
Collapse
|
198
|
Favre J, Scanlan SF, Erhart-Hledik JC, Blazek K, Andriacchi TP. Patterns of femoral cartilage thickness are different in asymptomatic and osteoarthritic knees and can be used to detect disease-related differences between samples. J Biomech Eng 2014; 135:101002-10. [PMID: 23722563 DOI: 10.1115/1.4024629] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 05/22/2013] [Indexed: 01/02/2023]
Abstract
Measures of mean cartilage thickness over predefined regions in the femoral plate using magnetic resonance imaging have provided important insights into the characteristics of knee osteoarthritis (OA), however, this quantification method suffers from the limited ability to detect OA-related differences between knees and loses potentially important information regarding spatial variations in cartilage thickness. The objectives of this study were to develop a new method for analyzing patterns of femoral cartilage thickness and to test the following hypotheses: (1) asymptomatic knees have similar thickness patterns, (2) thickness patterns differ with knee OA, and (3) thickness patterns are more sensitive than mean thicknesses to differences between OA conditions. Bi-orthogonal thickness patterns were extracted from thickness maps of segmented magnetic resonance images in the medial, lateral, and trochlea compartments. Fifty asymptomatic knees were used to develop the method and establish reference asymptomatic patterns. Another subgroup of 20 asymptomatic knees and three subgroups of 20 OA knees each with a Kellgren/Lawrence grade (KLG) of 1, 2, and 3, respectively, were selected for hypotheses testing. The thickness patterns were similar between asymptomatic knees (coefficient of multiple determination between 0.8 and 0.9). The thickness pattern alterations, i.e., the differences between the thickness patterns of an individual knee and reference asymptomatic thickness patterns, increased with increasing OA severity (Kendall correlation between 0.23 and 0.47) and KLG 2 and 3 knees had significantly larger thickness pattern alterations than asymptomatic knees in the three compartments. On average, the number of significant differences detected between the four subgroups was 4.5 times greater with thickness pattern alterations than mean thicknesses. The increase was particularly marked in the medial compartment, where the number of significant differences between subgroups was 10 times greater with thickness pattern alterations than mean thickness measurements. Asymptomatic knees had characteristic regional thickness patterns and these patterns were different in medial OA knees. Assessing the thickness patterns, which account for the spatial variations in cartilage thickness and capture both cartilage thinning and swelling, could enhance the capacity to detect OA-related differences between knees.
Collapse
|
199
|
Image based weighted center of proximity versus directly measured knee contact location during simulated gait. J Biomech 2014; 47:2483-9. [PMID: 24837219 DOI: 10.1016/j.jbiomech.2014.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 11/21/2022]
Abstract
To understand the mechanical consequences of knee injury requires a detailed analysis of the effect of that injury on joint contact mechanics during activities of daily living. Three-dimensional (3D) knee joint geometric models have been combined with knee joint kinematics to dynamically estimate the location of joint contact during physiological activities-using a weighted center of proximity (WCoP) method. However, the relationship between the estimated WCoP and the actual location of contact has not been defined. The objective of this study was to assess the relationship between knee joint contact location as estimated using the image-based WCoP method, and a directly measured weighted center of contact (WCoC) method during simulated walking. To achieve this goal, we created knee specific models of six human cadaveric knees from magnetic resonance imaging. All knees were then subjected to physiological loads on a knee simulator intended to mimic gait. Knee joint motion was captured using a motion capture system. Knee joint contact stresses were synchronously recorded using a thin electronic sensor throughout gait, and used to compute WCoC for the medial and lateral plateaus of each knee. WCoP was calculated by combining knee kinematics with the MRI-based knee specific model. Both metrics were compared throughout gait using linear regression. The anteroposterior (AP) location of WCoP was significantly correlated with that of WCoC on both tibial plateaus in all specimens (p<0.01, 95% confidence interval of Pearson׳s coefficient r>0), but the correlation was not significant in the mediolateral (ML) direction for 4/6 knees (p>0.05). Our study demonstrates that while the location of joint contact obtained from 3D knee joint contact model, using the WCoP method, is significantly correlated with the location of actual contact stresses in the AP direction, that relationship is less certain in the ML direction.
Collapse
|
200
|
Stiebel M, Miller LE, Block JE. Post-traumatic knee osteoarthritis in the young patient: therapeutic dilemmas and emerging technologies. Open Access J Sports Med 2014; 5:73-9. [PMID: 24744616 PMCID: PMC3986283 DOI: 10.2147/oajsm.s61865] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Traumatic knee injury is common in young adults and strongly contributes to premature development of knee osteoarthritis (OA). Post-traumatic knee OA poses a therapeutic dilemma to the physician, since no known therapy has an acceptable safety profile, effectively relieves joint pain, and enjoys reasonable patient acceptance. Consequently, these young patients will ultimately be faced with the decision to either undergo surgical intervention, despite prosthesis durability concerns, or to continue with ineffective nonsurgical treatment. Emerging therapies, such as biologics, disease-modifying drugs, partial joint resurfacings, and minimally invasive joint-unloading implants are currently being studied to fill this therapeutic void in the young patient with post-traumatic knee OA.
Collapse
Affiliation(s)
| | - Larry E Miller
- Miller Scientific Consulting, Inc, Asheville, NC, USA ; The Jon Block Group, San Francisco, CA, USA
| | | |
Collapse
|