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Garcia SA, Johnson AK, Orzame M, Palmieri-Smith RM. Biomechanical Effects of Manipulating Preferred Cadence During Treadmill Walking in Patients With ACL Reconstruction. Sports Health 2024; 16:420-428. [PMID: 37021815 PMCID: PMC11025515 DOI: 10.1177/19417381231163181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Abnormal gait is common after anterior cruciate ligament reconstruction (ACLR) which may influence osteoarthritis risk in this population. Yet few gait retraining options currently exist in ACLR rehabilitation. Cueing cadence changes is a simple, low-cost method that can alter walking mechanics in healthy adults, but few studies have tested its effectiveness in an ACLR population. Here, we evaluated the acute effects of altering cadence on knee mechanics in patients 9 to 12 months post ACLR. HYPOTHESIS Cueing larger steps will facilitate larger knee angles and moments, while cueing smaller steps would induce smaller knee angles and moments. STUDY DESIGN Randomized cross-sectional design. LEVEL OF EVIDENCE Level 3. METHODS Twenty-eight patients with unilateral ACLR underwent gait assessments on a treadmill at preferred pace. Preferred walking gait was assessed first to obtain preferred cadence. Participants then completed trials while matching an audible beat set to 90% and 110% of preferred cadence in a randomized order. Three-dimensional sagittal and frontal plane biomechanics were evaluated bilaterally. RESULTS Compared with preferred cadence, cueing larger steps induced larger peak knee flexion moments (KFMs) and knee extension excursions bilaterally (P < 0.01), whereas cueing smaller steps only reduced knee flexion excursions (P < 0.01). Knee adduction moments remain unchanged across conditions and were similar between limbs (P > 0.05). Peak KFMs and excursions were smaller in the injured compared with uninjured limb (P < 0.01). CONCLUSION Frontal plane gait outcomes were unchanged across conditions suggesting acute cadence manipulations result in mainly sagittal plane adaptations. Follow-up studies using a longitudinal cadence biofeedback paradigm may be warranted to elucidate the utility of this gait retraining strategy after ACLR. CLINICAL RELEVANCE Cueing changes in walking cadence can target sagittal plane knee loading and joint range of motion in ACLR participants. This strategy may offer high clinical translatability given it requires relatively minimal equipment (ie, free metronome app) outside of a treadmill.
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Affiliation(s)
- Steven A. Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Alexa K. Johnson
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Marissa Orzame
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Riann M. Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, Michigan
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Bjornsen E, Berkoff D, Blackburn JT, Davis-Wilson H, Evans-Pickett A, Franz JR, Harkey MS, Horton WZ, Lisee C, Luc-Harkey B, Munsch AE, Nissman D, Pfeiffer S, Pietrosimone B. Sustained Limb-Level Loading: A Ground Reaction Force Phenotype Common to Individuals at High Risk for and Those With Knee Osteoarthritis. Arthritis Rheumatol 2024; 76:566-576. [PMID: 37961759 DOI: 10.1002/art.42744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/08/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The objective of this study was to compare the vertical (vGRF), anterior-posterior (apGRF), and medial-lateral (mlGRF) ground reaction force (GRF) profiles throughout the stance phase of gait (1) between individuals 6 to 12 months post-anterior cruciate ligament reconstruction (ACLR) and uninjured matched controls and (2) between ACLR and individuals with differing radiographic severities of knee osteoarthritis (KOA), defined as Kellgren and Lawrence (KL) grades KL2, KL3, and KL4. METHODS A total of 196 participants were included in this retrospective cross-sectional analysis. Gait biomechanics were collected from individuals 6 to 12 months post-ACLR (n = 36), uninjured controls matched to the ACLR group (n = 36), and individuals with KL2 (n = 31), KL3 (n = 67), and KL4 osteoarthritis (OA) (n = 26). Between-group differences in vGRF, apGRF, and mlGRF were assessed in reference to the ACLR group throughout each percentage of stance phase using a functional linear model. RESULTS The ACLR group demonstrated lower vGRF and apGRF in early and late stance compared to the uninjured controls, with large effects (Cohen's d range: 1.35-1.66). Conversely, the ACLR group exhibited greater vGRF (87%-90%; 4.88% body weight [BW]; d = 0.75) and apGRF (84%-94%; 2.41% BW; d = 0.79) than the KL2 group in a small portion of late stance. No differences in mlGRF profiles were observed between the ACLR and either the uninjured controls or the KL2 group. The magnitude of difference in GRF profiles between the ACLR and OA groups increased with OA disease severity. CONCLUSION Individuals 6 to 12 months post-ACLR exhibit strikingly similar GRF profiles as individuals with KL2 KOA, suggesting both patient groups may benefit from targeted interventions to address aberrant GRF profiles.
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Affiliation(s)
| | - David Berkoff
- University of North Carolina at Chapel Hill, Chapel Hill
| | | | | | | | - Jason R Franz
- University of North Carolina at Chapel Hill, Chapel Hill, and North Carolina State University, Raleigh
| | | | | | - Caroline Lisee
- University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Amanda E Munsch
- University of North Carolina at Chapel Hill, Chapel Hill, and North Carolina State University, Raleigh
| | - Daniel Nissman
- University of North Carolina at Chapel Hill, Chapel Hill
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Buck AN, Lisee C, Bjornsen E, Büttner C, Birchmeier T, Nilius A, Favoreto N, Spang J, Blackburn T, Pietrosimone B. Acutely Normalizing Walking Speed Does Not Normalize Gait Biomechanics Post-Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:464-475. [PMID: 38051127 PMCID: PMC10922289 DOI: 10.1249/mss.0000000000003330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE To determine the effect of acutely increasing walking speed on gait biomechanics in ACLR individuals compared with their habitual speed and uninjured matched-controls. METHODS Gait biomechanics were collected on 30 ACLR individuals (20 females; age, 22.0 ± 4.2 yr; body mass index, 24.0 ± 3.0 kg·m -2 ) at their habitual speed and at 1.3 m·s -1 , a speed similar to controls, and 30 uninjured matched-controls (age: 21.9 ± 3.8, body mass index: 23.6 ± 2.5) at their habitual speed. Functional waveform analyses compared biomechanics between: i) walking at habitual speed vs 1.3 m·s -1 in ACLR individuals; and ii) ACLR individuals at 1.3 m·s -1 vs controls. RESULTS In the ACLR group, there were no statistically significant biomechanical differences between walking at habitual speed (1.18 ± 0.12 m·s -1 ) and 1.3 m·s -1 (1.29 ± 0.05 m·s -1 ). Compared with controls (habitual speed: 1.34 ± 0.12 m·s -1 ), the ACLR group while walking at 1.3 m·s -1 exhibited smaller vertical ground reaction force (vGRF) during early and late stance (13-28, 78-90% stance phase), greater midstance vGRF (47-61%), smaller early-to-midstance knee flexion angle (KFA; 1-44%), greater mid-to-late stance KFA (68-73, 96-101%), greater internal knee abduction moment (69-101%), and smaller internal knee extension moment (4-51, 88-96%). CONCLUSIONS Increasing walking speed to a speed similar to uninjured controls did not elicit significant changes to gait biomechanics, and ACLR individuals continued to demonstrate biomechanical profiles that are associated with PTOA development and differ from controls.
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Affiliation(s)
| | - Caroline Lisee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Thomas Birchmeier
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Natalia Favoreto
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Davis-Wilson HC, Thoma LM, Franz JR, Blackburn JT, Longobardi L, Schwartz TA, Hackney AC, Pietrosimone B. Physical Activity Associates with T1rho MRI of Femoral Cartilage After Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:411-417. [PMID: 37796166 PMCID: PMC10922225 DOI: 10.1249/mss.0000000000003318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE Less physical activity has been associated with systemic biomarkers of cartilage breakdown after anterior cruciate ligament reconstruction (ACLR). However, previous research lacks analysis of deleterious cartilage compositional changes and objective physical activity after ACLR. The purpose of this study was to determine the association between physical activity quantified via accelerometer-based measures of daily steps and time in moderate-to-vigorous physical activity (MVPA), and T1rho magnetic resonance imaging (MRI) of the femoral articular cartilage, a marker of proteoglycan density in individuals with ACLR. METHODS Daily steps and MVPA were assessed over 7 d using an accelerometer worn on the hip in 26 individuals between 6 and 12 months after primary unilateral ACLR. Resting T1rho MRI was collected bilaterally, and T1rho MRI interlimb ratios (ILR: ACLR limb/contralateral limb) were calculated for lateral and medial femoral condyle regions of interest. We conducted univariate linear regression analyses to determine associations between T1rho MRI ILRs and daily steps and MVPA with and without controlling for sex. RESULTS Greater T1rho MRI ILR of the central lateral femoral condyle, indicative of less proteoglycan density in the ACLR limb, was associated with greater time in MVPA ( R2 = 0.178, P = 0.032). Sex-adjusted models showed significant interaction terms between daily steps and sex in the anterior ( P = 0.025), central ( P = 0.002), and posterior ( P = 0.002) medial femoral condyle. CONCLUSIONS Lesser physical activity may be a risk factor for maintaining cartilage health after ACLR; additionally, the relationship between physical activity and cartilage health may be different between males and females.
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Affiliation(s)
- Hope C. Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Louise M. Thoma
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lara Longobardi
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Todd A. Schwartz
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anthony C. Hackney
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Garcia SA, Pamukoff DN, Johnson AK, Palmieri-Smith RM. Joint and Limb Loading during Gait in Adults with ACL Reconstruction: Comparison between Single-Step and Cumulative Load Metrics. Med Sci Sports Exerc 2023; 55:1706-1716. [PMID: 37126038 PMCID: PMC10524219 DOI: 10.1249/mss.0000000000003201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE Individuals with anterior cruciate ligament reconstruction (ACLR) generally exhibit limb underloading behaviors during walking, but most research focuses on per-step comparisons. Cumulative loading metrics offer unique insight into joint loading as magnitude, duration, and total steps are considered, but few studies have evaluated if cumulative loads are altered post-ACLR. Here, we evaluated if underloading behaviors are apparent in ACLR limbs when using cumulative load metrics and how load metrics change in response to walking speed modifications. METHODS Treadmill walking biomechanics were evaluated in 21 participants with ACLR at three speeds (self-selected (SS); 120% SS and 80% SS). Cumulative loads per step and per kilometer were calculated using knee flexion and adduction moment (KFM and KAM) and vertical ground reaction force (GRF) impulses. Traditional magnitude metrics for KFM, KAM, and GRF were also calculated. RESULTS The ACLR limb displayed smaller KFM and GRF in early and late stances, but larger KFM and GRF during midstance compared with the contralateral limb ( P < 0.01). Only GRF cumulative loads (per step and per kilometer) were reduced in the ACLR limb ( P < 0.01). In response to speed modifications, load magnitudes generally increased with speed. Conversely, cumulative load metrics (per step and per kilometer) decreased at faster speeds and increased at slow speeds ( P < 0.01). CONCLUSIONS Patients with ACLR underload their knee in the sagittal plane per step, but cumulatively over the course of many steps/distance, this underloading phenomenon was not apparent. Furthermore, cumulative load increased at slower speeds, opposite to what is identified with traditional single-step metrics. Assessing cumulative load metrics may offer additional insight into how load outcomes may be impacted in injured populations or in response to gait modifications.
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Affiliation(s)
- Steven A. Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI
| | | | - Alexa K. Johnson
- School of Kinesiology, University of Michigan, Ann Arbor, MI
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI
| | - Riann M. Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, MI
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI
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Armitano-Lago C, Davis-Wilson HC, Evans-Pickett A, Lisee C, Kershner CE, Blackburn T, Franz JR, Kiefer AW, Nissman D, Pietrosimone B. Gait Variability Structure Linked to Worse Cartilage Composition Post-ACL Reconstruction. Med Sci Sports Exerc 2023; 55:1499-1506. [PMID: 36940200 PMCID: PMC10363223 DOI: 10.1249/mss.0000000000003174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Aberrant gait variability has been observed after anterior cruciate ligament reconstruction (ACLR), yet it remains unknown if gait variability is associated with early changes in cartilage composition linked to osteoarthritis development. Our purpose was to determine the association between femoral articular cartilage T1ρ magnetic resonance imaging relaxation times and gait variability. METHODS T1ρ magnetic resonance imaging and gait kinematics were collected in 22 ACLR participants (13 women; 21 ± 4 yr old; 7.52 ± 1.43 months post-ACLR). Femoral articular cartilage from the ACLR and uninjured limbs were segmented into anterior, central, and posterior regions from the weight-bearing portions of the medial and lateral condyles. Mean T1ρ relaxation times were extracted from each region and interlimb ratios (ILR) were calculated (i.e., ACLR/uninjured limb). Greater T1ρ ILR values were interpreted as less proteoglycan density (worse cartilage composition) in the injured limb compared with the uninjured limb. Knee kinematics were collected at a self-selected comfortable walking speed on a treadmill with an eight-camera three-dimensional motion capture system. Frontal and sagittal plane kinematics were extracted, and sample entropy was used to calculate kinematic variability structure (KV structure ). Pearson's product-moment correlations were conducted to determine the associations between T1ρ and KV structure variables. RESULTS Lesser frontal plane KV structure was associated with greater mean T1ρ ILR in the anterior lateral ( r = - 0.44, P = 0.04) and anterior medial condyles ( r = - 0.47, P = 0 .03). Lesser sagittal plane KV structure was associated with greater mean T1ρ ILR in the anterior lateral condyle ( r = - 0.47, P = 0.03). CONCLUSIONS The association between less KV structure and worse femoral articular cartilage proteoglycan density suggests a link between less variable knee kinematics and deleterious changes joint tissue changes. The findings suggest that less knee kinematic variability structure is a mechanism linking aberrant gait to early osteoarthritis development.
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Affiliation(s)
- Cortney Armitano-Lago
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hope C. Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Alyssa Evans-Pickett
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Lisee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cassidy E. Kershner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason R. Franz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam W. Kiefer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel Nissman
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Garcia SA, Kahan S, Gallegos J, Balza I, Krishnan C, Palmieri-Smith RM. Walking speed differentially affects lower extremity biomechanics in individuals with anterior cruciate ligament reconstruction compared to uninjured controls. Clin Biomech (Bristol, Avon) 2023; 108:106059. [PMID: 37562332 DOI: 10.1016/j.clinbiomech.2023.106059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Walking biomechanics are commonly affected after anterior cruciate ligament reconstruction and differ compared to uninjured controls. Manipulating task difficulty has been shown to affect the magnitude of walking impairments in those early after knee surgery but it is unclear if patients in later phases post-op are similarly affected by differing task demands. Here, we evaluated the effects of manipulating walking speed on between-limb differences in ground reaction force and knee biomechanics in those with and without anterior cruciate ligament reconstruction. METHODS We recruited 28 individuals with anterior cruciate ligament reconstruction and 20 uninjured control participants to undergo walking assessments at three speeds (self-selected, 120%, and 80% self-selected speed). Main outcomes included sagittal plane knee moments, angles, excursions, and ground reaction forces (vertical and anterior-posterior). FINDINGS We observed walking speed differentially impacted force and knee-outcomes in those with anterior cruciate ligament reconstruction. Between-limb differences increased at fast and decreased at slow speeds in those with anterior cruciate ligament reconstruction while uninjured participants maintained between-limb differences regardless of speed (partial η2 = 0.13-0.33, p < 0.05). Anterior cruciate ligament reconstruction patients underloaded the surgical limb relative to both the contralateral, and uninjured controls in GRFs and sagittal plane knee moments (partial η2 range = 0.13-0.25, p < 0.05). INTERPRETATION Overall, our findings highlight the persistence of walking impairments in those with anterior cruciate ligament reconstruction despite completing formal rehabilitation. Further research should consider determining if those displaying larger changes in gait asymmetries in response to fast walking also exhibit poorer strength and/or joint health outcomes.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Seth Kahan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Jovanna Gallegos
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Isabella Balza
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Neuromuscular and Rehabilitation Robotics Laboratory, University of Michigan, Ann Arbor, MI, USA; Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA; Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI, USA.
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Werner DM, Golightly YM, Tao M, Post A, Wellsandt E. Environmental Risk Factors for Osteoarthritis: The Impact on Individuals with Knee Joint Injury. Rheum Dis Clin North Am 2022; 48:907-930. [PMID: 36333003 DOI: 10.1016/j.rdc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteoarthritis is a debilitating chronic condition involving joint degeneration, impacting over 300 million people worldwide. This places a high social and economic burden on society. The knee is the most common joint impacted by osteoarthritis. A common cause of osteoarthritis is traumatic joint injury, specifically injury to the anterior cruciate ligament. The purpose of this review is to detail the non-modifiable and modifiable risk factors for osteoarthritis with particular focus on individuals after anterior cruciate ligament injury. After reading this, health care providers will better comprehend the wide variety of factors linked to osteoarthritis.
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Affiliation(s)
- David M Werner
- Office of Graduate Studies, Medical Sciences Interdepartmental Area, University of Nebraska Medical Center, 987815 Nebraska Medical Center, Omaha, NE 68198-7815, USA; Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA.
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center Omaha, NE 68198-4035, USA
| | - Matthew Tao
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Austin Post
- College of Medicine, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
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Munsch AE, Pietrosimone B, Franz JR. Walking speed does not affect net vastus lateralis fascicle length change on average during weight acceptance. J Biomech 2022; 144:111300. [DOI: 10.1016/j.jbiomech.2022.111300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
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10
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Evans-Pickett A, Lisee C, Zachary Horton W, Lalush D, Nissman D, Troy Blackburn J, Spang JT, Pietrosimone B. Worse Tibiofemoral Cartilage Composition Is Associated with Insufficient Gait Kinetics After ACL Reconstruction. Med Sci Sports Exerc 2022; 54:1771-1781. [PMID: 35700436 PMCID: PMC9481723 DOI: 10.1249/mss.0000000000002969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Greater articular cartilage T1ρ magnetic resonance imaging relaxation times indicate less proteoglycan density and are linked to posttraumatic osteoarthritis development after anterior cruciate ligament reconstruction (ACLR). Although changes in T1ρ relaxation times are associated with gait biomechanics, it is unclear if excessive or insufficient knee joint loading is linked to greater T1ρ relaxation times 12 months post-ACLR. The purpose of this study was to compare external knee adduction (KAM) and flexion (KFM) moments in individuals after ACLR with high versus low tibiofemoral T1ρ relaxation profiles and uninjured controls. METHODS Gait biomechanics were collected in 26 uninjured controls (50% females; age, 22 ± 4 yr; body mass index, 23.9 ± 2.8 kg·m -2 ) and 26 individuals after ACLR (50% females; age, 22 ± 4 yr; body mass index, 24.2 ± 3.5 kg·m -2 ) at 6 and 12 months post-ACLR. ACLR-T1ρ High ( n = 9) and ACLR-T1ρ Low ( n = 17) groups were created based on 12-month post-ACLR T1ρ relaxation times using a k-means cluster analysis. Functional analyses of variance were used to compare KAM and KFM. RESULTS ACLR-T1ρ High exhibited lesser KAM than ACLR-T1ρ Low and uninjured controls 6 months post-ACLR. ACLR-T1ρ Low exhibited greater KAM than uninjured controls 6 and 12 months post-ACLR. KAM increased in ACLR-T1ρ High and decreased in ACLR-T1ρ Low between 6 and 12 months, both groups becoming more similar to uninjured controls. There were scant differences in KFM between ACLR-T1ρ High and ACLR-T1ρ Low 6 or 12 months post-ACLR, but both groups demonstrated lesser KFM compared with uninjured controls. CONCLUSIONS Associations between worse T1ρ profiles and increases in KAM may be driven by the normalization of KAM in individuals who initially exhibit insufficient KAM 6 months post-ACLR.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Lisee
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - W. Zachary Horton
- Department of Statistics, University of California at Santa Cruz, Santa Cruz, CA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, NC
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
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11
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Davis-Wilson HC, Thoma LM, Johnston CD, Young E, Evans-Pickett A, Spang JT, Blackburn JT, Hackney AC, Pietrosimone B. Fewer daily steps are associated with greater cartilage oligomeric matrix protein response to loading post-ACL reconstruction. J Orthop Res 2022; 40:2248-2257. [PMID: 35060165 DOI: 10.1002/jor.25268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/19/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Aberrant joint loading contributes to the development of posttraumatic knee osteoarthritis (PTOA) following anterior cruciate ligament reconstruction (ACLR); yet little is known about the association between joint loading due to daily walking and cartilage health post-ACLR. Accelerometer-based measures of daily steps and cadence (i.e., rate of steps/min) provide information regarding daily walking in a real-world setting. The purpose of this study was to determine the association between changes in serum cartilage oligomeric matrix protein (COMP; %∆COMP), a mechanosensitive biomarker that is associated with osteoarthritis progression, following a standardized walking protocol and daily walking in individuals with ACLR and uninjured controls. Daily walking was assessed over 7 days using an accelerometer worn on the right hip in 31 individuals with ACLR and 21 controls and quantified as mean steps/day and time spent in ≥100 steps/min. Serum COMP was measured before and following a 3000-step walking protocol at a preferred speed. %∆COMP was calculated as a change in COMP relative to the prewalking value. Linear regressions were used to examine associations between daily walking and %∆COMP after adjusting for preferred speed. Fewer daily steps (ΔR2 = 0.18, p = 0.02) and fewer minutes spent in ≥100 steps/min (ΔR2 = 0.16, p = 0.03) were associated with greater %∆COMP following walking in individuals with ACLR; no statistically significant associations existed in controls (daily steps: ΔR2 = 0.03, p = 0.47; time ≥100 steps/min: ΔR2 < 0.01, p = 0.81). Clinical significance: Individuals with ACLR who engage in less daily walking undergo greater %ΔCOMP, which may represent greater cartilage degradation or turnover in response to walking.
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Affiliation(s)
- Hope C Davis-Wilson
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Louise M Thoma
- Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher D Johnston
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emma Young
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Athletic Training Program, The Steadman Clinic, Vail, Colorado, USA
| | - Alyssa Evans-Pickett
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J Troy Blackburn
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anthony C Hackney
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Nawasreh ZH, Yabroudi MA, Al-Shdifat A, Daradkeh S, Kassas M, Bashaireh K. Kinetic energy absorption differences during drop jump between athletes with and without radiological signs of knee osteoarthritis: Two years post anterior cruciate ligament reconstruction. Gait Posture 2022; 98:289-296. [PMID: 36252434 DOI: 10.1016/j.gaitpost.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients demonstrate decreased knee loading and energy absorption after anterior cruciate ligament reconstruction (ACLR). This study aimed to determine the differences in the contribution of joints to the absorbed energy between athletes with and without radiological signs of knee OA 2 years after ACLR during drop jump (DJ) landing from 20, 30, and 40 cm. METHODS Forty-one (level I/II) athletes 2 years after ACLR participated in this cross-sectional study and completed motion analysis testing of DJ. Proportional contribution of the joints (foot, ankle, knee, and hip) to the absorbed energy were computed. Posterior-anterior bent-knee radiographs were completed and graded in the medial compartment of the reconstructed knee using the Kellgren-Lawrence (KL) system (OA group: KL ≥2; Non-OA group: KL<2) RESULTS: Thirteen (31.7%) athletes showed radiological signs of knee OA in the medial compartment. There was a significant joint-by-group-by-limb interaction for the contribution of joints to absorbed energy during DJ 40 cm (p ≤ 0.019) and a joint-by-group interaction for the contribution of joints during DJ 20 cm (p = 0.018). The OA group had a lower involved knee (p = 0.043) and higher involved hip contributions (p = 0.014) compared to the Non-OA group, and the non-involved knee (p = 0.007). While the Non-OA group had a lower involved ankle contribution (p = 0.045) compared to their non-involved ankle during DJ 40 cm. The OA group also had higher involved hip contribution than the Non-OA group (p = 0.010), lower involved knee (p = 0.002), and higher involved hip contribution than the non-involved limb during DJ 20 cm. SIGNIFICANCE The OA group may have adopted a compensatory pattern characterized by a decreased involved knee and increased involved hip to attenuate absorbed energy compared to the Non-OA group and their non-involved limb. The contribution of joints to the absorbed energy during DJ landing might be used as an assessment tool to identify patients with radiological signs of knee OA after ACLR.
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Affiliation(s)
- Zakariya H Nawasreh
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan.
| | - Mohammad A Yabroudi
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Anan Al-Shdifat
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Sharf Daradkeh
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Mohamed Kassas
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Khaldoon Bashaireh
- Jordan University of Science and Technology (JUST), Department of Special Surgery, College of Medicine, P.O. Box 3030, Irbid 22110, Jordan
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13
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Collins K, Fajardo R, Harkey M, Knake J, Lisee C, Wilcox L, Tasco J, Kuenze C. Knee symptoms do not affect walking biomechanics among women 6 months after anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:2240-2247. [PMID: 35001419 DOI: 10.1002/jor.25265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Women with anterior cruciate ligament reconstruction report worse pain and knee-related symptoms, and also exhibit biomechanical changes that may be related to knee osteoarthritis (OA) development. This is particularly concerning as symptom state has been previously associated with knee OA development. The purpose of this study was to compare lower extremity walking biomechanics between women (age: 21.40 ± 8.54 years) experiencing clinically significant knee-related symptoms and women with acceptable symptoms 6 months following surgery. Twenty-eight women with history of primary, unilateral anterior cruciate ligament reconstruction who completed a lower extremity walking biomechanics assessment 6 months following surgery were included in this analysis. Women were dichotomized as experiencing acceptable or clinically significant knee symptoms according to Knee injury and OA Outcomes Score cut-offs described by Englund et al. Walking biomechanics were compared between women with clinically significant and acceptable symptoms using one-way analysis of covariances for involved limb biomechanics. Biomechanical variables of interest were: peak vertical ground reaction forces (vGRFs), vGRF loading rates, knee flexion angles, knee extension moments, knee adduction angles, and knee adduction moments, and gait speed. Nearly 60% of women reported clinically significant knee symptoms 6 months postoperative. There were no statistically significant differences between symptom groups for walking biomechanics and gait speed outcomes. These findings suggest patient reported knee symptoms may not be a primary influence on walking biomechanics 6 months following anterior cruciate ligament reconstruction. Though, longitudinal assessment of changes in symptom state and walking biomechanics may be warranted as poorer walking biomechanics and symptoms are indicators of knee OA.
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Affiliation(s)
- Katherine Collins
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Ryan Fajardo
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jeffrey Knake
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luke Wilcox
- Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
| | - Jamie Tasco
- Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
| | - Christopher Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA.,Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
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14
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Lisee CM, Bjornsen E, Horton WZ, Davis-Wilson H, Blackburn JT, Fisher MB, Pietrosimone B. Differences in Gait Biomechanics Between Adolescents and Young Adults With Anterior Cruciate Ligament Reconstruction. J Athl Train 2022; 57:921-928. [PMID: 36638344 PMCID: PMC9842117 DOI: 10.4085/1062-6050-0052.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Adolescents and adults are treated similarly in rehabilitation and research despite differences in clinical recovery after anterior cruciate ligament reconstruction (ACLR). Aberrant gait is a clinical outcome associated with poor long-term health post-ACLR but has not been compared between adolescents and adults. OBJECTIVE To compare gait biomechanical waveforms throughout stance between adolescents (<18 years old) and young adults (≥18 years old) post-ACLR. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Adolescents (n = 13, girls = 77%, age = 16.7 ± 0.6 years, height = 1.7 ± 0.1 m, weight = 22.2 ± 3.7 kg/m2) were identified from a cross-sectional cohort assessing clinical outcomes 6 to 12 months post-ACLR. Young adults (n = 13, women = 77%, age = 22.3 ± 4.0 years, height = 1.7 ± 0.1 m, weight = 22.9 ± 3.3 kg/m2) were matched based on sex, time since surgery (±2 months), and body mass index (±3 kg/m2). INTERVENTION(S) Participants performed 5 gait trials at their habitual speed. MAIN OUTCOME MEASURE(S) Three-dimensional gait biomechanics and forces were collected. Vertical ground reaction force normalized to body weight (xBW), knee-flexion angle (°), knee-abduction moment (xBW × height), and knee-extension moment (BW × height) waveforms were calculated during the stance phase of gait (0%-100%). Habitual walking speed was compared using independent t tests. We used functional waveforms to compare gait biomechanics throughout stance with and without controlling for habitual walking speed by calculating mean differences between groups with 95% CIs. RESULTS Adolescents walked with slower habitual speeds compared with adults (adolescents = 1.1 ± 0.1 m/s, adults = 1.3 ± 0.1 m/s, P < .001). When gait speed was not controlled, adolescents walked with less vertical ground reaction force (9%-15% of stance) and knee-abduction moment (12%-25% of stance) during early stance and less knee-extension moment during late stance (80%-99% of stance). Regardless of their habitual walking speed, adolescents walked with greater knee-flexion angle throughout most stances (0%-21% and 29%-100% of stance). CONCLUSIONS Adolescents and adults demonstrated different gait patterns post-ACLR, suggesting that age may play a role in altered gait biomechanics.
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Affiliation(s)
| | - Elizabeth Bjornsen
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | | | - Hope Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
| | - J. Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, and North Carolina State University, Raleigh
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
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15
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Washabaugh EP, Brown SR, Palmieri-Smith RM, Krishnan C. Functional Resistance Training Differentially Alters Gait Kinetics After Anterior Cruciate Ligament Reconstruction: A Pilot Study. Sports Health 2022; 15:372-381. [PMID: 35766451 PMCID: PMC10170229 DOI: 10.1177/19417381221104042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction and can alter gait mechanics. Functional resistance training (FRT) is a novel approach to retraining strength after injury, but it is unclear how it alters gait mechanics. Therefore, we tested how 3 different types of FRT devices: a knee brace resisting extension (unidirectional brace), a knee brace resisting extension and flexion (bidirectional brace), and an elastic band pulling backwards on the ankle (elastic band)-acutely alter gait kinetics in this population. HYPOTHESIS The type of FRT device will affect ground-reaction forces (GRFs) during and after the training. Specifically, the uni- and bidirectional braces will increase GRFs when compared with the elastic band. STUDY DESIGN Crossover study. LEVEL OF EVIDENCE Level 2. METHODS A total of 15 individuals with ACL reconstruction received FRT with each device over 3 separate randomized sessions. During training, participants walked on a treadmill while performing a tracking task with visual feedback. Sessions contained 5 training trials (180 seconds each) with rest between. Vertical and anterior-posterior GRFs were assessed on the ACL-reconstructed leg before, during, and after training. Changes in GRFs were compared across devices using 1-dimensional statistical parametric mapping. RESULTS Resistance applied via bidirectional brace acutely increased gait kinetics during terminal stance/pre-swing (ie, push-off), while resistance applied via elastic band acutely increased gait kinetics during initial contact/loading (ie, braking). Both braces behaved similarly, but the unidirectional brace was less effective for increasing push-off GRFs. CONCLUSION FRT after ACL reconstruction can acutely alter gait kinetics during training. Devices can be applied to selectively alter gait kinetics. However, the long-term effects of FRT after ACL reconstruction with these devices are still unknown. CLINICAL RELEVANCE FRT may be applied to alter gait kinetics of the involved limb after ACL reconstruction, depending on the device used.
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Affiliation(s)
- Edward P Washabaugh
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Scott R Brown
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Kinesiology, Aquinas College, Grand Rapids, Michigan
| | - Riann M Palmieri-Smith
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Michigan Robotics Institute, University of Michigan, Ann Arbor, Michigan
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16
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Kosik KB, Hoch M, Allison RL, Bain KA, Slone S, Gribble PA. Talar-Cartilage Deformation and Spatiotemporal Gait Patterns in Individuals With and Those Without Chronic Ankle Instability. J Athl Train 2022; 57:564-570. [PMID: 35969663 PMCID: PMC9387372 DOI: 10.4085/1062-6050-733-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals with chronic ankle instability (CAI) present with alterations in the compositional structure of their talar articular cartilage. These alterations likely influence how the talar cartilage responds to the loading associated with activities of daily living, such as walking. Ultrasonography has emerged as an alternative imaging modality for assessing the amount of cartilage deformation in response to loading because it is clinically accessible and cost effective for routine measurements. OBJECTIVES To (1) compare talar-cartilage deformation in response to a standardized exercise protocol between those with and those without CAI and (2) examine the association between spatiotemporal walking gait parameters and cartilage deformation. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A volunteer sample of 24 participants with self-reported CAI (age = 23.2 ± 3.9 years, body mass index [BMI] = 25.1 ± 3.7 kg/m2) and 24 uninjured controls (age = 24.3 ± 2.9 years, BMI = 22.9 ± 2.8 kg/m2). MAIN OUTCOME MEASURE(S) Spatiotemporal walking gait was first assessed from 5 self-selected trials using an electronic walkway with data sampled at 120 Hz. An 8- to 13-MHz linear-array ultrasound transducer placed transversely in line with the medial and lateral malleoli captured 3 images before and after a standardized loading protocol consisting of 30 single- and double-limb squats, 2-minute single-limb balance, and 10 single-legged drops from a 40-cm-height box. RESULTS After controlling for BMI, we found that the participants with CAI had greater deformation than the uninjured control participants (P = .034). No other between-groups differences were observed (P values > .05). No significant partial correlations were noted between talar-cartilage deformation and spatiotemporal gait parameters when controlling for BMI (P > .05). CONCLUSIONS Individuals with CAI had greater talar-cartilage deformation in response to a standardized exercise protocol than control individuals. The amount of talar-cartilage deformation was not associated with the spatiotemporal walking gait.
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Affiliation(s)
- Kyle B. Kosik
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington
| | - Matthew Hoch
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington
| | - Rae L. Allison
- Department of Athletic Training, Keiser University–Flagship Campus, West Palm Beach, FL
| | - Katherine Ann Bain
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington
| | - Stacey Slone
- Department of Statistics, University of Kentucky, Lexington
| | - Phillip A. Gribble
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington
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17
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Wikstrom EA, Song K, Tennant JN, Pietrosimone B. Gait Biomechanics and Balance Associate with Talar and Subtalar T1ρ Relaxation Times in Those with Chronic Ankle Instability. Med Sci Sports Exerc 2022; 54:1013-1019. [PMID: 35576137 DOI: 10.1249/mss.0000000000002867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine associations between T1ρ relaxation times of talar and subtalar articular cartilage and commonly altered gait biomechanics and postural control outcomes in those with chronic ankle instability (CAI). METHODS Fifteen individuals with CAI (21.13 ± 1.81 yr) completed a T1ρ magnetic resonance imaging as well as a postural control and an overground gait assessment. Talocrural and subtalar cartilage was segmented manually to calculate T1ρ relaxation times. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Pearson product-moment bivariate correlations examined the relationships between T1ρ relaxation times and the gait biomechanics and postural control outcomes. RESULTS Across multiple variables, worse postural control demonstrated moderate to strong associations (range, 0.433-0.642 and -0.713) with greater talar T1ρ relaxation times. At the subtalar joint, greater T1ρ relaxation times were associated with lower peak vertical ground reaction forces, lower average vertical ground reaction force loading rates, and lower peak loading rates (range, -0.438 to -0.622). At the talar dome, greater talar T1ρ relaxation times were associated with increased knee extensor moments (r = 0.457), as well as greater knee flexion (r = 0.482) and knee adduction (r = 0.407) at initial contact. Larger step spatiotemporal gait parameters also associated with greater talar and subtalar T1ρ relaxation times (range, 0.434-0.697). CONCLUSIONS In individuals with CAI, worse postural control and altered kinematic, kinetic, and spatiotemporal outcomes demonstrate moderate to strong associations with greater talar T1ρ and/or subtalar relaxation times (i.e., less proteoglycan content). Associations between modifiable neuromechanical variables and greater T1ρ relaxation times may represent potential therapeutic interventions to mitigate ankle joint degeneration in those with CAI.
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Affiliation(s)
- Erik A Wikstrom
- MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kyeongtak Song
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY
| | - Joshua N Tennant
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
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18
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Lisee C, Davis-Wilson H, Evans-Pickett A, Horton WZ, Blackburn T, Franz JR, Thoma L, Spang JT, Pietrosimone B. Linking Gait Biomechanics and Daily Steps After ACL Reconstruction. Med Sci Sports Exerc 2022; 54:709-716. [PMID: 35072659 PMCID: PMC9255696 DOI: 10.1249/mss.0000000000002860] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Aberrant biomechanics and altered loading frequency are associated with poor knee joint health in osteoarthritis development. After anterior cruciate ligament reconstruction (ACLR), individuals demonstrate underloading (lesser vertical ground reaction force (vGRF)) with stiffened knee gait biomechanics (lesser knee extension moment (KEM) and knee flexion angle) and take fewer daily steps as early as 6 months after surgery. The purpose of this cross-sectional laboratory study is to compare gait biomechanics throughout stance between individuals 6-12 months after ACLR who take the lowest, moderate, and highest daily steps. METHODS Individuals with primary, unilateral history of ACLR between the ages of 16 and 35 yr were included (n = 36, 47% females; age, 21 ± 5 yr; months since ACLR, 8 ± 2). Barefoot gait biomechanics of vGRF (body weight), KEM (body weight × height), and knee flexion angle during stance were collected and time normalized. Average daily steps were collected via a waist-mounted accelerometer in free-living settings over 7 d. Participants were separated into tertiles based on lowest daily steps (3326-6042 daily steps), moderate (6043-8198 daily steps), and highest (8199-12,680 daily steps). Biomechanical outcomes of the ACLR limb during stance were compared between daily step groups using functional waveform gait analyses. RESULTS There were no significant differences in sex, body mass index, age, or gait speed between daily step groups. Individuals with the lowest daily steps walk with lesser vGRF and lesser KEM during weight acceptance, and lesser knee flexion angle throughout stance in the ACLR limb compared with individuals with highest and moderate daily steps. CONCLUSIONS After ACLR, individuals who take the fewest daily steps also walk with lesser vGRF during weight acceptance and a stiffened knee strategy throughout stance. These results highlight complex interactions between joint loading parameters after ACLR.
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Affiliation(s)
- Caroline Lisee
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
| | - Hope Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
| | - W. Zachary Horton
- Department of Statistics, University of California Santa Cruz, Santa Cruz, California
| | - Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | - Louise Thoma
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, NC
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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19
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Bjornsen E, Schwartz TA, Lisee C, Blackburn T, Lalush D, Nissman D, Spang J, Pietrosimone B. Loading during Midstance of Gait Is Associated with Magnetic Resonance Imaging of Cartilage Composition Following Anterior Cruciate Ligament Reconstruction. Cartilage 2022; 13:19476035211072220. [PMID: 35098719 PMCID: PMC9137315 DOI: 10.1177/19476035211072220] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE A complex association exists between aberrant gait biomechanics and posttraumatic knee osteoarthritis (PTOA) development. Previous research has primarily focused on the link between peak loading during the loading phase of stance and joint tissue changes following anterior cruciate ligament reconstruction (ACLR). However, the associations between loading and cartilage composition at other portions of stance, including midstance and late stance, is unclear. The objective of this study was to explore associations between vertical ground reaction force (vGRF) at each 1% increment of stance phase and tibiofemoral articular cartilage magnetic resonance imaging (MRI) T1ρ relaxation times following ACLR. DESIGN Twenty-three individuals (47.82% female, 22.1 ±4.1 years old) with unilateral ACLR participated in a gait assessment and T1ρ MRI collection at 12.25 ± 0.61 months post-ACLR. T1ρ relaxation times were calculated for the articular cartilage of the weightbearing medial and lateral femoral (MFC, LFC) and tibial (MTC, LTC) condyles. Separate bivariate, Pearson product moment correlation coefficients (r) were used to estimate strength of associations between T1ρ MRI relaxation times in the medial and lateral tibiofemoral articular cartilage with vGRF across the entire stance phase. RESULTS Greater vGRF during midstance (46%-56% of stance phase) was associated with greater T1ρ MRI relaxation times in the MFC (r ranging between 0.43 and 0.46). CONCLUSIONS Biomechanical gait profiles that include greater vGRF during midstance are associated with MRI estimates of lesser proteoglycan density in the MFC. Inability to unload the ACLR limb during midstance may be linked to joint tissue changes associated with PTOA development.
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Affiliation(s)
- Elizabeth Bjornsen
- Human Movement Science Curriculum, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Elizabeth Bjornsen, Human Movement Science Curriculum, The University of North Carolina at Chapel Hill, Fetzer Hall, 210 South Road, Chapel Hill, NC 27599, USA.
| | - Todd A. Schwartz
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline Lisee
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Troy Blackburn
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Nissman
- Department of Radiology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey Spang
- Department of Orthopaedics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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20
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Wellsandt E, Kallman T, Golightly Y, Podsiadlo D, Dudley A, Vas S, Michaud K, Tao M, Sajja B, Manzer M. Knee joint unloading and daily physical activity associate with cartilage T2 relaxation times 1 month after ACL injury. J Orthop Res 2022; 40:138-149. [PMID: 33783030 PMCID: PMC8478972 DOI: 10.1002/jor.25034] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/14/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is prevalent after anterior cruciate ligament (ACL) injury, but mechanismsunderlying its development are poorly understood. The purpose of this study was to determine if gait biomechanics and daily physical activity (PA) associate with cartilage T2 relaxation times, a marker of collagen organization and water content, 1 month after ACL injury. Twenty-seven participants (15-35 years old) without chondral lesions completed magnetic resonance imaging, three-dimensional gait analysis, and 1 week of PA accelerometry. Interlimb differences and ratios were calculated for gait biomechanics and T2 relaxation times, respectively. Multiple linear regression models adjusted for age, sex, and concomitant meniscus injury were used to determine the association between gait biomechanics and PA with T2 relaxation times, respectively. Altered knee adduction moment (KAM) impulse, less knee flexion excursion (kEXC) and higher daily step counts accounted for 35.8%-65.8% of T2 relaxation time variation in the weightbearing and posterior cartilage of the medial and lateral compartment (all p ≤ .011). KAM impulse was the strongest factor for T2 relaxation times in all models (all p ≤ .001). Lower KAM impulse associated with longer T2 relaxation times in the injured medial compartment (β = -.720 to -.901) and shorter T2 relaxation in the lateral compartment (β = .713 to .956). At 1 month after ACL injury, altered KAM impulse, less kEXC, and higher PA associated with longer T2 relaxation times, which may indicate poorer cartilage health. Statement of Clinical Significance: Gait biomechanics and daily PA are modifiable targets that may improve cartilage health acutely after ACL injury and slow progression to OA.
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Affiliation(s)
- Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA,Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tyler Kallman
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Yvonne Golightly
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Podsiadlo
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew Dudley
- Department of Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Stephanie Vas
- Department of Clinical Diagnostic and Therapeutic Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaleb Michaud
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA,Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Matthew Tao
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA,Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Balasrinivasa Sajja
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa Manzer
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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21
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Zheng H. Detection of Tibiofemoral Joint Injury in High-Impact Motion Based on Neural Network Reconstruction Algorithm. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5800893. [PMID: 34900197 PMCID: PMC8654531 DOI: 10.1155/2021/5800893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022]
Abstract
In order to reduce the damage degree of joint bones, ligaments, and soft tissues caused by the high impact on the tibiofemoral joint during landing, a method for detecting the damage of tibiofemoral joint under high-impact action based on neural network reconstruction algorithm is proposed. Two dimensional X-ray images of knee joints from straightening to bending in 10 healthy volunteers were selected. CT scans were performed on the knee joint on the same side, and the 3D model from the acquired images was reconstructed. The kinematics data of the femur relative to the tibia with full degree of freedom were measured by registering the 3D model with 2D images. The results showed that in the extended position, the femur was rotated inward (5.5° ± 6.3°) relative to the tibia. The range of femoral external rotation is (18.7° ± 5.9°) from flexion to 90° in straight position. However, from 90° to 120°, a small amount of internal rotation occurred (1.4° ± 1.9°), so during the whole flexion process, the femur rotated (17.3° ± 6.9°), among which, from the straight position to 15°, the femur rotated (10.0° ± 5.6°). Damage in different areas is determined by the size of the interlayer displacement sample size method of sample space reduction. It is proved that the detection method of tibiofemoral joint injury in high-impact motion based on neural network reconstruction algorithm has high accuracy and consistency.
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Affiliation(s)
- Hongbo Zheng
- PE Department of Shenyang Pharmaceutical University, Shenyang 110016, China
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22
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Jang J, Migel KG, Kim H, Wikstrom EA. Acute Vibration Feedback During Gait Reduces Mechanical Ankle Joint Loading in Chronic Ankle Instability Patients. Gait Posture 2021; 90:261-266. [PMID: 34536690 DOI: 10.1016/j.gaitpost.2021.09.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/05/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with chronic ankle instability (CAI) exhibit altered vertical ground reaction forces (vGRF), a laterally shifted center of pressure, and an inverted foot position during walking. These neuromechanical alterations are linked with altered ankle joint loading in this population. Vibration-based gait retraining improves center of pressure positioning but effects on neuromechanical variables influencing joint loading remains unknown. RESEARCH QUESTION Do patients with CAI exhibit altered vGRF and ankle joint contact forces (JCF) after receiving a single session of vibration-based gait retraining? METHODS Ten individuals with CAI underwent a single session of vibration-based gait retraining. Kinematic and kinetic data were collected during walking on an instrumental treadmill with force plates embedded in it. Following a baseline gait assessment without feedback, participants walked at a self-selected speed for 10 minutes while receiving feedback. Data was collected during an early (1 st and 2 nd minute) and late adaptation phase (9 th and 10 th minute) and, compared to baseline values. Impact and propulsive vGRF variables (i.e. peak, time to peak, and loading rate) were obtained. Musculoskeletal modeling was used to calculate ankle JCF variables (peak, impulse, and loading rate) during stance phase. RESULTS Propulsive vGRF and ankle JCF outcomes were significantly reduced during the early and late adaptation phases (p ≤ 0.039). SIGNIFICANCE These results indicate that vibration-based gait retraining can immediately reduce propulsive vGRF and ankle JCF and may represent a modality that could help restore appropriate ankle joint loading patterns in those with CAI.
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Affiliation(s)
- Jaeho Jang
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA.
| | - Kimmery G Migel
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA
| | - Hoon Kim
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA
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23
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Pfeiffer SJ, Spang JT, Nissman D, Lalush D, Wallace K, Harkey MS, Pietrosimone LS, Padua D, Blackburn T, Pietrosimone B. Association of Jump-Landing Biomechanics With Tibiofemoral Articular Cartilage Composition 12 Months After ACL Reconstruction. Orthop J Sports Med 2021; 9:23259671211016424. [PMID: 34368382 PMCID: PMC8299897 DOI: 10.1177/23259671211016424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Excessively high joint loading during dynamic movements may negatively influence articular cartilage health and contribute to the development of posttraumatic osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Little is known regarding the link between aberrant jump-landing biomechanics and articular cartilage health after ACLR. PURPOSE/HYPOTHESIS The purpose of this study was to determine the associations between jump-landing biomechanics and tibiofemoral articular cartilage composition measured using T1ρ magnetic resonance imaging (MRI) relaxation times 12 months postoperatively. We hypothesized that individuals who demonstrate alterations in jump-landing biomechanics, commonly observed after ACLR, would have longer T1ρ MRI relaxation times (longer T1ρ relaxation times associated with less proteoglycan density). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 27 individuals with unilateral ACLR participated in this cross-sectional study. Jump-landing biomechanics (peak vertical ground-reaction force [vGRF], peak internal knee extension moment [KEM], peak internal knee adduction moment [KAM]) and T1ρ MRI were collected 12 months postoperatively. Mean T1ρ relaxation times for the entire weightbearing medial femoral condyle, lateral femoral condyle (global LFC), medial tibial condyle, and lateral tibial condyle (global LTC) were calculated bilaterally. Global regions of interest were further subsectioned into posterior, central, and anterior regions of interest. All T1ρ relaxation times in the ACLR limb were normalized to the uninjured contralateral limb. Linear regressions were used to determine associations between T1ρ relaxation times and biomechanics after accounting for meniscal/chondral injury. RESULTS Lower ACLR limb KEM was associated with longer T1ρ relaxation times for the global LTC (ΔR 2 = 0.24; P = .02), posterior LTC (ΔR 2 = 0.21; P = .03), and anterior LTC (ΔR 2 = 0.18; P = .04). Greater ACLR limb peak vGRF was associated with longer T1ρ relaxation times for the global LFC (ΔR 2 = 0.20; P = .02) and central LFC (ΔR 2 = 0.15; P = .05). Peak KAM was not associated with T1ρ outcomes. CONCLUSION At 12 months postoperatively, lower peak KEM and greater peak vGRF during jump landing were related to longer T1ρ relaxation times, suggesting worse articular cartilage composition.
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Affiliation(s)
- Steven J. Pfeiffer
- Ohio Musculoskeletal & Neurological Institute, Athens, Ohio, USA
- Division of Exercise Physiology, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Athens, Ohio, USA
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, North Carolina, USA
| | - Kyle Wallace
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew S. Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Laura S. Pietrosimone
- Doctor of Physical Therapy Division, Department of Orthopedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Darin Padua
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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24
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Karamchedu NP, Murray MM, Sieker JT, Proffen BL, Portilla G, Costa MQ, Molino J, Fleming BC. Bridge-Enhanced Anterior Cruciate Ligament Repair Leads to Greater Limb Asymmetry and Less Cartilage Damage Than Untreated ACL Transection or ACL Reconstruction in the Porcine Model. Am J Sports Med 2021; 49:667-674. [PMID: 33534613 PMCID: PMC8099149 DOI: 10.1177/0363546521989265] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The extent of posttraumatic osteoarthritis (PTOA) in the porcine anterior cruciate ligament (ACL) transection model is dependent on the surgical treatment selected. In a previous study, animals treated with bridge-enhanced ACL repair using a tissue-engineered implant developed less PTOA than those treated with ACL reconstruction (ACLR). Alterations in gait, including asymmetric weightbearing and shorter stance times, have been noted in clinical studies of subjects with osteoarthritis. HYPOTHESIS Animals receiving a surgical treatment that results in less PTOA (ie, bridge-enhanced ACL repair) would exhibit fewer longitudinal postoperative gait asymmetries over a 1-year period when compared with treatments that result in greater PTOA (ie, ACLR and ACL transection). STUDY DESIGN Controlled laboratory study. METHODS Thirty-six Yucatan minipigs underwent ACL transection and were randomized to receive (1) no further treatment, (2) ACLR, or (3) bridge-enhanced ACL repair. Gait analyses were performed preoperatively, and at 4, 12, 26, and 52 weeks postoperatively. Macroscopic cartilage assessments were performed at 52 weeks. RESULTS Knees treated with bridge-enhanced ACL repair had less macroscopic damage in the medial tibial plateau than those treated with ACLR or ACL transection (adjusted P = .03 for both comparisons). The knees treated with bridge-enhanced ACL repair had greater asymmetry in hindlimb maximum force and impulse loading at 52 weeks than the knees treated with ACL transection (adjusted P < .05 for both comparisons). Although not significant, there was a trend that knees treated with bridge-enhanced ACL repair had greater asymmetry in hindlimb maximum force and impulse loading (adjusted P < .10 for both comparisons) compared with ACLR. CONCLUSION Contrary to our hypothesis, the surgical treatment resulting in less macroscopic cartilage damage (ie, bridge-enhanced ACL repair) exhibited greater asymmetry in load-related gait parameters than the other surgical groups. This finding suggests that increased offloading of the surgical knee may be associated with a slower rate of PTOA development. CLINICAL RELEVANCE Less cartilage damage at 52 weeks was found in the surgical group that continued to protect the limb from full body weight during gait. This finding suggests that protection of the knee from maximum stresses may be important in minimizing the development of PTOA in the ACL-injured knee within 1 year.
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Affiliation(s)
- Naga Padmini Karamchedu
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Martha M. Murray
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jakob T. Sieker
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Benedikt L. Proffen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriela Portilla
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Meggin Q. Costa
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
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25
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Pietrosimone B, Davis-Wilson HC, Seeley MK, Johnston C, Spang JT, Creighton RA, Kamath GM, Blackburn JT. Gait Biomechanics in Individuals Meeting Sufficient Quadriceps Strength Cutoffs Following Anterior Cruciate Ligament Reconstruction. J Athl Train 2021; 56:960-966. [PMID: 33481020 DOI: 10.4085/425-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Quadriceps weakness is associated with disability and aberrant gait biomechanics following anterior cruciate ligament reconstruction (ACLR). Strength sufficiency cutoff scores, that normalize quadriceps strength to the mass of an individual, are capable of predicting individuals who will report better function following ACLR. Yet, it remains unknown if gait biomechanics differ between individuals who meet a strength sufficiency cutoff (strong) compared to those who do not (weak). OBJECTIVE Determine if vertical ground reaction force (vGRF), knee flexion angle (KFA) and internal knee extension moment (KEM) differ between strong and weak individuals with an ACLR throughout stance phase of walking. DESIGN Comparison-control. SETTING Laboratory Participants: Individuals who received unilateral ACLR ≥12 months prior to testing were dichotomized into strong (n=31) and weak groups (n=116). MAIN OUTCOME MEASURES Maximal isometric quadriceps strength was collected at 90° of knee flexion using an isokinetic dynamometer and normalized to body mass. Individuals demonstrating ≥3.0Nm/kg were considered strong. Three-dimensional gait biomechanics were collected at a self-selected walking speed. Biomechanical data were time-normalized to 100% of stance phase. vGRF were normalized to body weight (BW), and KEM was normalized to BW*height. Pairwise comparison functions were calculated for each outcome to identify between-group differences for each percentile of stance. RESULTS vGRF was significantly greater in weak participants for the first 22% of stance (average difference of 6.2% BW) and lesser in weak participants between 36-43% of stance (1.4% BW). KFA was significantly greater (i.e., more flexion) in strong participants between 6-62% of stance (2.3°) and lesser (i.e., less flexion) between 68-79% of stance (1.0°). KEM was significantly greater in strong participants between 7-62% of stance (0.007 BW*height). CONCLUSIONS ACLR individuals able to generate knee extension torque ≥3.0Nm/kg exhibit different biomechanical gait profiles compared to weak individuals, which may allow for better energy attenuation following ACLR.
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Affiliation(s)
- Brian Pietrosimone
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Hope C Davis-Wilson
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Matthew K Seeley
- 4Department of Exercise Sciences, Brigham Young University, Provo, Utah, United States
| | - Christopher Johnston
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Jeffrey T Spang
- 3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - R Alexander Creighton
- 3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Ganesh M Kamath
- 3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - J Troy Blackburn
- 1MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.,3Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
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26
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Boling MC, Dupell M, Pfeiffer SJ, Wallace K, Lalush D, Spang JT, Nissman D, Pietrosimone B. In vivo Compositional Changes in the Articular Cartilage of the Patellofemoral Joint following Anterior Cruciate Ligament Reconstruction. Arthritis Care Res (Hoboken) 2021; 74:1172-1178. [PMID: 33460530 PMCID: PMC8286261 DOI: 10.1002/acr.24561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/16/2020] [Accepted: 01/12/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare T1ρ relaxation times of the medial and lateral regions of the patella and femoral trochlea at 6 and 12 months post-anterior cruciate ligament reconstruction (ACLR) on the ACLR and contralateral limb. Greater T1ρ relaxation times are associated with a lesser proteoglycan density of articular cartilage. METHODS Twenty individuals (11 males, 9 females; age=22±3.9yrs; mass=76.11±13.48kg; height=178.32±12.32) who underwent a previous unilateral ACLR using a patellar tendon autograft. Magnetic resonance images from both limbs were acquired at 6 and 12 months post-ACLR. Voxel by voxel T1ρ relaxation times were calculated using a five-image sequence. The medial and lateral regions of the femoral trochlea and patellar articular cartilage were manually segmented on both limbs. Separate limb (ACLR and contralateral limb) by time (6-months and 12-months) ANOVAs were performed for each region (P<0.05). RESULTS For the medial patella and lateral trochlea, T1ρ relaxation times increased in both limbs between 6 and 12-months post-ACLR (medial patella: P=0.012; lateral trochlea: P=0.043). For the lateral patella, T1ρ relaxation times were significantly greater on the contralateral limb compared to the ACLR limb (P=0.001). The T1ρ relaxation times of the medial trochlea on the ACLR limb were significantly greater at 6 (P=0.005) and 12-months (P<0.001) compared to the contralateral limb. T1ρ relaxation times of the medial trochlea significantly increased from 6 to 12-months on the ACLR limb (P=0.003). CONCLUSION Changes in T1ρ relaxation times occur within the first 12 months following ACLR in specific regions of the patellofemoral joint on the ACLR and contralateral limb.
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Affiliation(s)
- Michelle C Boling
- University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
| | - Matthew Dupell
- University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
| | - Steven J Pfeiffer
- University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
| | - Kyle Wallace
- University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
| | - David Lalush
- University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
| | - Jeffrey T Spang
- University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
| | - Daniel Nissman
- University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224, USA
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27
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Davis-Wilson HC, Johnston CD, Young E, Song K, Wikstrom EA, Blackburn JT, Pietrosimone B. Effects of BMI on Walking Speed and Gait Biomechanics after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2021; 53:108-114. [PMID: 32826633 DOI: 10.1249/mss.0000000000002460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE History of an anterior cruciate ligament reconstruction (ACLR) and high body mass index (BMI) are strong independent risk factors for knee osteoarthritis (KOA) onset. The combination of these risk factors may further negatively affect joint loading and KOA risk. We sought to determine the combined influence of BMI and ACLR on walking speed and gait biomechanics that are hypothesized to influence KOA onset. METHODS Walking speed and gait biomechanics (peak vertical ground reaction force [vGRF], peak vGRF instantaneous loading rate [vGRF-LR], peak knee flexion angle, knee flexion excursion [KFE], peak internal knee extension moment [KEM], and peak internal knee abduction moment [KAM]) were collected in 196 individuals with unilateral ACLR and 106 uninjured controls. KFE was measured throughout stance phase, whereas all other gait biomechanics were analyzed during the first 50% of stance phase. A 2 × 2 ANOVA was performed to evaluate the interaction between BMI and ACLR and main effects for both BMI and ACLR on walking speed and gait biomechanics between four cohorts (high BMI ACLR, normal BMI ACLR, high BMI controls, and normal BMI controls). RESULTS History of an ACLR and high BMI influenced slower walking speed (F1,298 = 7.34, P = 0.007), and history of an ACLR and normal BMI influenced greater peak vGRF-LR (F1,298 = 6.56, P = 0.011). When evaluating main effects, individuals with an ACLR demonstrated lesser KFE (F1,298 = 7.85, P = 0.005) and lesser peak KEM (F1,298 = 6.31, P = 0.013), and individuals with high BMI demonstrated lesser peak KAM (F1,297 = 5.83, P = 0.016). CONCLUSION BMI and history of ACLR together influence walking speed and peak vGRF-LR. History of an ACLR influences KFE and peak KEM, whereas BMI influences peak KAM. BMI may need to be considered when designing interventions aimed at restoring gait biomechanics post-ACLR.
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Affiliation(s)
| | | | - Emma Young
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
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28
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Davis-Wilson HC, Pfeiffer SJ, Johnston CD, Seeley MK, Harkey MS, Blackburn JT, Fockler RP, Spang JT, Pietrosimone B. Bilateral Gait 6 and 12 Months Post-Anterior Cruciate Ligament Reconstruction Compared with Controls. Med Sci Sports Exerc 2020; 52:785-794. [PMID: 31809411 DOI: 10.1249/mss.0000000000002208] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare gait biomechanics throughout stance phase 6 and 12 months after unilateral anterior cruciate ligament reconstruction (ACLR) between ACLR and contralateral limbs and compared with controls. METHODS Vertical ground reaction force (vGRF), knee flexion angle (KFA), and internal knee extension moment (KEM) were collected bilaterally 6 and 12 months post-ACLR in 30 individuals (50% female, 22 ± 3 yr, body mass index = 23.8 ± 2.2 kg·m) and at a single time point in 30 matched uninjured controls (50% female, 22 ± 4 yr, body mass index = 23.6 ± 2.1 kg·m). Functional analyses of variance were used to evaluate the effects of limb (ACLR, contralateral, and control) and time (6 and 12 months) on biomechanical outcomes throughout stance. RESULTS Compared with the uninjured controls, the ACLR group demonstrated bilaterally lesser vGRF (ACLR, 9% body weight [BW]; contralateral, 4%BW) during early stance and greater vGRF during midstance (ACLR, 5%BW; contralateral, 4%BW) 6 months post-ACLR. Compared to the uninjured controls, the ACLR group demonstrated bilaterally lesser vGRF (ACLR, 10%BW; contralateral, 8%BW) during early stance and greater vGRF during midstance (ACLR, 5%BW; contralateral, 5%BW) 12 months post-ACLR. Compared with controls, the ACLR limb demonstrated lesser KFA during early stance at 6 (2.3°) and 12 months post-ACLR (2.0°), and the contralateral limb demonstrated lesser KFA during early stance at 12 months post-ACLR (2.8°). Compared with controls, the ACLR limb demonstrated lesser KEM during early stance at both 6 months (0.011BW × height) and 12 months (0.007BW × height) post-ACLR, and the contralateral limb demonstrated lesser KEM during early stance only at 12 months (0.006BW × height). CONCLUSIONS Walking biomechanics are altered bilaterally after ACLR. During the first 12 months post-ACLR, both the ACLR and contralateral limbs demonstrate biomechanical differences compared with control limbs. Differences between the contralateral and control limbs increase from 6 to 12 months post-ACLR.
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Affiliation(s)
| | | | | | - Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | | | | | - Ryan P Fockler
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey T Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
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Lisee CM, Montoye AHK, Lewallen NF, Hernandez M, Bell DR, Kuenze CM. Assessment of Free-Living Cadence Using ActiGraph Accelerometers Between Individuals With and Without Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:994-1000. [PMID: 32818959 DOI: 10.4085/1062-6050-425-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Anterior cruciate ligament reconstruction (ACLR) and gait speed are risk factors for developing knee osteoarthritis (OA). Measuring minute-level cadence during free-living activities may aid in identifying individuals at elevated risk of developing slow habitual gait speed and, in the long term, OA. OBJECTIVE To assess differences in peak 1-minute cadence and weekly time in different cadence intensities between individuals with and without ACLR. DESIGN Cross-sectional study. SETTING Short-term, free-living conditions. PATIENTS OR OTHER PARTICIPANTS A total of 57 participants with ACLR (34 women, 23 men; age = 20.9 ± 3.2 years, time since surgery = 28.7 ± 17.7 months) and 42 healthy control participants (22 women, 20 men; age = 20.7 ± 1.7 years). MAIN OUTCOME MEASURE(S) Each participant wore a physical activity monitor for 7 days. Data were collected at 30 Hz, processed in 60-second epochs, and included in the analyses if the activity monitor was worn for at least 10 hours per day over 4 days. Mean daily steps, peak 1-minute cadence, and weekly minutes spent at 60 to 79 (slow walking), 80 to 99 (medium walking), 100 to 119 (brisk walking), ≥100 (moderate- to vigorous-intensity ambulation), and ≥130 (vigorous-intensity ambulation) steps per minute were calculated. One-way analyses of covariance were conducted to determine differences between groups, controlling for height and activity-monitor wear time. RESULTS Those with ACLR took fewer daily steps (8422 ± 2663 versus 10 033 ± 3046 steps; P = .005) and spent fewer weekly minutes in moderate- to vigorous-intensity cadence (175.8 ± 116.5 minutes versus 218.5 ± 137.1 minutes; P = .048) than participants without ACLR. We observed no differences in minutes spent at slow (ACLR = 77.4 ± 40.5 minutes versus control = 83.9 ± 34.3 minutes; P = .88), medium (ACLR = 71.6 ± 40.2 minutes versus control = 82.9 ± 46.8 minutes; P = .56), brisk (ACLR = 115.3 ± 70.3 minutes versus control = 138.3 ± 73.3 minutes; P = .18), or vigorous-intensity (ACLR = 24.3 ± 36.5 minutes versus control = 38.1 ± 60.9 minutes; P = .10) cadences per week. CONCLUSIONS Participants with ACLR walked approximately 40 fewer minutes per week in moderate- to vigorous-intensity cadence than participants without ACLR. Increasing the time spent at cadence ≥100 steps per minute and overall volume of physical activity may be useful as interventional targets to help reduce the risk of early development of OA after ACLR.
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Affiliation(s)
- Caroline M Lisee
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | | | - Noble F Lewallen
- Department of Integrative Physiology and Health Science, Alma College, MI
| | | | - David R Bell
- Department of Kinesiology, University of Wisconsin-Madison
| | - Christopher M Kuenze
- Department of Integrative Physiology and Health Science, Alma College, MI.,Department of Kinesiology, Michigan State University, East Lansing
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30
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Losciale JM, Bullock G, Cromwell C, Ledbetter L, Pietrosimone L, Sell TC. Hop Testing Lacks Strong Association With Key Outcome Variables After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Am J Sports Med 2020; 48:511-522. [PMID: 31063403 DOI: 10.1177/0363546519838794] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Single-legged hop tests are commonly used assessments in return to sport (RTS) testing after anterior cruciate ligament reconstruction (ACLR). Although these tests are commonly used, their predictive validity has not yet been established. PURPOSE To determine the strength of association between hop testing and RTS, knee reinjury, subjective report of knee function, and posttraumatic knee osteoarthritis (PTOA) after primary ACLR. Secondarily, to determine whether hop testing is able to predict a favorable result on the same outcome variables. STUDY DESIGN Systematic review. METHODS A systematic, computer-assisted literature search was performed in PubMed/MEDLINE, CINAHL, EMBASE, SPORTDiscus, Cochrane Library, and ClinicalTrials.gov. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed when conducting and reporting this review. Primary outcome variables for this review were self-report of knee function, return to preinjury level of activity, presence of reinjury, and presence of PTOA. The Oxford Centre for Evidence-Based Medicine Levels of Evidence tool was used to assess the level of evidence for each included study. Quality assessment of each included study was performed through use of a modified Downs and Black scale. Available metrics were tabulated based on outcome variables. RESULTS Overall, 21 studies (4476 patients) met inclusion for this review. The majority of evidence (95.2%) was of moderate to high methodologic quality. The most commonly associated outcome measure was the International Knee Documentation Committee (IKDC) score, with Pearson correlation coefficients ranging from 0.20 to 0.60. The strength of association between the Knee injury and Osteoarthritis Outcome Score (KOOS) and hop testing ranged from -0.10 to 0.62 in 4 studies. In all, 10 studies examined the relationship between hop testing and RTS, with variable association statistics reported. No meaningful association was found between hop testing and knee reinjury in 2 studies. Worse preoperative hop testing was associated with PTOA in 1 study. CONCLUSION Hop testing appears to possess fair association to subjective report of knee function measured by the KOOS and IKDC and a patient's ability to RTS after ACLR. Insufficient evidence is available to determine the relationship between hop testing and PTOA and knee reinjury. Predictive validity cannot be established based on available literature.
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Affiliation(s)
| | - Garrett Bullock
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Oxford, UK
| | - Christina Cromwell
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina, USA
| | - Laura Pietrosimone
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Timothy C Sell
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, USA.,Michael W. Krzyzewski Human Performance Laboratory, Duke Sports Medicine, James R. Urbaniak Sports Sciences Institute, Duke University Health System, Duke University, Durham, North Carolina, USA
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31
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Open-Source Remote Gait Analysis: A Post-Surgery Patient Monitoring Application. Sci Rep 2019; 9:17966. [PMID: 31784691 PMCID: PMC6884492 DOI: 10.1038/s41598-019-54399-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/14/2019] [Indexed: 12/13/2022] Open
Abstract
Critical to digital medicine is the promise of improved patient monitoring to allow assessment and personalized intervention to occur in real-time. Wearable sensor-enabled observation of physiological data in free-living conditions is integral to this vision. However, few open-source algorithms have been developed for analyzing and interpreting these data which slows development and the realization of digital medicine. There is clear need for open-source tools that analyze free-living wearable sensor data and particularly for gait analysis, which provides important biomarkers in multiple clinical populations. We present an open-source analytical platform for automated free-living gait analysis and use it to investigate a novel, multi-domain (accelerometer and electromyography) asymmetry measure for quantifying rehabilitation progress in patients recovering from surgical reconstruction of the anterior cruciate ligament (ACL). Asymmetry indices extracted from 41,893 strides were more strongly correlated (r = −0.87, p < 0.01) with recovery time than standard step counts (r = 0.25, p = 0.52) and significantly differed between patients 2- and 17-weeks post-op (p < 0.01, effect size: 2.20–2.96), and controls (p < 0.01, effect size: 1.74–4.20). Results point toward future use of this open-source platform for capturing rehabilitation progress and, more broadly, for free-living gait analysis.
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32
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Harkey MS, Price LL, McAlindon TE, Davis JE, Stout AC, Lu B, Zhang M, Eaton CB, Barbe MF, Lo GH, Driban JB. Association Between Declining Walking Speed and Increasing Bone Marrow Lesion and Effusion Volume in Individuals with Accelerated Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2019; 71:259-270. [PMID: 29882630 DOI: 10.1002/acr.23613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/05/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether a decline in walking speed during the year prior to disease onset is associated with concurrent changes in cartilage, bone marrow lesions (BMLs), or effusion in adults who develop common knee osteoarthritis (OA), accelerated knee OA, or no knee OA. METHODS We identified 3 groups from the Osteoarthritis Initiative based on annual radiographs from baseline to 48 months: accelerated knee OA, common knee OA, and no knee OA. We used the cartilage damage index (CDI) to assess tibiofemoral cartilage damage and used a semiautomated program to measure BML and effusion volume. Walking speed was assessed as an individual's habitual walking speed over 20 meters. One-year change in walking speed and structural measures were calculated as index visit measurements minus measurements from the year prior visit. Logistic regression models were used to determine whether change in walking speed (exposure) was associated with change in each structural measure (outcome) for the overall group and then separately for the accelerated knee OA, common knee OA, and no knee OA groups. RESULTS Adults who slowed their walking speed were almost twice as likely to present with increased BML volume, with a significant association (odds ratio 3.04 [95% confidence interval (95% CI) 1.03-8.95]) among adults with accelerated knee OA. Adults with accelerated knee OA who slowed their walking speed were approximately 3.4 times (95% CI 1.10-10.49) more likely to present with increased effusion volume. Walking speed change was not significantly associated with CDI change. CONCLUSION A change in an easily assessable clinical examination (i.e., 20-meter walk test) was associated with concurrent worsening in BML and effusion volume in adults who developed accelerated knee OA.
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Affiliation(s)
| | - Lori Lyn Price
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| | | | | | | | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ming Zhang
- Tufts Medical Center, Boston, Massachusetts
| | - Charles B Eaton
- Alpert Medical School of Brown University, Pawtucket, Rhode Island
| | - Mary F Barbe
- Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Grace H Lo
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston Texas
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Shultz SJ, Schmitz RJ, Cameron KL, Ford KR, Grooms DR, Lepley LK, Myer GD, Pietrosimone B. Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14-16, 2019, Greensboro, NC. J Athl Train 2019; 54:970-984. [PMID: 31461312 PMCID: PMC6795093 DOI: 10.4085/1062-6050-54.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Kenneth L. Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | | | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, and Departments of Pediatrics and Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Pietrosimone B, Pfeiffer SJ, Harkey MS, Wallace K, Hunt C, Blackburn JT, Schmitz R, Lalush D, Nissman D, Spang JT. Quadriceps weakness associates with greater T1ρ relaxation time in the medial femoral articular cartilage 6 months following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:2632-2642. [PMID: 30560446 DOI: 10.1007/s00167-018-5290-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/09/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Quadriceps weakness following anterior cruciate ligament reconstruction (ACLR) is linked to decreased patient-reported function, altered lower extremity biomechanics and tibiofemoral joint space narrowing. It remains unknown if quadriceps weakness is associated with early deleterious changes to femoral cartilage composition that are suggestive of posttraumatic osteoarthritis development. The purpose of the cross-sectional study was to determine if quadriceps strength was associated with T1ρ relaxation times, a marker of proteoglycan density, of the articular cartilage in the medial and lateral femoral condyles 6 months following ACLR. It is hypothesized that individuals with weaker quadriceps would demonstrate lesser proteoglycan density. METHODS Twenty-seven individuals (15 females, 12 males) with a patellar tendon autograft ACLR underwent isometric quadriceps strength assessments in 90°of knee flexion during a 6-month follow-up exam. Magnetic resonance images (MRI) were collected bilaterally and voxel by voxel T1ρ relaxation times were calculated using a five-image sequence and a monoexponential equation. Following image registration, the articular cartilage for the weight-bearing surfaces of the medial and lateral femoral condyles (MFC and LFC) were manually segmented and further sub-sectioned into posterior, central and anterior regions of interest (ROI) based on the corresponding meniscal anatomy viewed in the sagittal plane. Univariate linear regression models were used to determine the association between quadriceps strength and T1ρ relaxation times in the entire weight-bearing MFC and LFC, as well as the ROI in each respective limb. RESULTS Lesser quadriceps strength was significantly associated with greater T1ρ relaxation times in the entire weight-bearing MFC (R2 = 0.14, P = 0.05) and the anterior-MFC ROI (R2 = 0.22, P = 0.02) of the ACLR limb. A post hoc analysis found lesser strength and greater T1ρ relaxation times were significantly associated in a subsection of participants (n = 18) without a concomitant medial tibiofemoral compartment meniscal or chondral injury in the entire weight-bearing MFC, as well as anterior-MFC and central-MFC ROI of the ACLR and uninjured limb. CONCLUSIONS The association between weaker quadriceps and greater T1ρ relaxation times in the MFC suggests deficits in lower extremity muscle strength may be related to cartilage composition as early as 6 months following ACLR. Maximizing quadriceps strength in the first 6 months following ACLR may be critical for promoting cartilage health early following ACLR. LEVEL OF EVIDENCE Prognostic level 1.
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Affiliation(s)
- Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA. .,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Fetzer Hall 209 South Road, Chapel Hill, NC, 27599, USA. .,Department of Orthopaedics, University of North Carolina at Chapel Hill, 102 Mason Farm Rd # 2, Chapel Hill, NC, 27599, USA.
| | - Steven J Pfeiffer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Fetzer Hall 209 South Road, Chapel Hill, NC, 27599, USA
| | - Matthew S Harkey
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, South Building, 3rd Floor, Boston, MA, 02111, USA
| | - Kyle Wallace
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA
| | - Christian Hunt
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Fetzer Hall 209 South Road, Chapel Hill, NC, 27599, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, 102 Mason Farm Rd # 2, Chapel Hill, NC, 27599, USA
| | - Randy Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Coleman Building, 1408 Walker Avenue, Greensboro, NC, 27402, USA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 333 S Columbia St, Raleigh, NC, 27514, USA
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Dr # 2, Chapel Hill, NC, 27599, USA
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, 102 Mason Farm Rd # 2, Chapel Hill, NC, 27599, USA
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Abstract
The classification and monitoring of individuals with early knee osteoarthritis (OA) are important considerations for the design and evaluation of therapeutic interventions and require the identification of appropriate outcome measures. Potential outcome domains to assess for early OA include patient-reported outcomes (such as pain, function and quality of life), features of clinical examination (such as joint line tenderness and crepitus), objective measures of physical function, levels of physical activity, features of imaging modalities (such as of magnetic resonance imaging) and biochemical markers in body fluid. Patient characteristics such as adiposity and biomechanics of the knee could also have relevance to the assessment of early OA. Importantly, research is needed to enable the selection of outcome measures that are feasible, reliable and validated in individuals at risk of knee OA or with early knee OA. In this Perspectives article, potential outcome measures for early symptomatic knee OA are discussed, including those measures that could be of use in clinical practice and/or the research setting.
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36
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Pietrosimone B, Seeley MK, Johnston C, Pfeiffer SJ, Spang JT, Blackburn JT. Walking Ground Reaction Force Post-ACL Reconstruction: Analysis of Time and Symptoms. Med Sci Sports Exerc 2019; 51:246-254. [PMID: 30157111 DOI: 10.1249/mss.0000000000001776] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The association between lower-extremity loading and clinically relevant knee symptoms at different time points after anterior cruciate ligament reconstruction (ACLR) is unclear. Vertical ground reaction force (vGRF) from walking was compared between individuals with and without clinically relevant knee symptoms in three cohorts: <12 months post-ACLR, 12-24 months post-ACLR, and >24 months post-ACLR. METHODS One hundred twenty-eight individuals with unilateral ACLR were classified as symptomatic or asymptomatic, based on previously defined cutoff values for the Knee Osteoarthritis and Injury Outcome Score (<12 months post-ACLR [symptomatic n = 28, asymptomatic n = 24]; 12-24 months post-ACLR [symptomatic n = 15, asymptomatic n = 15], and >24 months post-ACLR [symptomatic, n = 13; asymptomatic, n = 33]). Vertical ground reaction force exerted on the ACLR limb was collected during walking gait, and functional analyses of variance were used to evaluate the effects of symptoms and time post-ACLR on vGRF throughout stance phase (α = 0.05). RESULTS Symptomatic individuals, <12 months post-ACLR, demonstrated less vGRF during both vGRF peaks (i.e., weight acceptance and propulsion) and greater vGRF during midstance, compared to asymptomatic individuals. Vertical ground reaction force characteristics were not different between symptomatic and asymptomatic individuals for most of stance in individuals between 12 and 24 months post-ACLR. Symptomatic individuals who were >24 months post-ACLR, exhibited greater vGRF during both peaks, but lesser vGRF during midstance, compared to asymptomatic individuals. CONCLUSION Relative to asymptomatic individuals, symptomatic individuals are more likely to underload the ACLR limb early after ACLR (i.e., <12 months) during both vGRF peaks, but overload the ACLR limb, during both vGRF peaks, at later time points (i.e., >24 months). We propose these differences in lower-extremity loading during walking might have implications for long-term knee health, and should be considered when designing therapeutic interventions for individuals with an ACLR.
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Affiliation(s)
- Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - Christopher Johnston
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Steven J Pfeiffer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffery T Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Atkinson HF, Birmingham TB, Moyer RF, Yacoub D, Kanko LE, Bryant DM, Thiessen JD, Thompson RT. MRI T2 and T1ρ relaxation in patients at risk for knee osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:182. [PMID: 31039785 PMCID: PMC6492327 DOI: 10.1186/s12891-019-2547-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/28/2019] [Indexed: 12/19/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) T2 and T1ρ relaxation are increasingly being proposed as imaging biomarkers potentially capable of detecting biochemical changes in articular cartilage before structural changes are evident. We aimed to: 1) summarize MRI methods of published studies investigating T2 and T1ρ relaxation time in participants at risk for but without radiographic knee OA; and 2) compare T2 and T1ρ relaxation between participants at-risk for knee OA and healthy controls. Methods We conducted a systematic review of studies reporting T2 and T1ρ relaxation data that included both participants at risk for knee OA and healthy controls. Participant characteristics, MRI methodology, and T1ρ and T2 relaxation data were extracted. Standardized mean differences (SMDs) were calculated within each study. Pooled effect sizes were then calculated for six commonly segmented knee compartments. Results 55 articles met eligibility criteria. There was considerable variability between scanners, coils, software, scanning protocols, pulse sequences, and post-processing. Moderate risk of bias due to lack of blinding was common. Pooled effect sizes indicated participants at risk for knee OA had lengthened T2 relaxation time in all compartments (SMDs from 0.33 to 0.74; p < 0.01) and lengthened T1ρ relaxation time in the femoral compartments (SMD from 0.35 to 0.40; p < 0.001). Conclusions T2 and T1ρ relaxation distinguish participants at risk for knee OA from healthy controls. Greater standardization of MRI methods is both warranted and required for progress towards biomarker validation. Electronic supplementary material The online version of this article (10.1186/s12891-019-2547-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hayden F Atkinson
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. .,Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada. .,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada. .,Musculoskeletal Rehabilitation, Elborn College, University of Western Ontario, London, Ontario, N6G 1H1, Canada.
| | - Rebecca F Moyer
- Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Yacoub
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Lauren E Kanko
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Dianne M Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Jonathan D Thiessen
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
| | - R Terry Thompson
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
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Wellsandt E, Axe MJ, Snyder-Mackler L. Poor Performance on Single-Legged Hop Tests Associated With Development of Posttraumatic Knee Osteoarthritis After Anterior Cruciate Ligament Injury. Orthop J Sports Med 2018; 6:2325967118810775. [PMID: 30505875 PMCID: PMC6259076 DOI: 10.1177/2325967118810775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The risk for knee osteoarthritis (OA) is substantially increased after anterior cruciate ligament (ACL) injury. Tools are needed to identify characteristics of patients after ACL injury who are most at risk for posttraumatic OA. Purpose To determine whether clinical measures of knee function after ACL injury are associated with the development of radiographic knee OA 5 years after injury. Study Design Cohort study; Level of evidence, 2. Methods A total of 76 athletes (mean age, 28.7 ± 11.3 years; 35.5% female) with ACL injury were included. Clinical measures of knee function (quadriceps strength, single-legged hop tests, patient-reported outcomes) were assessed after initial impairment resolution (baseline), after 10 additional preoperative or nonoperative rehabilitation sessions (posttraining), and 6 months after ACL reconstruction or nonoperative rehabilitation. Posterior-anterior bent-knee radiographs were completed at 5 years and graded in the medial compartment by use of the Kellgren-Lawrence system. Logistic regression models were used at each of the 3 time points to determine the ability of clinical measures to predict knee OA at 5 years. Results Of the 76 patients, 9 (11.8%) had knee OA at 5 years. After adjustment for ACL reconstruction compared with nonoperative management, ipsilateral second ACL injuries, and the presence of contralateral knee OA, clinical measures of knee function at posttraining (6-m timed hop, Knee Outcomes Survey-Activities of Daily Living Scale) explained the most variance in posttraumatic OA development at 5 years (P = .006; ▵R 2, 27.5%). The 6-m hop test was the only significant posttraining predictor of OA at 5 years (P = .023; patients without OA, 96.6% ± 5.4%; patients with OA, 84.9% ± 14.1%). Similar significant group differences in hop scores and subjective knee function were present at baseline. No significant group differences in clinical measures existed at 6 months after ACL reconstruction or nonoperative rehabilitation. Conclusion Poor performance in single-legged hop tests early after ACL injury but not after reconstruction or nonoperative rehabilitation is associated with the development of radiographic posttraumatic knee OA 5 years after injury. Clinical measures of knee function were most predictive of subsequent OA development following an extended period of rehabilitation early after ACL injury.
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Affiliation(s)
- Elizabeth Wellsandt
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.,Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Michael J Axe
- First State Orthopaedics, Newark, Delaware, USA.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Activities of daily living influence tibial cartilage T1rho relaxation times. J Biomech 2018; 82:228-233. [PMID: 30455059 DOI: 10.1016/j.jbiomech.2018.10.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/06/2018] [Accepted: 10/23/2018] [Indexed: 12/20/2022]
Abstract
Quantitative T1rho magnetic resonance imaging (MRI) can potentially help identify early-stage osteoarthritis (OA) by non-invasively assessing proteoglycan concentration in articular cartilage. T1rho relaxation times are negatively correlated with proteoglycan concentration. Cartilage compresses in response to load, resulting in water exudation, a relative increase in proteoglycan concentration, and a decrease in the corresponding T1rho relaxation times. To date, there is limited information on changes in cartilage composition resulting from daily activity. Therefore, the objective of this study was to quantify changes in tibial cartilage T1rho relaxation times in healthy human subjects following activities of daily living. It was hypothesized that water exudation throughout the day would lead to decreased T1rho relaxation times. Subjects underwent MR imaging in the morning and afternoon on the same day and were free to go about their normal activities between scans. Our findings confirmed the hypothesis that tibial cartilage T1rho relaxation times significantly decreased (by 7%) over the course of the day with loading, which is indicative of a relative increase in proteoglycan concentration. Additionally, baseline T1rho values varied with position within the cartilage, supporting a need for site-specific measurements of T1rho relaxation times. Understanding how loading alters the proteoglycan concentration in healthy cartilage may hold clinical significance pertaining to cartilage homeostasis and potentially help to elucidate a mechanism for OA development. These results also indicate that future studies using T1rho relaxation times as an indicator of cartilage health should control the loading history prior to image acquisition to ensure the appropriate interpretation of the data.
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Luc-Harkey BA, Franz JR, Losina E, Pietrosimone B. Association between kinesiophobia and walking gait characteristics in physically active individuals with anterior cruciate ligament reconstruction. Gait Posture 2018; 64:220-225. [PMID: 29933185 PMCID: PMC6355249 DOI: 10.1016/j.gaitpost.2018.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/24/2018] [Accepted: 06/15/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with anterior cruciate ligament reconstruction (ACLR) demonstrate persistent alterations in walking gait characteristics that contribute to poor long-term outcomes. Higher kinesiophobia, or fear of movement/re-injury, may result in the avoidance of movements that increase loading on the ACLR limb. RESEARCH QUESTION Determine the association between kinesiophobia and walking gait characteristics in physically active individuals with ACLR. METHODS We enrolled thirty participants with a history of unilateral ACLR (49.35 ± 27.29 months following ACLR) into this cross-sectional study. We used the Tampa Scale for Kinesiophobia (TSK-11) to measure kinesiophobia. We collected walking gait characteristics during a 60-s walking trial, which included gait speed, peak vertical ground reaction force (vGRF), instantaneous vGRF loading rate, peak internal knee extension moment (KEM), and knee flexion excursion. We calculated lower extremity kinetic and kinematic measures on the ACLR limb, and limb symmetry indices between ACLR and contralateral limbs (LSI= [ACLR/contralateral]*100). We used linear regression models to determine the association between TSK-11 score and each walking gait characteristic. We determined the change in R2 (ΔR2) when adding TSK-11 scores into the linear regression model after accounting for demographic covariates (sex, Tegner activity score, graft type, time since reconstruction, history of concomitant meniscal procedure). RESULTS We did not find a significant association between kinesiophobia and self-selected gait speed (ΔR2 0.038, P = 0.319). Kinesiophobia demonstrated weak, non-significant associations with kinetic and kinematic outcomes on the ACLR limb and all LSI outcomes (ΔR2 range = 0.001-0.098). SIGNIFICANCE These data do not support that kinesiophobia is a critical factor contributing to walking gait characteristics in physically active individuals with ACLR.
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Affiliation(s)
- Brittney A. Luc-Harkey
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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