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Sasaki R, Kaneda K, Yamada Y, Niki Y, Nakamura M, Nagura T, Jinzaki M. Extra-articular location of the three-dimensional mechanical axis in advanced knee osteoarthritis: an upright computed tomography study. Jpn J Radiol 2023; 41:1405-1413. [PMID: 37440161 DOI: 10.1007/s11604-023-01468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE One of the most widely used benchmarks of lower-limb alignment is the mechanical axis (MA), which passes through the centers of the femoral head and the ankle in the weight-bearing position. However, where the MA passes through three-dimensionally (3D) is unclear. We investigated the MA in 3D (3D-MA) in knee osteoarthritis (OA) using upright computed tomography (CT). MATERIALS AND METHODS This study included 66 varus OA knees from 38 patients [age 70.0 (64.8-77.0) years; median (interquartile range)]. The 3D-MA was determined using upright CT data and compared among Kellgren-Lawrence (KL) grades. Further, correlations between the 3D-MA and other parameters were evaluated. RESULTS The 3D-MA was located at 5.3 (1.3-14.4)% medially and 7.1 (0.7-15.3)% posteriorly on the tibial plateau in KL-1, and was translated medioposteriorly with increased KL grade. The 3D-MA in KL-3 [30.6 (22.6-42.6)% medially and 50.9 (45.8-80.2)% posteriorly] and KL-4 [56.7 (48.5-62.9)% medially and 92.3 (50.2-127.1)% posteriorly] was located extra-articularly. The mediolateral position of the 3D-MA correlated with the femorotibial angle [correlation coefficient (CC) = - 0.85, p < 0.001], and the anteroposterior position of the 3D-MA correlated with the knee flexion angle (CC = - 0.93, p < 0.001). CONCLUSION Our analysis demonstrated that the 3D-MA in low-grade OA knees passes slightly medial and posterior to the knee center, and the 3D-MA is translated medioposteriorly with the progression of knee OA. Further, the 3D-MA is translated medially with varus progression and posteriorly with the progression of knee flexion contracture.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kazuya Kaneda
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Winnock de Grave P, Van Criekinge T, Luyckx T, Moreels R, Gunst P, Claeys K. Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments. Knee Surg Sports Traumatol Arthrosc 2023; 31:4692-4704. [PMID: 37311955 DOI: 10.1007/s00167-023-07464-2] [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: 01/07/2023] [Accepted: 05/20/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Patient-specific alignment in total knee arthroplasty (TKA) has shown promising patient-reported outcome measures; however, the clinical and biomechanical effects of restoring the native knee anatomy remain debated. The purpose of this study was to compare the gait pattern between a mechanically aligned TKA cohort (adjusted mechanical alignment-aMA) and a patient-specific alignment TKA cohort (inverse kinematic alignment-iKA). METHODS At two years postoperatively, the aMA and iKA groups, each with 15 patients, were analyzed in a retrospective case-control study. All patients underwent TKA with robotic assistance (Mako, Stryker) through an identical perioperative protocol. The patients' demographics were identical. The control group comprised 15 healthy participants matched for age and gender. Gait analysis was performed with a 3D motion capture system (VICON). Data collection was conducted by a blinded investigator. The primary outcomes were knee flexion during walking, knee adduction moment during walking and spatiotemporal parameters (STPs). The secondary outcomes were the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS). RESULTS During walking, the maximum knee flexion did not differ between the iKA group (53.0°) and the control group (55.1°), whereas the aMA group showed lower amplitudes of sagittal motion (47.4°). In addition, the native limb alignment in the iKA group was better restored, and although more in varus, the knee adduction moments in the iKA group were not increased (225 N mm/kg) compared to aMA group (276 N mm/kg). No significant differences in STPs were observed between patients receiving iKA and healthy controls. Six of 7 STPs differed significantly between patients receiving aMA and healthy controls. The OKS was significantly better in patients receiving iKA than aMA: 45.4 vs. 40.9; p = 0.05. The FJS was significantly better in patients receiving iKA than aMA: 84.8 vs. 55.5; p = 0.002. CONCLUSION At two years postoperatively, the gait pattern showed greater resemblance to that in healthy controls in patients receiving iKA rather than aMA. The restoration of the native coronal limb alignment does not lead to increased knee adduction moments due to the restoration of the native tibial joint line obliquity. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Philip Winnock de Grave
- Department Rehabilitation Sciences, KU Leuven, Brugge, Belgium.
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium.
| | | | - Thomas Luyckx
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Leuven, Louvain, Belgium
| | - Robin Moreels
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Gent, Ghent, Belgium
| | - Paul Gunst
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
| | - Kurt Claeys
- Department Rehabilitation Sciences, KU Leuven, Brugge, Belgium
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LaMarca AL, Krenn MJ, Kelso-Trass MA, MacDonald KC, Demeo CC, Bazarek SF, Brown JM. Selective Tibial Neurotomy Outcomes for Spastic Equinovarus Foot: Patient Expectations and Functional Assessment. Neurosurgery 2023; 93:1026-1035. [PMID: 37199494 DOI: 10.1227/neu.0000000000002530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/27/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Spastic equinovarus foot (SEF) is a common dysfunctional foot posture after stroke that impairs balance and mobility. Selective tibial neurotomy (STN) is a simple but underutilized surgical option that can effectively address critical aspects of SEF and thereby provide enduring quality of life gains. There are few studies that examine both functional outcomes and patient satisfaction with this treatment option. OBJECTIVE To elucidate the patient goals that motivated their decision to undergo the procedure and compare subjective and objective changes in balance and functional mobility as a consequence of surgery. METHODS Thirteen patients with problematic SEF who had previously failed conservative measures were treated with STN. Preoperative and postoperative (on average 6 months) assessments evaluated gait quality and functional mobility. In addition, a custom survey was conducted to investigate patient perspectives on STN intervention. RESULTS The survey showed that participants who opted for STN were dissatisfied with their previous spasticity management. The most common preoperative expectation for STN treatment was to improve walking, followed by improving balance, brace comfort, pain, and tone. Postoperatively, participants rated the improvement in their expectations and were, on average, 71 on a 100-point scale, indicating high satisfaction. The gait quality, assessed with the Gait Intervention and Assessment Tool, improved significantly between preoperative and postoperative assessment (M = -4.1, P = .01) with a higher average difference in stance of -3.3 than in swing -0.5. Improvement in both gait endurance (M = 36 m, P = .01) and self-selected gait speed (M = .12 m/s, P = .03) was statistically significant. Finally, static balance (M = 5.0, P = .03) and dynamic balance (M = 3.5, P = .02) were also significantly improved. CONCLUSION STN improved gait quality and functional mobility and was associated with high satisfaction in patients with SEF.
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Affiliation(s)
- Amber L LaMarca
- Department of Neurosurgery, The Paralysis Center, Massachusetts General Hospital, Boston , Massachusetts , USA
- Rehabilitation Sciences, MGH Institute of Health Professions, Boston , Massachusetts , USA
- Physical Therapy Department, Spaulding Rehabilitation Hospital, Boston , Massachusetts , USA
| | - Matthias J Krenn
- Department of Neurosurgery, The Paralysis Center, Massachusetts General Hospital, Boston , Massachusetts , USA
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson , Mississippi , USA
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson , Mississippi , USA
| | - Molly A Kelso-Trass
- Physical Therapy Department, Wentworth-Douglass Hospital, Dover , New Hampshire , USA
| | - Kathryn C MacDonald
- Rehabilitation Sciences, MGH Institute of Health Professions, Boston , Massachusetts , USA
- Physical Therapy Department, Spaulding Rehabilitation Hospital, Boston , Massachusetts , USA
- Physical Therapy Department, Wentworth-Douglass Hospital, Dover , New Hampshire , USA
| | - Cristina C Demeo
- Department of Neurosurgery, The Paralysis Center, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Stanley F Bazarek
- Department of Neurosurgery, The Paralysis Center, Massachusetts General Hospital, Boston , Massachusetts , USA
- Harvard Medical School, Cambridge , Massachusetts , USA
- Brigham and Women's Hospital, Boston , Massachusetts , USA
| | - Justin M Brown
- Department of Neurosurgery, The Paralysis Center, Massachusetts General Hospital, Boston , Massachusetts , USA
- Rehabilitation Sciences, MGH Institute of Health Professions, Boston , Massachusetts , USA
- Harvard Medical School, Cambridge , Massachusetts , USA
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van Drongelen S, Holder J, Stief F. Lower limb joint loading in patients with unilateral hip osteoarthritis during bipedal stance and the effect of total hip replacement. Front Bioeng Biotechnol 2023; 11:1190712. [PMID: 37397970 PMCID: PMC10313106 DOI: 10.3389/fbioe.2023.1190712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Abstract
Osteoarthritis of the hip is a common condition that affects older adults. Total hip replacement is the end-stage treatment to relief pain and improve joint function. Little is known about the mechanical load distribution during the activity of bipedal stance, which is an important daily activity for older adults who need to rest more frequently. This study investigated the distribution of the hip and knee joint moments during bipedal stance in patients with unilateral hip osteoarthritis and how the distribution changed 1 year after total hip replacement. Kinematic and kinetic data from bipedal stance were recorded. External hip and knee adduction moments were calculated and load distribution over both limbs was calculated using the symmetry angle. Preoperatively, the non-affected limb carried 10% more body weight than the affected limb when standing on two legs. Moreover, the mean external hip and knee adduction moments of the non-affected limb were increased compared to the affected limb. At follow-up no significant differences were observed between the patients' limbs. Preoperative and postoperative changes in hip adduction moment were mainly explained by the combination of the vertical ground reaction force and the hip adduction angle. Stance width also explained changes in the hip and knee adduction moments of the affected leg. Furthermore, as with walking, bipedal standing also showed an asymmetric mechanical load distribution in patients with unilateral hip osteoarthritis. Overall, the findings suggest the need for preventive therapy concepts that focus not only on walking but also on optimizing stance towards a balanced load distribution of both legs.
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Affiliation(s)
- S. van Drongelen
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - J. Holder
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - F. Stief
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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Charlton JM, Xia H, Shull PB, Eng JJ, Li LC, Hunt MA. Multi-day monitoring of foot progression angles during unsupervised, real-world walking in people with and without knee osteoarthritis. Clin Biomech (Bristol, Avon) 2023; 105:105957. [PMID: 37084548 DOI: 10.1016/j.clinbiomech.2023.105957] [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: 06/21/2022] [Revised: 03/03/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Foot progression angle is a biomechanical target in gait modification interventions for knee osteoarthritis. To date, it has only been evaluated within laboratory settings. METHODS Adults with symptomatic knee osteoarthritis (n = 30) and healthy adults (n = 15) completed two conditions: 1) treadmill walking in the laboratory (5-min), and 2) real-world walking outside of the laboratory (1-week). Foot progression angle was estimated via shoe-embedded inertial sensing. We calculated the foot progression angle magnitude (median) and variability (interquartile range, coefficient of variation), and used mixed models to compare outcomes between the conditions, participant groups, and disease severities. Reliability was quantified by the intraclass correlation coefficient, standardized error of the measurement, and the minimum detectable change. FINDINGS Foot progression angle magnitude did not differ between groups or conditions but variability significantly higher in real-world walking (P < 0.001). Structural and symptomatic severity were unrelated to FPA in either walking condition, except for real-world coefficient of variation which was higher for moderate-severe structural osteoarthritis compared to the treadmill for those with mild structural severity (P < 0.034). All real-world outcomes showed excellent reliability including intraclass correlation coefficients above 0.95. The participants recorded a mean (standard deviation) of 298 (33) and 10,447 (5232) steps in the laboratory and real-world walking conditions, respectively. INTERPRETATION This study provides the first characterization of foot progression angles during real-world walking in people with and without symptomatic knee osteoarthritis. These results indicate that foot progression angles can be feasibly and reliably measured in unsupervised real-world walking conditions.
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Affiliation(s)
- Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada.
| | - Haisheng Xia
- Department of Automation, University of Science and Technology of China, Hefei, China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, China
| | - Peter B Shull
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada
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Iwasaki K, Ohkoshi Y, Hosokawa Y, Chida S, Ukishiro K, Kawakami K, Suzuki S, Maeda T, Onodera T, Kondo E, Iwasaki N. Higher Association of Pelvis-Knee-Ankle Angle Compared With Hip-Knee-Ankle Angle With Knee Adduction Moment and Patient-Reported Outcomes After High Tibial Osteotomy. Am J Sports Med 2023; 51:977-984. [PMID: 36786244 DOI: 10.1177/03635465221150513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) reduces the load distribution of the medial compartment by modifying leg alignment. Knee adduction moment (KAM), a surrogate measure of dynamic loading in the knee joint, decreases after HTO. However, leg alignment does not fully account for KAM. PURPOSE To assess the association between the pelvis-knee-ankle angle (PKA), a novel radiographic parameter reflecting leg alignment and pelvic width, and KAM and patient-reported outcomes after HTO. STUDY DESIGN Cross sectional study; Level of evidence, 3. METHODS PKA is the angle between the line from the midpoint of the anterior superior iliac spine to the center of the knee joint and the mechanical axis of the tibia. In this study, 54 patients with medial compartment knee osteoarthritis and varus alignment who underwent 3-dimensional gait analysis preoperatively and 2 years after medial open-wedge HTO were evaluated. The primary outcomes were hip-knee-ankle angle (HKA), PKA, KAM peaks, and Knee Society Score (KSS). Single and multivariate regression analysis including PKA and KAM peaks as well as other demographic and radiologic factors was performed. RESULTS HKA was weakly correlated with the first peak KAM (r = -0.33; P < .01) and second peak KAM (r = -0.27; P = .01) before HTO, but not significantly correlated after HTO. PKA was moderately correlated with the first peak KAM (r = 0.45; P < .01) and second peak KAM (r = 0.45; P < .01) before HTO and with the first peak KAM (r = 0.51; P < .01) and second peak KAM (r = 0.56; P < .01) after HTO. Multivariate linear regression revealed that postoperative PKA was still associated with the KAM peaks after HTO. Only postoperative PKA was correlated with the KSS satisfaction subscale (r = -0.30; P = .03). CONCLUSION Although HKA was not correlated with KAM peaks after HTO, PKA was significantly correlated with KAM peaks in patients with varus knee osteoarthritis after HTO.
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Affiliation(s)
- Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Yoshiaki Hosokawa
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shuya Chida
- Department of Rehabilitation, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Kengo Ukishiro
- Department of Rehabilitation, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Kensaku Kawakami
- Department of Production Systems Engineering, National Institute of Technology, Hakodate College, Hakodate, Japan
| | - Sho'ji Suzuki
- Department of Complex and Intelligent Systems, Future University Hakodate, Hakodate, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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da Rosa BN, Camargo EN, Candotti CT. Radiographic Measures for the Assessment of Frontal and Sagittal Knee Alignments and the Associated Normality Values: A Meta-Analysis. J Chiropr Med 2023; 22:72-84. [PMID: 36844994 PMCID: PMC9947998 DOI: 10.1016/j.jcm.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The purpose of this literature review was to identify knee alignment assessment methods using radiography in the sagittal and frontal planes and to identify normality values for classifying knee alignment using these methods. Methods A systematic review with a meta-analysis was conducted. The eligibility criterion was studies that performed radiographic examinations to assess the knee alignment of adults without a history of hip or knee prosthesis surgery. The methodological qualities of the included studies were assessed using the QUADAS-2 tool. A meta-analysis was performed to measure the normality values of knee alignment in the frontal plane. Results The hip-knee-ankle (HKA) angle was the measure most frequently used to assess knee alignment. Only a meta-analysis of HKA normality values was possible. Thereby, we found normality values of the HKA angle for the overall population, men, and women. The normality values of knee alignment for healthy adults that were found in this study were as follows: overall sample (male and female patients) HKA angle = -0.2° (-2.8° to 2.41°), male patient HKA angle = 0.77° (-2.91° to 7.94°), and female patient HKA angle = -0.67° (-5.32° to 3.98°). Conclusion This review identified the most common methods and expected values for knee alignment assessment methods using radiography in the sagittal and frontal planes. We suggest HKA angles ranging from -3° to 3° as the cutoff for classifying knee alignment in the frontal plane, in accordance with the normality limits found in the meta-analysis.
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Affiliation(s)
- Bruna Nichele da Rosa
- School of Physical Education, Physiotherapy and Dance, Federal University of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Nunes Camargo
- School of Physical Education, Physiotherapy and Dance, Federal University of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia Tarragô Candotti
- School of Physical Education, Physiotherapy and Dance, Federal University of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Haba T, Iwatsuki H. Effect of foot progression angle alteration on medial-lateral center of pressure position during single-leg standing. J Phys Ther Sci 2023; 35:237-241. [PMID: 36866021 PMCID: PMC9974318 DOI: 10.1589/jpts.35.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/14/2022] [Indexed: 03/04/2023] Open
Abstract
[Purpose] This study aimed to investigate the effect of altering the foot progression angle (FPA) on the center of pressure (COP) position during single-leg standing. [Participants and Methods] Fifteen healthy adult males participated. The participants performed single-leg standing on the left leg in three different FPA conditions, namely toe-in, neutral, and toe-out, in which the FPA was set to 0°, 10°, and 20°, respectively. The COP positions and pelvis angles were measured using a 3D motion analysis system, and each measurement value among the three conditions was compared. [Results] The medial-lateral COP position differed among conditions in the coordinate system based on the laboratory condition but did not differ in the coordinate system based on the longitudinal axis of the foot segment. Moreover, no changes were observed in pelvis angles that would affect COP position. [Conclusion] Altering the FPA does not change the medial-lateral position of the COP during single-leg standing. Here we show that COP displacement based on the laboratory coordinate system is involved in the mechanism-linking alteration of FPA and changes in knee adduction moment.
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Affiliation(s)
- Toshihiro Haba
- Department of Physical Therapy, Aomori University of Health
and Welfare: 58-1 Hamadate Mase, Aomori-shi, Aomori 030-8505, Japan,Corresponding author. Toshihiro Haba (E-mail: )
| | - Hiroyasu Iwatsuki
- Department of Physical Therapy, Aomori University of Health
and Welfare: 58-1 Hamadate Mase, Aomori-shi, Aomori 030-8505, Japan
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Soon J, Lee DW, Choi GR, Kim KJ, Bahn S. Identification of Gait and Personal Factors Associated with Shoe Abrasion Patterns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12558. [PMID: 36231853 PMCID: PMC9566539 DOI: 10.3390/ijerph191912558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Shoe abrasion data can be used as major evidence to distinguish suspects, but their actual application in the field is limited due to a lack of associated empirical studies. This study analyzed the significant factors of shoe abrasion by identifying significant differences between gait, personal characteristics, and shoe abrasion patterns. Experiments were conducted on 291 Korean subjects, and data were analyzed using cluster analysis and cross-tabulation analysis with data collected to identify significant factors. As a result, overall, medial abrasion was very rare and would be useful for human identification. The greater the gait characteristics of the knee valgus, the greater the inner abrasion characteristics shown. In the case of knee varus, outer abrasion characteristics occurred more often. Additionally, in the double support phase while walking, the greater the tilt to the left or right, the more the outer parts of the shoes tend to wear out. Men have the characteristic of wearing out the outer side of their shoes more compared to women. Regarding human body dimensions, there were significant differences between the abrasion patterns of the shoes with some body dimensions. The results of this study could be used effectively in the identification of suspects using shoe abrasion patterns.
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Affiliation(s)
- Jiman Soon
- Industrial and Management Systems Engineering, College of Engineering, Kyung Hee University, Yongin 17104, Korea
| | - Dae Wook Lee
- Department of Biomedical Engineering, College of Electronics & Information, Kyung Hee University, Yongin 17104, Korea
| | - Gyu Ri Choi
- Industrial and Management Systems Engineering, College of Engineering, Kyung Hee University, Yongin 17104, Korea
| | - Ki Joon Kim
- Industrial and Management Systems Engineering, College of Engineering, Kyung Hee University, Yongin 17104, Korea
| | - Sangwoo Bahn
- Industrial and Management Systems Engineering, College of Engineering, Kyung Hee University, Yongin 17104, Korea
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Bayram E, Şener N, Korkmaz M, Yıldırım C, Aydın M, Yurdaışık I, Çetinus ME. Internal tibial torsion is associated with medial meniscus posterior horn tears. Knee Surg Sports Traumatol Arthrosc 2022; 31:2251-2256. [PMID: 36153779 DOI: 10.1007/s00167-022-07173-2] [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: 06/01/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Risk factors for meniscal tears play a decisive role in deciding on treatment and rehabilitation. The purpose of this study was to investigate the effect of tibial rotation on medial meniscus posterior horn tears (MMPHTs). METHODS This study is a retrospective case-control study. Fifty patients with meniscal tears and 57 knees with intact meniscus were compared. Tibial rotation, femoral version, tibial slope and knee varus were measured in each participant. Knee osteoarthritis was classified according to the Kellgren-Lawrence classification. Demographic characteristics were noted. RESULTS There were significant differences in the mean tibial torsion angles and mean mechanical axes between the groups. The mean tibial rotation and mean mechanical axis were 26.3° ± 6.7 and 3.7° ± 2.7 in the MMPHT group and 30.3° ± 8.4 and 2.05° ± 2.7 in the control group, respectively (p = 0.008, p = 0.002). CONCLUSION The current retrospective study has shown that tibial rotation is markedly reduced in patients with MMPHTs. Although the actual mechanism is not clear, the internal torsion of the tibia causes a decrease in the foot progression angle and increases the knee adduction moment, which in turn increases the medial tibial contact pressure. Internal torsion of the tibia, such as knee varus, may play a role in the aetiology of MMPHTs by this way. Whilst there was a significant difference in the mean varus and tibial torsion between the groups, there was no significant difference in the mean femoral version or tibial slope. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Erhan Bayram
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey.
| | - Nurullah Şener
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey
| | - Musa Korkmaz
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey
| | - Cem Yıldırım
- Department of Orthopedics and Traumatology, Çam Ve Sakura Training and Research Hospital, Istanbul, Turkey
| | - Mahmud Aydın
- Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Işıl Yurdaışık
- Department of Radiology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Istanbul, Turkey
| | - Mahmut Ercan Çetinus
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey
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11
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Mancini J, Oliff Z, Abu-Sbaih R, Simone J, LaRosa A, Mody S, Li TS, Leder A. Abnormal Foot Progression Angle Kinematics in Cervical Dystonia Improved After Osteopathic Manipulative Medicine: A Prospective Case Series. Cureus 2022; 14:e26459. [PMID: 35915700 PMCID: PMC9338781 DOI: 10.7759/cureus.26459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Cervical dystonia (CD), a rare disorder, is the most common form of dystonia, a movement disorder. Impairments in activities of daily living and quality of life may result from chronic pain, perceived stigma, difficulty walking, and/or lack of control over movements. Studies of treatments for difficulty walking in CD have been inconclusive. Osteopathic manipulative medicine (OMM) has been used to improve gait biomechanics in other health conditions. Foot progression angle (FPA) while walking indicates functional gait abnormalities that increase the risk of knee injury and osteoarthritis. Objective The aim of this study is to test if five-weekly treatments using an OMM sequence designed for CD improved abnormal gait biomechanics in individuals with CD by identifying and addressing somatic dysfunctions. Methods In this prospective case series, independently ambulating individuals with CD symptom onset before the age of 40 years, not due to traumatic injury, were evaluated utilizing validated scales for severity (Toronto western spasmodic torticollis rating scale [TWSTRsI]) and symptoms affecting quality of life (Cervical Dystonia Impact Profile [CDIP-58]), physical examination, and FPA before and after five-weekly OMM treatments. Lower body joint range of motion and angles were captured in a clinical gait lab by nine cameras collecting three-dimensional Whole-body position data during three trials of one gait cycle at participant-selected walking speed. The FPA waveforms during the gait cycle were quantified by Vicon Nexus and Polygon applications. Pretreatment and posttreatment results were compared to established healthy gait waveforms and tested by repeated measures ANOVA (α=0.05). Results Pretreatment waveforms in CD had a mean 5.13° of excess FPA during gait cycle phases requiring lower-extremity pronation compared to previously published age-gender-matched healthy waveforms. There was 96% improvement in pronation after five treatments, with a mean 0.21° (p=0.041) of excess FPA. Mean TWSTRs and CDIP-58 scores improved. On physical examination, the rotational direction of C2 vertebrae was contralateral to neck muscle hypertonicity. Vertical sphenobasilar synchondrosis strains were present in those with anterotorticollis. Participants had ipsilateral anterolateral neck muscle and anterolateral abdominal wall muscle hypertonicity. All patients had pelvic somatic dysfunctions with left-side superior relative to right-side and restriction from lower-extremity pronation (i.e., supination dysfunctions). Conclusion The FPA was significantly improved after treatment. This OMM sequence was well tolerated and may be useful for improving gait kinematics in individuals with CD. Randomized, controlled, long-term studies are needed to determine effectiveness.
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Liu Q, Liu Y, Li H, Fu X, Zhang X, Liu S, Zhang J, Zhang T. Marker- three dimensional measurement versus traditional radiographic measurement in the treatment of tibial fracture using Taylor spatial frame. BMC Musculoskelet Disord 2022; 23:155. [PMID: 35172802 PMCID: PMC8849035 DOI: 10.1186/s12891-022-05112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Taylor Spatial Frame (TSF) has been widely used for tibial fracture. However, traditional radiographic measurement method is complicated and the reduction accuracy is affected by various factors. The purpose of this study was to propose a new marker- three dimensional (3D) measurement method and determine the differences of reduction outcomes, if any, between marker-3D measurement method and traditional radiographic measurement in the TSF treatment. Methods Forty-one patients with tibial fracture treated by TSF in our institution were retrospectively analyzed from January 2016 to June 2019, including 21 patients in the marker-3D measurement group (experimental group) and 20 patients in the traditional radiographic measurement group (control group). In the experimental group, 3D reconstruction with 6 markers installed on the TSF was performed to determine the electronic prescription. In the control group, the anteroposterior (AP) and lateral radiographs were performed for the traditional parameter measurements. The effectiveness was evaluated by the residual displacement deformity (RDD) and residual angle deformity (RAD) in the coronal and sagittal plane, according to the AP and lateral X-rays after reduction. Results All patients achieved functional reduction. The residual RDD in AP view was 0.5 (0, 1.72) mm in experimental group and 1.74 (0.43, 3.67) mm in control group. The residual RAD in AP view was 0 (0, 1.25) ° in experimental group and 1.25 (0.62, 1.95) °in control group. As for the lateral view, the RDD was 0 (0, 1.22) mm in experimental group and 2.02 (0, 3.74) mm in control group, the RAD was 0 (0, 0) ° in experimental group and 1.42 (0, 1.93) ° in control group. Significant differences in all above comparisons were observed between the two groups (AP view RDD: P = 0.024, RAD: P = 0.020; Lateral view RDD: P = 0.016, RAD: P = 0.004). Conclusions The present study introduced a marker-3D measurement method to complement the current TSF treatment. This method avoids the manual measurement error and improves the accuracy of fracture reduction, providing potential advantages of bone healing and function rehabilitation.
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Affiliation(s)
- Qixin Liu
- Graduate College of Tianjin Medical University, Tianjin, China
| | - Yanshi Liu
- Department of Trauma and Microreconstructive surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hong Li
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Xuefei Fu
- Department of Orthopedics, Anhui No.2 Provincial People's Hospital, Hefei, Anhui, China
| | - Xingpeng Zhang
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Sida Liu
- College of Mechanical Engineering, Tianjin University, Tianjin, China
| | - Jinli Zhang
- Department of Orthopedics and Trauma, Tianjin Hospital, Tianjin, China.
| | - Tao Zhang
- Department of Orthopedics and Trauma, Tianjin Hospital, Tianjin, China.
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13
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Yamamoto M, Shimatani K, Hasegawa M, Kurita Y, Ishige Y, Takemura H. Accuracy of Temporo-Spatial and Lower Limb Joint Kinematics Parameters Using OpenPose for Various Gait Patterns With Orthosis. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2666-2675. [PMID: 34914592 DOI: 10.1109/tnsre.2021.3135879] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A cost-effective gait analysis system without attachments and specialized large environments can provide useful information to determine effective treatment in clinical sites. This study investigates the capability of a single camera-based pose estimation system using OpenPose (OP) to measure the temporo-spatial and joint kinematics parameters during gait with orthosis. Eleven healthy adult males walked under different conditions of speed and foot progression angle (FPA). Temporo-spatial and joint kinematics parameters were measured using a single camera-based system with OP and a three-dimensional motion capture system. The limit of agreement, mean absolute error, absolute agreement (ICC2, 1), and relative consistency (ICC3, 1) between the systems under each condition were assessed for reliability and validity. The results demonstrated that most of the ICC for temporo-spatial parameters and hip and knee kinematics parameters were good to excellent (0.60 - 0.98). Conversely, most of the ICC for ankle kinematics in all conditions were poor to fair (< 0.60). Thus, the gait analysis using OP can be used as a clinical assessment tool for determining the temporo-spatial, hip, and knee sagittal plane angles during gait.
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14
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Wu KW, Lee WC, Ho YT, Wang TM, Kuo KN, Lu TW. Balance control and lower limb joint work in children with bilateral genu valgum during level walking. Gait Posture 2021; 90:313-319. [PMID: 34564004 DOI: 10.1016/j.gaitpost.2021.09.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Genu valgum results in lower limb malalignment and altered joint mechanics. The study aimed to identify the effects of genu valgum on balance control and muscular work at the joints during gait in children. RESEARCH QUESTION Would bilateral genu valgum affect balance control and muscular work at the joints during gait in children? METHODS Thirteen children with genu valgum and thirteen healthy peers walked at their preferred speed while the body's motions and ground reaction forces were measured to calculate the inclination angles (IA) and the rates of change of IA (RCIA) of the body's center of mass (COM) relative to the center of pressure (COP), as well as the muscular work done at the joints. An independent t-test was used to compare the variables between groups (α = 0.05). RESULTS Compared to the controls, the patients showed significantly increased step width with altered frontal IA and RCIA variables (p < 0.05), including increased average IA over single-limb support and increased peak RCIA during double-limb support (p < 0.05). The patients significantly increased posterior RCIA at heel-strike but decreased anterior RCIA at toe-off (p < 0.05). The patients showed increased muscular work at both the hip and knee during single-limb support (p < 0.05). SIGNIFICANCE The children with genu valgum showed a specific balance control strategy during gait. In the frontal plane, greater hip and knee muscular work was needed to maintain balance under an increased IA, likely owing to increased step width associated with the valgus alignment. In the sagittal plane, less smooth and less stable COM-COP control with increased RCIA at the key gait events indicates faster weight transfer between double-limb and single-limb support. It is suggested that patients with genu valgum, especially in more severe cases, should be monitored for signs of decreased ability and/or muscular strength in maintaining balance during gait.
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Affiliation(s)
- Kuan-Wen Wu
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan, ROC; Department of Biomedical Engineering, National Taiwan University, Taiwan, ROC; Department of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan, ROC
| | - Wei-Chun Lee
- Department of Biomedical Engineering, National Taiwan University, Taiwan, ROC; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taiwan, ROC
| | - Ya-Ting Ho
- Department of Biomedical Engineering, National Taiwan University, Taiwan, ROC
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan, ROC; Department of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan, ROC
| | - Ken N Kuo
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan, ROC
| | - Tung-Wu Lu
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan, ROC; Department of Biomedical Engineering, National Taiwan University, Taiwan, ROC.
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Song O, Seo KE, O’Sullivan DM, Park JJ. A Biomechanical Analysis of the Effect of Pilates Exercise on Female College Students with Knee Joint Deformity. THE ASIAN JOURNAL OF KINESIOLOGY 2021. [DOI: 10.15758/ajk.2021.23.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Current research on genu varum shows the favorable influence of exercise on the biomechanics of the knee joint by reducing the static malalignment and mechanical imbalances, however the transference to a more optimum gait has not been investigated.OBJECTIVES To investigate the effects of Pilates exercise on the changes of gait and lower limb malalignment in female students with genu varum.METHODS A total of 23 female college students with verified genu varum participated in this study. The participants were randomly assigned to two groups a Pilates exercise group (n=15) and a control group (n=8). The Pilates exercise group participated in 1 hour Pilates exercise 3 times per week for a total of 10 weeks. Each of the participants had an X-ray and performed gait 5 times before and after the exercise treatment. The participants kinetic and kinematic data were gathered using an eight Vicon Motion camera system and two force platforms.RESULTS For the Pilates group gait their maximum extension and internal rotation knee moment, and maximum adduction and internal rotation hip moment significantly increased, while the maximum knee moment flexion decreased. For the control group gait their maximum hip extension and hip adduction moment significantly decreased. For the Pilates group there was a significant reduction in the distance from the anatomical axis to the weight bearing line in the left leg, but there was no significant change for the control group.CONCLUSIONS The results suggest that Pilates exercise may be beneficial for females with genu varum by helping to improve both their static alignment and helping their gait to become more balanced.
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16
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Hunt MA, Charlton JM, Felson DT, Liu A, Chapman GJ, Graffos A, Jones RK. Frontal plane knee alignment mediates the effect of frontal plane rearfoot motion on knee joint load distribution during walking in people with medial knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:678-686. [PMID: 33582238 DOI: 10.1016/j.joca.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/08/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the nature of differences in the relationship between frontal plane rearfoot kinematics and knee adduction moment (KAM) magnitudes. DESIGN Cross-sectional study resulting from a combination of overground walking biomechanics data obtained from participants with medial tibiofemoral osteoarthritis at two separate sites. Statistical models were created to examine the relationship between minimum frontal plane rearfoot angle (negative values = eversion) and different measures of the KAM, including examination of confounding, mediation, and effect modification from knee pain, radiographic disease severity, static rearfoot alignment, and frontal plane knee angle. RESULTS Bivariable relationships between minimum frontal plane rearfoot angle and the KAM showed consistent negative correlations (r = -0.411 to -0.447), indicating higher KAM magnitudes associated with the rearfoot in a more everted position during stance. However, the nature of this relationship appears to be mainly influenced by frontal plane knee kinematics. Specifically, frontal plane knee angle during gait was found to completely mediate the relationship between minimum frontal plane rearfoot angle and the KAM, and was also an effect modifier in this relationship. No other variable significantly altered the relationship. CONCLUSIONS While there does appear to be a moderate relationship between frontal plane rearfoot angle and the KAM, any differences in the magnitude of this relationship can likely be explained through an examination of frontal plane knee angle during walking. This finding suggests that interventions derived distal to the knee should account for the effect of frontal plane knee angle to have the desired effect on the KAM.
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Affiliation(s)
- M A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia: Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia: Vancouver, BC, Canada.
| | - J M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia: Vancouver, BC, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia: Vancouver, BC, Canada.
| | - D T Felson
- Department of Rheumatology, Boston University School of Medicine, Boston, MA, USA; NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester, UK; Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
| | - A Liu
- School of Health and Society, University of Salford: Manchester, UK.
| | - G J Chapman
- School of Sport and Health Sciences, University of Central Lancashire: Preston, UK.
| | - A Graffos
- Motion Analysis and Biofeedback Laboratory, University of British Columbia: Vancouver, BC, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia: Vancouver, BC, Canada.
| | - R K Jones
- School of Health and Society, University of Salford: Manchester, UK.
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Snow M. Tibial Torsion and Patellofemoral Pain and Instability in the Adult Population: Current Concept Review. Curr Rev Musculoskelet Med 2021; 14:67-75. [PMID: 33420589 DOI: 10.1007/s12178-020-09688-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Tibial torsion is a recognized cause of patellofemoral pain and instability in the paediatric population; however, it is commonly overlooked in the adult population. The aim of this review article is to summarize the current best evidence on tibial torsion for the adult orthopaedic surgeon. RECENT FINDINGS The true incidence of tibial torsion in the adult population is unknown, with significant geographical variations making assessment very difficult. CT currently remains the gold standard for quantitatively assessing the level of tibial torsion and allows assessment of any associated femoral and knee joint rotational anomalies. Surgical correction should only be considered after completion of a course of physiotherapy aimed at addressing the associated proximal and gluteal weakness. Tibial torsion greater than 30° is used as the main indicator for tibial de-rotation osteotomy by the majority of authors. In patients with associated abnormal femoral rotation, current evidence would suggest that a single-level correction of the tibia (if considered to be a dominant deformity) is sufficient in the majority of cases. Proximal de-rotational osteotomy has been more commonly reported in the adult population and confers the advantage of allowing simultaneous correction of patella alta or excessive tubercle lateralization. Previous surgery prior to de-rotational osteotomy is common; however, in patients with persistent symptoms surgical correction still provides significant benefit. Tibial torsion persists into adulthood and can play a significant role in patellofemoral pathology. A high index of suspicion is required in order to identify torsion clinically. Surgical correction is effective for both pain and instability, but results are inferior in patients with very high pain levels pre-surgery and multiple previous surgeries.
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Affiliation(s)
- Martyn Snow
- The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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18
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Graef F, Falk R, Tsitsilonis S, Perka C, Zahn RK, Hommel H. Correction of excessive intraarticular varus deformities in total knee arthroplasty is associated with deteriorated postoperative ankle function. Knee Surg Sports Traumatol Arthrosc 2020; 28:3758-3765. [PMID: 31776626 DOI: 10.1007/s00167-019-05812-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/19/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to demonstrate, whether the degree of limb alignment correction in varus knee osteoarthritis correlated with an increase in ankle symptoms and to define a cut-off value concerning the degree of correction above which to expect ankle problems. METHODS Ninety-nine consecutive patients with preoperative intraarticular varus knee deformities who underwent total knee arthroplasty were retrospectively analyzed. Patients were examined clinically (Knee Society Score, Forgotten Joint Score, Foot Function Index, Range of Motion of the knee and ankle joint, pain scales) as well as radiologically. The mean follow-up time was 57 months. RESULTS The degree of operative limb alignment correction strongly correlated with the Foot Function Index (R = 0.91, p < 0.05). Given this, higher degrees of knee malalignment corrections were associated with worse postoperative outcomes in the knee and ankle joint-despite postoperative improved joint line orientations. Subsequently, a cut-off value for arthritic varus deformities (14.5°) could be calculated, above which the prevalence of ankle symptoms increased manifold [OR = 15.6 (3.2-77.2 95% CI p < 0.05)]. Furthermore, ROM restrictions in the subtalar joint were associated with a worse outcome in the ankle joint. CONCLUSIONS When correcting excessive intraarticular varus knee osteoarthritis, surgeons have to be aware of possible postoperative ankle symptoms and should consider ankle deformities or decreased subtalar ROM before operative procedures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Frank Graef
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - R Falk
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
| | - S Tsitsilonis
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - C Perka
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - R K Zahn
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - H Hommel
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
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Saida T, Kawada M, Kuroki D, Nakai Y, Miyazaki T, Kiyama R, Tsuneyoshi Y. Accelerometer Measurement of Trunk Lateral Fluctuation During Walking Following Total Knee Arthroplasty in Patients With Osteoarthritis. J Aging Phys Act 2020; 28:669-674. [PMID: 32208361 DOI: 10.1123/japa.2019-0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 12/10/2019] [Accepted: 12/14/2019] [Indexed: 11/18/2022]
Abstract
This study aimed to clarify the effect of total knee arthroplasty (TKA) on trunk fluctuation and regularity of gait in patients with knee osteoarthritis by an accelerometer. The participants included 18 patients with knee osteoarthritis undergoing TKA. The gait at a comfortable velocity was assessed pre- and post-TKA by a triaxial accelerometer attached to the neck and lumbar regions. Measurement post-TKA was performed 4 weeks after surgery. Trunk fluctuation was estimated by the root mean square (RMS) of acceleration and RMS ratio (the ratio of RMS in each direction to the total RMS). Regularity of gait was estimated using the autocorrelation function. The results showed that TKA significantly decreased the RMS ratio in mediolateral acceleration of the neck and lumbar regions and reduced gait regularity. TKA appears to reduce compensatory trunk motion through the improvement of knee function. An assessment of trunk fluctuation using an accelerometer is useful for the clinical assessment of patients with knee osteoarthritis pre- and post-TKA.
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20
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Qiu R, Xu R, Wang D, Ming D. The effect of modifying foot progression angle on the knee loading parameters in healthy participants with different static foot postures. Gait Posture 2020; 81:7-13. [PMID: 32650240 DOI: 10.1016/j.gaitpost.2020.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have found that toe-in gait reduced the peak knee adduction moment (KAM) during early stance, while toe-out gait reduced the peak KAM during late stance. However, some other studies found that toe-in or toe-out gait could reduce the KAM throughout stance phase. There is still a divergence of opinion on the use of toe-in or toe-out gait for reducing the KAM. RESEARCH QUESTION This study aimed to investigate whether static foot posture affected participants' biomechanical responses to three self-selected foot progression angles (FPA): neutral, toe-out and toe-in. METHODS Twenty-seven healthy participants were recruited for this FPA gait modification experiment and classified into three groups: neutral (n = 8), supination (n = 9) and pronation (n = 10), based on the Foot Posture Index (FPI). The kinematic and kinetic data were recorded with Vicon motion capture system and three force plates. The knee adduction moment and ankle eversion moment were calculated using an inverse dynamics model. The effect of the FPA modification on the knee loading parameters was analysed by the Friedman non-parametric test. RESULTS The KAM results in the neutral group showed that the toe-in gait modification reduced the first peak of the KAM (KAM1), while the KAM1 was increased in the supination group. The effect of the FPA modification on the KAM1 did not reach significance in the pronation group. The toe-out gait modification reduced the second peak (KAM2) regardless of the static posture. SIGNIFICANCE Different static foot postures were correlated with different peak KAM during the early stance phase due to FPA modification. These data suggest that the assessment of static foot posture provides a reference on how to offer adequate FPA modification for knee OA patients with different foot postures.
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Affiliation(s)
- Rongmei Qiu
- Lab of Neural Engineering & Rehabilitation, Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China; Department of Rehabilitation, Faculty of Rehabilitation, BinZhou Medical University, Yantai, Shandong, China.
| | - Rui Xu
- Lab of Neural Engineering & Rehabilitation, Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China.
| | - Deqiang Wang
- Department of Rehabilitation, Faculty of Rehabilitation, BinZhou Medical University, Yantai, Shandong, China; Department of Pain, BinZhou Medical University Affiliated Hospital, BinZhou, Shandong, China.
| | - Dong Ming
- Lab of Neural Engineering & Rehabilitation, Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
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21
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Xia H, Charlton JM, Shull PB, Hunt MA. Portable, automated foot progression angle gait modification via a proof-of-concept haptic feedback-sensorized shoe. J Biomech 2020; 107:109789. [PMID: 32321637 DOI: 10.1016/j.jbiomech.2020.109789] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/28/2022]
Abstract
Modifying the foot progression angle (FPA) is a non-pharmacological, non-surgical treatment option for knee osteoarthritis, however current widespread adoption has been limited by the requirement of laboratory-based motion capture systems. We present the first customized haptic feedback-sensorized shoe for estimating and modifying FPA during walking gait, which includes an electronic inertial and magnetometer module in the sole for estimating FPA, and two vibration motors attached to the medial and lateral shoe lining for providing vibrotactile feedback. Feasibility testing was performed by comparing FPA performance while wearing the haptic feedback-sensorized shoe with the training targets. Participants performed five walking trials with five randomly-presented FPA targets (10° toe-in, 0°, 10° toe-out, 20° toe-out, and 30° toe-out) of 2 min each on a treadmill. Overall average FPA performance error across all conditions was 0.2 ± 4.1°, and the overall mean absolute FPA performance error across all conditions was 3.1 ± 2.6°. Reducing the size of the no-feedback window resulted in less performance error during walking. This study demonstrates that a novel haptic feedback-sensorized shoe can be used to effectively train FPA modifications. The haptic feedback-sensorized shoe could potentially be used for FPA gait modification outside of specialized camera-based motion capture laboratories as a conservative treatment for knee osteoarthritis or other related clinical applications requiring FPA assessment and modification in daily life.
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Affiliation(s)
- Haisheng Xia
- State Key Laboratory of Mechanical Systems and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Peter B Shull
- State Key Laboratory of Mechanical Systems and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.
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Noyes FR. Editorial Commentary: Measurements for Successful High Tibial Osteotomy: Understanding Supine Versus Standing and Intraoperative Fluoroscopic Alignment Is Required. Arthroscopy 2020; 36:1665-1669. [PMID: 32503776 DOI: 10.1016/j.arthro.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
A high tibial osteotomy (HTO) that is used to correct varus malalignment, such as with medial arthrosis or before cartilage restoration or posterolateral reconstructions, represents an important and required surgery for clinical success. A major problem that occurs with HTO planning is that the preoperative measurements, with either lower limb supine or standing weight-bearing radiographs, will invariably show abnormal medial or lateral tibiofemoral compartment opening resulting from soft-tissue laxity or injury. It is imperative that this tibiofemoral joint opening be accounted for in the osteotomy correction calculations. There are well-described methods available that affect operative planning, such as the use of preoperative stress radiographs to determine the millimeters of tibiofemoral opening or closure. The use of intraoperative fluoroscopy with application of axial loading to the lower limb and verification of closure of the tibiofemoral joint is recommended. A careful fluoroscopic examination of the tibiofemoral compartments allows a final adjustment of the osteotomy correction and confirms the final weight-bearing line percent measurement and limb alignment. Postoperative radiographs are required to detect outliers resulting from unexpected soft-tissue laxity or inadequate correction.
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Affiliation(s)
- Frank R Noyes
- Cincinnati Sportsmedicine Research and Education Foundation
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Tibiofemoral kinematics in healthy and osteoarthritic knees during twisting. J Orthop 2020; 21:213-217. [PMID: 32273659 DOI: 10.1016/j.jor.2020.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose The purpose of this study was to determine the in vivo kinematics of healthy knees and those with osteoarthritis (OA), during twisting using density-based image-matching techniques. Methods Five healthy subjects and 26 patients with medial knee OA performed twisting under periodic X-ray imaging. Results The tibiofemoral rotation at the ipsilateral/contralateral twist in healthy and OA knees were 11° ± 9.3° externally/9.5° ± 5.6° internally (p < 0.05) and 4.4° ± 7.2° externally/2.7° ± 8° internally (p < 0.05), respectively. Conclusions The kinematic analysis of OA knees during twisting revealed significantly smaller tibiofemoral rotation than those of healthy knees.
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Shi D, Zhang W, Ding X, Sun L. Parametric generation of three-dimensional gait for robot-assisted rehabilitation. Biol Open 2020; 9:bio047332. [PMID: 32001490 PMCID: PMC7063668 DOI: 10.1242/bio.047332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/21/2020] [Indexed: 12/22/2022] Open
Abstract
For robot-assisted rehabilitation and assessment of patients with motor dysfunction, the parametric generation of their normal gait as the input for the robot is essential to match with the features of the patient to a greater extent. In addition, the gait needs to be in three-dimensional space, which meets the physiological structure of the human better, rather than only on a sagittal plane. Thus, a method for the parametric generation of three-dimensional gait based on the influence of the motion parameters and structure parameters is presented. First, the three-dimensional gait kinematic of participants is collected, and trajectories of ankle joint angle and ankle center position are calculated. Second, for the trajectories, gait features are extracted including gait events indicating the physiological features of walking gait, in addition to extremes indicating the geometrical features of the trajectories. Third, regression models are derived after using leave-one-out cross-validation for model optimization. Finally, cubic splines are fitted between the predicted gait features to generate the trajectories for a full gait cycle. It is inferred that the generated curves match the measured curves well. The method presented herein gives an important reference for research into lower limb rehabilitation robots.
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Affiliation(s)
- Di Shi
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Wuxiang Zhang
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China
| | - Xilun Ding
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China
| | - Lei Sun
- Beijing Institute Traumatology & Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
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Alexander N, Wegener R, Lengnick H, Payne E, Klima H, Cip J, Studer K. Compensatory gait deviations in patients with increased outward tibial torsion pre and post tibial derotation osteotomy. Gait Posture 2020; 77:43-51. [PMID: 31981934 DOI: 10.1016/j.gaitpost.2020.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial torsion describes the rotation between the proximal and distal joint axis along the shaft, which can be, as rotational deformity, pathologically increased or decreased. Some patients might increase hip internal rotation during walking to compensate increased outward tibial torsion. RESEARCH QUESTION The aim of this study was to assess the effect of tibial derotation osteotomy on gait deviations in patients with increased outward tibial torsion. METHODS Thirteen patients (13.5 ± 1.4 yrs, 22 limbs) with increased tibial torsion (CT confirmed 49.2 ± 4.8°) were analyzed pre and post tibial derotation osteotomy and compared with 17 typically developing children (TDC, 13.5 ± 2.3 yrs, 32 limbs). Kinematic and kinetic data were recorded. Subgroup analyses were performed whether patients showed compensatory hip internal rotation (Comp) or not (NoComp). Principal component (PC) analysis was used to achieve data transformation. A linear mixed model was used to estimate the main effect of PC-scores of retained PCs explaining 90% of the cumulative variance. RESULTS Compensatory hip internal rotation (Comp, present in 45.5% of limbs analyzed) led to a lower external foot progression angle compared to patients without compensatory hip internal rotation (NoComp). In both patient groups foot progression angle was normalized after tibial derotation osteotomy. Post-operative NoComp had normalized frontal plane joint loadings, while Comp showed an increased hip and knee adduction moment. SIGNIFICANCE Future studies should investigate if more time is needed for Comp to normalize gait patterns post-operative or if a pre and post-operative gait training might help. Otherwise the increased knee adduction moment might be clinically relevant due to previous studies reporting a possible association with knee osteoarthritis.
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Affiliation(s)
- Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Department of Orthopaedics and Traumatology, Cantonal Hospital, St. Gallen, Switzerland.
| | - Regina Wegener
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Department of Orthopaedics and Traumatology, Cantonal Hospital, St. Gallen, Switzerland
| | - Harald Lengnick
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Erika Payne
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Harry Klima
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Johannes Cip
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Kathrin Studer
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
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The Effects of Instruction Exercises on Performance and Kinetic Factors Associated With Lower-Extremity Injury in Landing After Volleyball Blocks. J Sport Rehabil 2020; 29:51-64. [PMID: 30526280 DOI: 10.1123/jsr.2018-0163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/15/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Female volleyball players are more predisposed to anterior cruciate ligament injury in comparison with their male counterparts. Recent research on anterior cruciate ligament injury prevention strategies has shown the positive results of adopting the external focus (EF) of attention in sports. OBJECTIVE To determine the effect of 6-week EF instruction exercises on performance and kinetic factors associated with lower-extremity injury in landing after the volleyball blocks of female athletes. DESIGN Pretest and posttest control study. SETTING University research laboratory. PARTICIPANTS Thirty-two female volleyball players (18-24 y old) from the same team randomly divided into experimental (n = 16) and control (n = 16) groups. INTERVENTION The experimental group performed a 6-week exercise program with EF instructions. The control group continued its regular volleyball team schedule. MAIN OUTCOME MEASURES To assess function, single-leg triple hop test for distance was used. A force plate was used to evaluate kinetic variables including vertical ground reaction forces, the rate of loading, and dynamic postural stability index. All data were assessed at baseline and after the intervention. RESULTS There was a significant increase in single-leg triple hop test (P < .05) and in the first and second peak ground reaction force, rate of loadings, dynamic postural stability index (P < .05). CONCLUSION According to the results of this study, anterior cruciate ligament injury prevention programs should incorporate EF instruction exercises to enhance the kinetics and to increase athletes' functional performance.
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Fantini Pagani C, Funken J, Heinrich K, Ellermann A, Schmidt-Wiethoff R, Potthast W. Predicting the knee adduction moment after high tibial osteotomy in patients with medial knee osteoarthritis using dynamic simulations. Knee 2020; 27:61-70. [PMID: 31883857 DOI: 10.1016/j.knee.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/24/2019] [Accepted: 08/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a surgical treatment for knee osteoarthritis, which alters the load distribution in the tibiofemoral joint. To date, all surgical planning methods are based on radiographs, which do not consider the loading characteristics during ambulation. This study aimed to develop and validate a simulation tool for predicting the knee adduction moment (KAM) expected after a HTO using the patient pre-operative gait analysis data and dynamic simulations. METHODS Ten patients selected for a HTO underwent a gait analysis before surgery. Pre-operative gait data along with the planned correction angle were used for simulation of the KAM expected after leg realignment. After surgery, the same procedures of gait analysis were performed and post-operative KAM was compared to the simulation results. RESULTS Significant reductions of the KAM were observed after surgery. During gait at 1.2 m/s, means of the 1st peak KAM were 3.19 ± 1.03 (standard deviation), 1.21 ± 0.80 and 1.21 ± 0.71% BW × Ht for the conditions pre-operative, post-operative and simulation, respectively. Mean root-mean-square error for the KAM was 0.45% BW × Ht (range: 0.23-0.78% BW × Ht) and Lin's concordance coefficient for the 1st peak KAM was 0.813. An individual analysis showed high agreement for several patients and lower agreement for others. Possible changes in gait pattern after surgery may explain this variability. CONCLUSION A novel approach for surgical planning based on dynamic loading of the knee during ambulation is presented. The simulation tool is based on patient-specific gait characteristics and may improve the surgical planning procedures used to date.
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Affiliation(s)
- Cynthia Fantini Pagani
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Johannes Funken
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Kai Heinrich
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Andree Ellermann
- ARCUS Clinics Pforzheim, Rastatter Str. 17-19, 75179 Pforzheim, Germany.
| | | | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany; ARCUS Clinics Pforzheim, Rastatter Str. 17-19, 75179 Pforzheim, Germany.
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Kim DY, Miyakawa S, Fukuda T, Takemura M. Sex Differences in Iliotibial Band Strain under Different Knee Alignments. PM R 2019; 12:479-485. [PMID: 31583829 DOI: 10.1002/pmrj.12255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/16/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Increased strain of the iliotibial band (ITB) is a plausible contributing factor for the development of iliotibial band syndrome (ITBS). Although several studies have found relationships between the strain of the ITB and kinematic factors during running, the associations of the ITB strain with knee alignment and sex, which are considered intrinsic factors, are not well understood. OBJECTIVE To clarify the sex differences in the ITB strain between genu varum and normal knee alignments in different postures. DESIGN Observational cross-sectional study. SETTING Laboratory research within a university. PARTICIPANTS Forty-four healthy recreational athletes (21 men and 23 women) volunteered for this study and were divided into four groups by sex and knee alignment: men with genu varum alignment, men with normal knee alignment, women with genu varum alignment, and women with normal knee alignment. METHODS An ultrasound real-time elastography (RTE) unit was used for distal ITB strain measurements in weight bearing and for different non-weight-bearing: neutral, knee flexion, hip adduction, and hip adduction with knee flexion. Gender information and the intercondylar distance data were collected to divide the participants into two groups. MAIN OUTCOME MEASUREMENTS Main Outcome was the ITB strain (strain ratio) measured by the RTE. RESULTS There were no significant differences in neutral and hip adduction postures among the four groups. However, during weight-bearing, the women's genu varum group (6.91 ± 1.69; Mean ± SD) exhibited greater strain than both the men's normal group (3.50 ± 1.04, P = .005) and the women's normal group (4.42 ± 1.42, P = .048). In addition, there were significant positive correlations between the intercondylar distance and the ITB strain during weight-bearing (r = 0.315, P = .037). CONCLUSIONS The women's genu varum group exhibited a higher ITB strain during weight-bearing, which may be related to the high incidence of ITBS in women athletes. Furthermore, the changes in alignment and muscle activities during weight-bearing could influence the strain of the ITB. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Da Yoon Kim
- Doctoral Programs in Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Shumpei Miyakawa
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Takashi Fukuda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Takemura
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
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Otsuki S, Murakami T, Okamoto Y, Nakagawa K, Okuno N, Wakama H, Neo M. Risk of patella baja after opening-wedge high tibial osteotomy. J Orthop Surg (Hong Kong) 2019; 26:2309499018802484. [PMID: 30295136 DOI: 10.1177/2309499018802484] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Medial opening-wedge high tibial osteotomy (OWHTO) induces a lower patellar position, and the subsequent degree of patellar movement may not be predicted preoperatively. The purpose of this study was to clarify the relationship between preoperative and postoperative patellar height based on the correction angle of OWHTO and to create a formula to predict the appearance of patella baja following OWHTO. MATERIALS AND METHODS Seventy-five knees with varus knee osteoarthritis treated with OWHTO were included in this study. The Caton-Deschamps index was used to evaluate patellar height preoperatively and postoperatively, and the cut-off value for preoperative parameters was determined by a receiver operating characteristic curve to determine the risk ratio for postoperative patella baja. RESULTS The Caton-Deschamps index significantly decreased from 0.93 to 0.77 after OWHTO ( p < 0.01). The OWHTO correction angle negatively correlated with the delta Caton-Deschamps index ( r = -0.44, p < 0.01), and a 1.7% decrease in the Caton-Deschamps index was shown with a 1° correction angle. Receiver operating characteristic curve analysis revealed that a Caton-Deschamps index of 0.8 was the cutoff for OWHTO; knees with a preoperative Caton-Deschamps index of < 0.8 tended to develop patella baja after OWHTO, with a risk ratio of 9.5 (95% confidence interval [4.3-20.7]). CONCLUSIONS OWHTO can induce patella baja, and a 1.7% decrease in the Caton-Deschamps index was shown with a 1°-correction angle. A preoperative Caton-Deschamps index < 0.8 should be considered a risk factor for postoperative patella baja. LEVEL OF EVIDENCE Retrospective study, Level IV.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Hull ML, Ross D, Nicolet-Petersen S, Howell SM. Does the condylar lift-off method or the separation method better detect loss of contact between tibial and femoral implants based on analysis of single-plane radiographs following total knee arthroplasty? J Biomech 2019; 86:40-47. [PMID: 30824235 DOI: 10.1016/j.jbiomech.2019.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/24/2018] [Accepted: 01/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Loss of contact between the femoral and tibial implants following total knee arthroplasty (TKA) has been related to accelerated polyethylene wear and other complications. Two methods have been used to detect loss of contact in single-plane fluoroscopy, the condylar lift-off method and the separation method. The objectives were to assess the ability of each method to detect loss of contact. METHODS TKA was performed on ten cadaveric knee specimens. Tibial force was measured in each compartment as specimens were flexed from 0° to 90° while internal-external and varus-valgus moments were applied. Single-plane radiographs taken simultaneously with tibial force were analyzed for loss of contact using the two methods. Receiver operating characteristic (ROC) and optimum threshold distances were determined. RESULTS For the lift-off method and the separation method, the areas under the ROC curves were 0.89 vs 0.60 for the lateral compartment only and 0.81 vs 0.70 for the medial compartment only, respectively. For the lift-off method, the optimum threshold distances were 0.7 mm in the lateral compartment only and 0.1 mm in the medial compartment only but the false positive rate for the medial compartment only almost doubled. For both compartments jointly, the areas under the ROC curves decreased to 0.70 and 0.59 for the lift-off and separation methods, respectively. CONCLUSION When detecting loss of contact using single-plane fluoroscopy, the lift-off method is useful for the lateral compartment only but not for the medial compartment only and not for both compartments jointly. The separation method is not useful.
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Affiliation(s)
- Maury L Hull
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA 95616, United States; Department of Mechanical Engineering, University of California Davis, One Shields Avenue, Davis, CA 95616, United States; Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento CA 95817, United States.
| | - Derrick Ross
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA 95616, United States
| | - Stephanie Nicolet-Petersen
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA 95616, United States
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA 95616, United States
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Knee alignment in adolescents is correlated with participation in weight-bearing sports. INTERNATIONAL ORTHOPAEDICS 2018; 42:2851-2858. [PMID: 29905900 DOI: 10.1007/s00264-018-4015-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Weight-bearing sports might influence the alignment of the lower extremities during growth. The relationship between participation in weight-bearing sports and the alignment of the lower extremities in adolescents has not been adequately studied yet. The aim of the study was to investigate whether sports participation during growth in early adolescence is correlated with the development of genu varum. METHODS The design was a correlation study in which 1008 (564 boys, 444 girls) healthy adolescents (from 12 to 19 years of age) were recruited in secondary schools. The alignment of the knee was determined by measuring the intercondylar (IC) and intermalleolar (IM) distance using a specially designed instrument and an inside calliper. The degree of sports participation of the participants was determined by a questionnaire in which they were asked how many hours a week they participated in sports and for how many years in total. RESULTS The results of this study revealed a significant correlation between participation in weight-bearing sports and genu varum in each of three different age groups, both for boys and girls. CONCLUSION Our results show that there is an association between the alignment of the knee joint and participation in weight-bearing sports during early adolescence.
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Thaller PH, Fürmetz J, Chen F, Degen N, Manz KM, Wolf F. Bowlegs and Intensive Football Training in Children and Adolescents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:401-408. [PMID: 29968558 DOI: 10.3238/arztebl.2018.0401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/03/2018] [Accepted: 05/30/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND In many countries around the world, football (association football, or "soccer" predominantly in North America) is the sport most commonly played by children and adolescents. It is widely thought that football players are more likely to develop genu varum (bowlegs); an association with knee arthritis also seems likely. The goals of this systematic review and meta-analysis are to provide an overview of the available evidence on genu varum after intensive soccer training in childhood and adolescence, and to discuss the possible pathogenetic mechanisms. METHODS We systematically searched the PubMed, Medline, Embase, and Coch- rane Library databases for studies of the relation between leg axis development and intensive football playing during the growing years. RESULTS Controlled studies employing the intercondylar distance (ICD) as the target variable were evaluated in a meta-analysis, with the mean difference as a measure of effect strength. This meta-analysis included 3 studies with a total of 1344 football players and 1277 control individuals. All three studies individually showed a signifi- cant difference in the mean ICD values of the two groups. The pooled effect esti- mator for the mean difference was 1.50 cm (95% confidence interval [0.53; 2.46]). Two further studies that could not be included in the meta-analysis had similar con- clusions. Asymmetrical, varus muscle forces and predominantly varus stress on the osseous growth plates neighboring the knee joint, especially during the prepubertal growth spurt, seem to be the cause of this phenomenon. CONCLUSION Intensive soccer playing during the growing years can promote the devel- opment of bowlegs (genu varum) and, in turn, increase the risk of knee arthritis. Phy- sicians should inform young athletes and their parents of this if asked to advise about the choice of soccer as a sport for intensive training. It cannot be concluded, however, that football predisposes to bowlegs when played merely as a leisure activity.
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Affiliation(s)
- Peter Helmut Thaller
- 3D-Surgery, Department of General-, Traumaand Reconstructive Surgery, University Hospital of Munich (LMU); Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig Maximilian University Munich
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Lewinson RT, Madden R, Killick A, Wannop JW, Preston Wiley J, Lun VMY, Patel C, LaMothe JM, Stefanyshyn DJ. Foot structure and knee joint kinetics during walking with and without wedged footwear insoles. J Biomech 2018; 73:192-200. [PMID: 29673934 DOI: 10.1016/j.jbiomech.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 10/01/2017] [Accepted: 04/01/2018] [Indexed: 11/19/2022]
Abstract
The relationship between static foot structure characteristics and knee joint biomechanics during walking, or the biomechanical response to wedged insoles are currently unknown. In this study, 3D foot scanning, dual X-ray absorptiometry and gait analysis methods were used to determine structural parameters of the foot and assess their relation to knee joint loading and biomechanical response to wedged insoles in 30 patients with knee osteoarthritis. In multiple linear regression models, foot fat content, height of the medial longitudinal arch and static hind foot angle were not associated with the magnitude of the knee adduction moment (R2 = 0.24, p = 0.060), knee adduction angular impulse (R2 = 0.21, p = 0.099) or 3D resultant knee moment (R2 = 0.23, p = 0.073) during gait. Furthermore, these foot structure parameters were not associated with the patients' biomechanical response to medial or lateral wedge footwear insoles (all p < 0.01). These findings suggest that static foot structure is not associated with gait mechanics at the knee, and that static foot structure alone cannot be utilized to predict an individual's biomechanical response to wedged footwear insoles in patients with knee osteoarthritis.
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Affiliation(s)
- Ryan T Lewinson
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada; Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Canada.
| | - Ryan Madden
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - Anthony Killick
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - John W Wannop
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - J Preston Wiley
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Canada
| | - Victor M Y Lun
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Canada
| | - Chirag Patel
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada
| | - Jeremy M LaMothe
- Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Canada
| | - Darren J Stefanyshyn
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
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Sritharan P, Lin YC, Richardson SE, Crossley KM, Birmingham TB, Pandy MG. Lower-limb muscle function during gait in varus mal-aligned osteoarthritis patients. J Orthop Res 2018; 36:2157-2166. [PMID: 29473665 DOI: 10.1002/jor.23883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/15/2018] [Indexed: 02/04/2023]
Abstract
This study quantified the contributions by muscular, gravitational and inertial forces to the ground reaction force (GRF) and external knee adduction moment (EKAM) for knee osteoarthritis (OA) patients and controls walking at similar speeds. Gait data for 39 varus mal-aligned medial knee OA patients and 15 controls were input into musculoskeletal models to calculate the contributions of individual muscles and gravity to the fore-aft (progression), vertical (support), and mediolateral (balance) GRF, and the EKAM. The temporal patterns of contributions to GRF and EKAM were similar between the groups. Magnitude differences in GRF contributions were small but some reached significance. Peak GRF contributions were lower in patients except hamstrings in early-stance progression (p < 0.001) and gastrocnemius in late-stance progression (p < 0.001). Both EKAM peaks were higher in patients, due mainly to greater adduction contribution from gravity (p < 0.001) at the first peak, and lower abduction contributions from soleus (p < 0.001) and gastrocnemius (p < 0.001) at the second peak. Gluteus medius contributed most to EKAM in both groups, but was higher in patients during mid-stance only (p < 0.001). Differences in GRF contributions were attributed to altered quadriceps-hamstrings action as well as compensatory adaptation of the ankle plantarflexors to reduced gluteus medius action. The large effect of varus mal-alignment on the frontal-plane moment arms of the gravity, soleus, and gastrocnemius GRF contributions about the knee explained greater patient EKAM. Our results shed further light on how the EKAM contributes to altered knee-joint loads in OA and why some interventions may affect different portions of the EKAM waveform. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Yi-Chung Lin
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Sara E Richardson
- Faculty of Health Sciences, University of Western Ontario, Ontario, Canada
| | - Kay M Crossley
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia
| | | | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
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Halonen KS, Dzialo CM, Mannisi M, Venäläinen MS, de Zee M, Andersen MS. Workflow assessing the effect of gait alterations on stresses in the medial tibial cartilage - combined musculoskeletal modelling and finite element analysis. Sci Rep 2017; 7:17396. [PMID: 29234021 PMCID: PMC5727195 DOI: 10.1038/s41598-017-17228-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 11/17/2017] [Indexed: 01/17/2023] Open
Abstract
Knee osteoarthritis (KOA) is most common in the medial tibial compartment. We present a novel method to study the effect of gait modifications and lateral wedge insoles (LWIs) on the stresses in the medial tibial cartilage by combining musculoskeletal (MS) modelling with finite element (FE) analysis. Subject's gait was recorded in a gait laboratory, walking normally, with 5° and 10° LWIs, toes inward ('Toe in'), and toes outward ('Toe out wide'). A full lower extremity MRI and a detailed knee MRI were taken. Bones and most soft tissues were segmented from images, and the generic bone architecture of the MS model was morphed into the segmented bones. The output forces from the MS model were then used as an input in the FE model of the subject's knee. During stance, LWIs failed to reduce medial peak pressures apart from Insole 10° during the second peak. Toe in reduced peak pressures by -11% during the first peak but increased them by 12% during the second. Toe out wide reduced peak pressures by -15% during the first and increased them by 7% during the second. The results show that the work flow can assess the effect of interventions on an individual level. In the future, this method can be applied to patients with KOA.
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Affiliation(s)
- K S Halonen
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D, DK-9220, Aalborg, Denmark.
| | - C M Dzialo
- Department of Mechanical and Manufacturing Engineering, Aalborg University, Fibigerstræde 16, DK-9220, Aalborg, Denmark
| | - M Mannisi
- School of Health and Life Science, Glasgow Caledonian University, Cowcaddens Rd, G4 0BA, Glasgow, United Kingdom
| | - M S Venäläinen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland
| | - M de Zee
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D, DK-9220, Aalborg, Denmark
| | - M S Andersen
- Department of Mechanical and Manufacturing Engineering, Aalborg University, Fibigerstræde 16, DK-9220, Aalborg, Denmark
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Li Z, Esposito CI, Koch CN, Lee YY, Padgett DE, Wright TM. Polyethylene Damage Increases With Varus Implant Alignment in Posterior-stabilized and Constrained Condylar Knee Arthroplasty. Clin Orthop Relat Res 2017; 475:2981-2991. [PMID: 28822068 PMCID: PMC5670063 DOI: 10.1007/s11999-017-5477-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/10/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Implant malalignment in primary TKA has been reported to increase stresses placed on the bearing surfaces of implant components. We used a longitudinally maintained registry coupled with an implant retrieval program to consider whether preoperative, postoperative, or prerevision malalignment was associated with increased risk of revision surgery after TKA. QUESTIONS/PURPOSES (1) What is the relative polyethylene damage on medial and lateral compartments of the tibial plateaus from revised TKAs? (2) Does coronal TKA alignment affect implant performance, such that TKAs aligned in varus are predisposed to experience increased polyethylene damage? (3) Does TKA alignment differ between postoperative and prerevision radiographs, and if so, what does this difference suggest about the mechanical contact load placed on a knee with a TKA? METHODS Between 2007 and 2012, we performed 18,065 primary TKAs at our institution. By March 2016, 178 of those TKAs (1%) were revised at our center at least 2 years after primary surgery at our institution. Eighteen of those TKAs were excluded from this analysis because the tibial insert was not explanted during revision surgery, and four more were excluded because the inserts were lost or returned to the patient before the study was initiated, leaving 156 retrieved polyethylene tibial inserts (in 153 patients) revised at greater than 2 years after the primary TKA for this retrospective study. Patients who underwent revision surgery elsewhere were not considered here, since this study depended on having retrieved components. Polyethylene damage modes of burnishing, pitting, scratching, delamination, surface deformation, abrasion, and third-body debris were subjectively graded on a scale of 0 to 3 to reflect the extent and severity of each damage mode. On preoperative, postoperative, and prerevision radiographs, overall alignment, femoral alignment, and tibial alignment in the coronal plane were measured according to the protocol recommended by the Knee Society. RESULTS Knees with more overall varus alignment after TKA had increased total damage on the retrieved tibial inserts (Spearman's rank correlation coefficients of -0.3 [95% CI, -0.4 to -0.1; p = 0.001]). We also found revised TKAs tended to drift back into greater varus before revision surgery, with a mean (SD) of 3.6° ± 4.0° valgus for postoperative alignment compared with 1.7° ± 6.4° prerevision (p = 0.04). CONCLUSIONS Despite surgical efforts to achieve neutral mechanical alignment, remaining varus alignment places an increased contact load on the polyethylene articular surfaces. The drift toward further varus alignment postoperatively is consistent with the knee adduction moment remaining high after surgery. CLINICAL RELEVANCE While we found a predisposition toward recurrence of the preoperative varus deformity, we did not find increased medial as opposed to lateral polyethylene damage, which may be explained by the curve-on-curve toroidal design of the articulating surfaces of the TKA implants in this study.
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Affiliation(s)
- Zhichang Li
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, China
| | - Christina I. Esposito
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Chelsea N. Koch
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Yuo-yu Lee
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY USA
| | - Douglas E. Padgett
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY USA
| | - Timothy M. Wright
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Zhang Z, Wang L, Hu K, Liu Y. Characteristics of Plantar Loads During Walking in Patients with Knee Osteoarthritis. Med Sci Monit 2017; 23:5714-5719. [PMID: 29194431 PMCID: PMC5721590 DOI: 10.12659/msm.905136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common disease that can change the load on lower limbs during walking. Plantar loads in patients with KOA may provide a basis for clinical decisions regarding footwear and foot orthoses. This study aimed to compare plantar loads in females with and without KOA during gait. MATERIAL AND METHODS Plantar pressure during walking was recorded in 23 females with KOA and 23 females without KOA. Maximum force (MF), contact area (CA), and peak pressure (PP) were measured at 7 different regions underneath the foot, named heel (M1), midfoot (M2), first metatarsophalangeal joint (MPJ) (M3), second MPJ (M4), third to fifth MPJ (M5), hallux (M6), and lesser toes (M7). RESULTS PPs for M2 and (M3) in females with KOA were higher than those in females without KOA. High PPs were also found in females with KOA for M2, M3, and M4. CONCLUSIONS Increased plantar loading in females with KOA may lead to foot pronation and gait changes during walking. Plantar loading may be offered to patients with KOA when considering footwear and foot orthoses.
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Affiliation(s)
- Zhiwang Zhang
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Shanghai, China (mainland)
| | - Lin Wang
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Shanghai, China (mainland)
| | - Kaijun Hu
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Shanghai, China (mainland)
| | - Yu Liu
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Shanghai, China (mainland)
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Telfer S, Lange MJ, Sudduth ASM. Factors influencing knee adduction moment measurement: A systematic review and meta-regression analysis. Gait Posture 2017; 58:333-339. [PMID: 28865395 DOI: 10.1016/j.gaitpost.2017.08.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/07/2017] [Accepted: 08/19/2017] [Indexed: 02/02/2023]
Abstract
The external knee adduction moment has been identified as a key biomarker in biomechanics research, with associations with this variable and degenerative diseases such as knee osteoarthritis. Heterogeneity in participant characteristics and the protocols used to measure this variable may however complicate its interpretation. Previous reviews have focused on interventions or did not control for potential moderator variables in their analysis. In this meta-regression analysis, we aimed to determine the influence of factors including the cohort type, footwear, and walking speed on the measurement of knee adduction moment. We performed a systematic review of the literature, identifying articles that used the Plug-in-Gait inverse dynamics model to calculate the knee adduction moment during level walking, and used a mixed effect model to determine the effect of the previously described factors on the measurement. Results for 861 individuals were described in 19 articles. Walking speed had the largest influence on knee adduction moment (p<0.001), and participants with medial knee osteoarthritis had an increased knee adduction moment (p=0.008) compared to healthy subjects. Footwear was found to have a significant overall effect (p=0.024). Participants tested barefoot or wearing their own shoes had lower adduction moments than those tested in footwear provided by the researchers. Overall, the moderators accounted for 60% of the heterogeneity in the results. These results support the hypothesis that an increased knee adduction moment is associated with medial compartment knee osteoarthritis, and that footwear choice can influence the results. Gait speed has the largest effect on knee adduction moment measurement and should be carefully controlled for in studies investigating this variable.
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Affiliation(s)
- Scott Telfer
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, United States.
| | - Moritz J Lange
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, United States
| | - Amanda S M Sudduth
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, United States
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Schmidt A, Meurer A, Lenarz K, Vogt L, Froemel D, Lutz F, Barker J, Stief F. Unilateral hip osteoarthritis: The effect of compensation strategies and anatomic measurements on frontal plane joint loading. J Orthop Res 2017; 35:1764-1773. [PMID: 27664397 DOI: 10.1002/jor.23444] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/15/2016] [Indexed: 02/04/2023]
Abstract
In order to reduce pain caused by the affected hip joint, unilateral hip osteoarthritis patients (HOAP) adopt characteristic gait patterns. However, it is unknown if the knee and hip joint loading in the non-affected (limbnon-affected ) and the affected (limbaffected ) limb differ from healthy controls (HC) and which gait parameters correlate with potential abnormal joint loading. Instrumented 3D-gait analysis was performed on 18 HOAP and 18 sex, age, and height matched HC. The limbnon-affected showed greater first and second peak external hip adduction moments (first HAM: +15%, p = 0.014; second HAM: +15%, p = 0.021, respectively), than seen in HC. In contrast, the second peak external knee adduction moment (KAM) in the limbaffected is reduced by about 23% and 30% compared to the limbnon-affected and HC, respectively. Furthermore, our patients showed characteristic gait compensation strategies including reduced peak vertical forces (pvF), a greater foot progression angle (FPA), and reduced knee range of motion (ROM) in the limbaffected . The limbaffected was 5.6 ± 3.8 mm shorter than the limbnon-affected . Results of stepwise regression analyses showed that increased first pvF explain 16% of first HAM alterations, whereas knee ROM and FPA explain 39% of second KAM alterations. We therefore expect an increased rate of progression of OA in the hip joint of the limbnon-affected and suggest that the shift in the medial-to-lateral knee joint load distribution may impact the rate of progression of OA in the limbaffected . The level of evidence is III. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1764-1773, 2017.
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Affiliation(s)
- André Schmidt
- Experimental Orthopedics and Trauma Surgery, Frankfurt Initiative for Regenerative Medicine, Johann Wolfgang Goethe University Frankfurt, Marienburgstraße 2, 60528, Frankfurt/Main, Germany.,Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
| | - Andrea Meurer
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
| | - Katharina Lenarz
- Department of Sports Medicine, Johann Wolfgang Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt/Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Johann Wolfgang Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt/Main, Germany
| | - Dara Froemel
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
| | - Frederick Lutz
- Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318, Frankfurt/Main, Germany
| | - John Barker
- Experimental Orthopedics and Trauma Surgery, Frankfurt Initiative for Regenerative Medicine, Johann Wolfgang Goethe University Frankfurt, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
| | - Felix Stief
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
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Xia H, Xu J, Wang J, Hunt MA, Shull PB. Validation of a smart shoe for estimating foot progression angle during walking gait. J Biomech 2017; 61:193-198. [PMID: 28780187 DOI: 10.1016/j.jbiomech.2017.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 07/06/2017] [Accepted: 07/16/2017] [Indexed: 10/19/2022]
Abstract
The foot progression angle is an important measurement related to knee loading, pain, and function for individuals with knee osteoarthritis, however current measurement methods require camera-based motion capture or floor-embedded force plates confining foot progression angle assessment to facilities with specialized equipment. This paper presents the validation of a customized smart shoe for estimating foot progression angle during walking. The smart shoe is composed of an electronic module with inertial and magnetometer sensing inserted into the sole of a standard walking shoe. The smart shoe charges wirelessly, and up to 160h of continuous data (sampled at 100Hz) can be stored locally on the shoe. For validation testing, fourteen healthy subjects were recruited and performed treadmill walking trials with small, medium, and large toe-in (internal foot rotation), small, medium, and large toe-out (external foot rotation) and normal foot progression angle at self-selected walking speeds. Foot progression angle calculations from the smart shoe were compared with measurements from a standard motion capture system. In general, foot progression angle values from the smart shoe closely followed motion capture values for all walking conditions with an overall average error of 0.1±1.9deg and an overall average absolute error of 1.7±1.0deg. There were no significant differences in foot progression angle accuracy across the seven different walking gait patterns. The presented smart shoe could potentially be used for knee osteoarthritis or other clinical applications requiring foot progression angle assessment in community settings or in clinics without specialized motion capture equipment.
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Affiliation(s)
- Haisheng Xia
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Junkai Xu
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jianren Wang
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Peter B Shull
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
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Briggs MS, Bout-Tabaku S, McNally MP, Chaudhari AMW, Best TM, Schmitt LC. Relationships Between Standing Frontal-Plane Knee Alignment and Dynamic Knee Joint Loading During Walking and Jogging in Youth Who Are Obese. Phys Ther 2017; 97:571-580. [PMID: 28339815 DOI: 10.1093/ptj/pzx011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Youth who are obese have high risk of poor knee health and cartilage damage. Understanding factors which may affect knee health in youth who are obese is critical for preservation of knee integrity and function. OBJECTIVE This study compared standing frontal-plane knee alignment and knee loading patterns between youth who are obese and those of healthy weight and determine the association between knee alignment and knee loading patterns during walking and jogging. DESIGN This study used a cross-sectional matched pair design. METHODS Twenty youth who were obese and 20 youth who were healthy-weight (ages 11-18 years) were recruited. Three-dimensional motion analysis quantified standing frontal-plane knee alignment as well as frontal- and sagittal-plane knee moments during walking and jogging. Paired t -tests, multiple analysis of covariance, and Spearman's rank correlation coefficients were used for analysis. RESULTS The youth who were obese demonstrated greater knee valgus in standing ( P = 0.02), lower normalized peak external knee adduction moments during walking ( P = 0.003), and greater normalized peak external knee extension moments during jogging ( P = 0.003) compared with the youth who were healthy-weight. Standing knee alignment did not correlate with knee moments in the youth who were obese. LIMITATIONS Results are limited to small, homogeneous cohorts. The standing alignment methodology is not validated in this population and may limit interpretation of results. CONCLUSION Youth who are obese stand in more knee valgus and have altered knee loading patterns during walking and jogging compared with youth who are healthy-weight. Frontal-plane knee alignment does not correlate with frontal-plane knee loading patterns in youth who are obese. A better understanding of other mechanisms related to joint loading in youth who are obese is necessary to maintain long-term joint integrity in this population.
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Affiliation(s)
- Matthew S Briggs
- The Ohio State University Wexner Medical Center-OSU Sports Medicine, Sports Medicine Research Institute, and Department of Orthopaedics, Columbus, Ohio
| | - Sharon Bout-Tabaku
- Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Michael P McNally
- Health and Rehabilitation Sciences PhD Program, The Ohio State University
| | - Ajit M W Chaudhari
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Thomas M Best
- Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami Miller School of Medicine
| | - Laura C Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave, Columbus, OH 43221 (USA)
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Nagura T, Niki Y, Harato K, Mochizuki T, Kiriyama Y. Analysis of the factors that correlate with increased knee adduction moment during gait in the early postoperative period following total knee arthroplasty. Knee 2017; 24:250-257. [PMID: 28173989 DOI: 10.1016/j.knee.2016.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/15/2016] [Accepted: 11/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Analysis of dynamic knee loading during gait is essential to prevent mechanical failures following total knee arthroplasty. External knee adduction moment during gait is the primary factor producing medial joint reaction force, and an increase in the moment is directly related to an increase in the medial compartment load on the knee. METHODS Knee adduction moment during gait in 39 knees of 32 female patients following a posterior stabilized knee replacement with a single surgeon was evaluated at 1.3months following surgery. A cut-off moment was determined as mean+1 standard deviation (SD) of the moment from 10 healthy subjects, and patients' knees were divided into high- and normal-moment groups. Significant differences in clinical assessments and gait parameters between the two groups were assessed. RESULTS Based on the cut-off moment, 23 knees were grouped into normal knees and 16 knees were grouped into high-moment knees. High-moment knees showed identical femorotibial angles and knee society scores but had greater toe-out angles and medially directed ground reaction forces compared to normal-moment knees. High-moment knees showed strong correlations between peak moment and knee adduction angle, and frontal plain moment arm. CONCLUSIONS The clinical significance of a high knee adduction moment following total knee arthroplasty remains unclear, but dynamic frontal alignment during gait is one of the key factors for residual high-moment knees following surgery.
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Affiliation(s)
- Takeo Nagura
- Department of Clinical Biomechanics, Keio University, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan.
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | | | - Yoshimori Kiriyama
- Department of Mechanical Systems Engineering, Kogakuin University, Tokyo, Japan
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Einfluss von Gangbildmodifikationen und Orthesen auf die Kniegelenkbelastung bei Kniearthrose. MANUELLE MEDIZIN 2017. [DOI: 10.1007/s00337-016-0220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Whelton C, Thomas A, Elson DW, Metcalfe A, Forrest S, Wilson C, Holt C, Whatling G. Combined effect of toe out gait and high tibial osteotomy on knee adduction moment in patients with varus knee deformity. Clin Biomech (Bristol, Avon) 2017; 43:109-114. [PMID: 28237873 DOI: 10.1016/j.clinbiomech.2017.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait adaptations, including toe out gait, have been proposed as treatments for knee osteoarthritis. The clinical application of toe out gait, however, is unclear. This study aims to identify the changes in Knee adduction moment in varus knee deformity assessing toe out gait as an alternative to high tibial osteotomy, and if any change in dynamic loading persists post operatively, when anatomical alignment is restored. METHODS Three-dimensional motion analysis was performed on 17 patients with medial compartment knee osteoarthritis and varus deformity prior to undergoing high tibial osteotomy, 13 patients were assessed post-operatively, and results compared to 13 healthy controls. FINDINGS Pre-operatively, there was no significant difference between natural and toe out gait for measures of knee adduction moment. Post high tibial osteotomy, first (2.70 to 1.51% BW·h) and second peak (2.28 to 1.21% BW·h) knee adduction moment were significantly reduced, as was knee adduction angular impulse (1.00 to 0.52% BW·h·s), to a healthy level. Adopting toe out gait post-operatively reduced the second peak further to a level below that of healthy controls. INTERPRETATION Increasing the foot progression angle from 20° (natural) to 30° in isolation did not significantly alter the knee adduction moment or angular impulse. This suggests that adopting a toe out gait, in isolation, in an already high natural foot progression angle, is not of benefit. Adopting toe out gait post-operatively, however, resulted in a further reduction in the second peak to below that of the healthy control cohort, however, this may increase lateral compartment load.
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Affiliation(s)
- C Whelton
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - A Thomas
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - D W Elson
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK
| | - A Metcalfe
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK
| | - S Forrest
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - C Wilson
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK
| | - C Holt
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - G Whatling
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK.
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Fenner VU, Behrend H, Kuster MS. Joint Mechanics After Total Knee Arthroplasty While Descending Stairs. J Arthroplasty 2017; 32:575-580. [PMID: 27642045 DOI: 10.1016/j.arth.2016.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/14/2016] [Accepted: 07/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Modern knee designs do not fully restore the anatomy and kinematics of the natural knee. This study evaluates the kinematic and kinetic changes of well-functioning patients with total knee arthroplasty (TKA) in comparison to a healthy age-matched control group while descending stairs and level walking. The aim was to have a baseline for further investigations of TKA patients with problems. METHODS Fifteen patients satisfied with TKA (8♀/7♂; 66.8 ± 7.4 years; body mass index (BMI) 25.9 ± 2.8 kg/m2; 2.1 ± 1.3 years postop, LCS Complete) and 17 healthy control subjects (7♀/10♂; 66.6 ± 6.8 years; BMI 25.0 ± 2.2 kg/m2) participated in the study. Kinematic (upper and lower body) and kinetic (lower body) data were collected during stair descending (step height 17 cm) and level walking, using an 8-camera Vicon system and 2 force plates. Parameters were compared using a Student t test. RESULTS Patients after TKA showed significantly lower frontal knee moments and a more externally rotated hip during stance for both level walking and stair descent. There were 31% more significantly different parameters during level walking than during stair descent. CONCLUSION The analysis of stair descending in addition to level walking for satisfied patients does not add additional information for the understanding of the kinematic and kinetic changes after TKA. It seems more important to include the kinematics and kinetics of the hip and ankle joint in all 3-dimensional planes.
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Affiliation(s)
- Verena U Fenner
- besser bewegen, Radolfzell, Germany; Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Henrik Behrend
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Markus S Kuster
- Perth Orthopaedic & Sports Medicine Centre, Perth, Australia
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Na YG, Chang MJ, Eom SH, Kim SJ, Park SC, Kim TK. Coronal alignment on the single-limb stance radiograph in posterolateral rotatory instability, osteoarthritis and healthy knees. Knee 2017; 24:63-69. [PMID: 27692866 DOI: 10.1016/j.knee.2016.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 07/15/2016] [Accepted: 09/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND We aimed to determine whether coronal alignment measured on the single-limb stance (SLS) radiographs differs from those on the double-limb stance (DLS) images. We also investigated whether the size of such differences was affected by the knee pathology, lower limb alignment, and geometry of the tibia or femur. METHODS We measured coronal alignment with mechanical tibiofemoral angle (MTFA) on the DLS and SLS radiographs in patients with posterolateral rotatory instability (PLRI, 30 knees), osteoarthritis (OA) with varus deformity who were scheduled for high tibial osteotomy (HTO) (60 knees), and in normal control (60 knees). The measurements on the SLS radiographs were compared with those on DLS images and the size of the differences were compared between the three groups. The correlation between the radiograph-related differences of coronal alignment and the limb alignment or geometry of tibia/femur was investigated. In the OA group, the size of the radiograph-related differences before HTO were compared with those after surgery. RESULTS The coronal alignment on the SLS radiographs indicated varus accentuation compared to those on the DLS radiographs in the PLRI and OA groups (1.6 and 2.4°, respectively), while it was negligible in the normal group. Greater varus inclination of the tibial plateau was related to greater varus accentuation (r=0.249). The HTO decreased the extent of varus accentuation in the OA group (reduction of varus accentuation=1.5°). CONCLUSIONS Coronal alignment on the SLS radiograph is different from static alignment measured on the DLS radiograph, which may reflect dynamic alignment.
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Affiliation(s)
- Young Gon Na
- Department of Orthopaedic Surgery, CM Hospital, Seoul, Republic of Korea.
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea.
| | - Sang Hwa Eom
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
| | - Seok Jin Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
| | - Seong Cheol Park
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
| | - Tae Kyun Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
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Gaunt T, Carey F, Cahir J, Toms A. Fluid signal changes around the knee on MRI are associated with increased volumes of subcutaneous fat: a case-control study. BMC Musculoskelet Disord 2016; 17:487. [PMID: 27881111 PMCID: PMC5121968 DOI: 10.1186/s12891-016-1345-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/18/2016] [Indexed: 11/12/2022] Open
Abstract
Background Fluid in the subcutaneous fat is a common finding anterior to the knee on MRI. This may be caused by chronic low-grade shearing injuries in patients who are overweight. The purpose of this study was to determine if there is a difference in the amount of subcutaneous fat around the knee between patients with these appearances and controls. Methods This was a retrospective case-control study. Following a sample size calculation on pilot data, eighteen sequential patients demonstrating hyper-intense subcutaneous signal changes around the knee on fat-saturated T2-weighted MRI were identified from PACS (18 females, mean age 45, range 31–62). Age and gender-matched patients without abnormal T2 MR signal changes were selected. Two observers independently drew regions of interest representing cross-sectional areas of bone and fat. The location of T2 signal hyper-intense lesions was characterized by consensus. Results Inter and intra-rater intraclass reproducibility was “excellent” (ICC > 0.8). The mean cross-sectional area of bone for patients with T2 hyper-intense lesions was 31.79cm2 (SD 2.57) and for controls 30.11cm2 (SD 3.20) which was not significantly different (p = 0.09). The median cross-sectional area of fat for the study group was 62.29cm2 (IQR 57.1–66.5) and for controls was 32.77cm2 (IQR 24.8–32.3) which was significantly different (p < 0.0001). Consensus agreement demonstrated all T2 hyper-intense lesions were anterior to the knee extensor mechanism. Conclusion Subcutaneous fluid around the knee is associated with an increased amount of subcutaneous fat, anterior to the knee extensor mechanism. This may be caused by shearing injuries in fat with reduced elasticity associated with metabolic syndrome.
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Affiliation(s)
- Trevor Gaunt
- Norwich Radiology Academy, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UB, UK.
| | - Frank Carey
- Norwich Radiology Academy, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UB, UK
| | - John Cahir
- Norwich Radiology Academy, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UB, UK
| | - Andoni Toms
- Norwich Radiology Academy, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UB, UK
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Exercise Alters Gait Pattern but Not Knee Load in Patients with Knee Osteoarthritis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7468937. [PMID: 27725941 PMCID: PMC5048036 DOI: 10.1155/2016/7468937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/04/2016] [Accepted: 06/12/2016] [Indexed: 11/18/2022]
Abstract
Six female patients with bilateral medial knee OA and 6 healthy controls were recruited. Patients with knee OA received a 6-week physiotherapist-supervised and home-based exercise program. Outcome measures, including the Western Ontario and McMaster Universities Arthritis Index and Short Form-36 Health Survey as well as objective biomechanical indices were obtained at baseline and follow-up. After treatment, no significant difference was observed in the knee abductor moment (KAM), lever arm, and ground reaction force. We, however, observed significantly improved pain and physical function as well as altered gait patterns, including a higher hip flexor moment and hip extension angle with a faster walking speed. Although KAM was unchanged, patients with bilateral knee OA showed an improved walking speed and altered the gait pattern after 6 weeks of supervised exercise. This finding suggests that the exercise intervention improves proximal joint mechanics during walking and can be considered for patients with bilateral knee OA. Non-weight-bearing strengthening without external resistance combined with stretching exercise may be an option to improve pain and function in individuals with OA who cannot perform high resistance exercises owing to pain or other reasons.
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Shimada S, Kobayashi S, Wada M, Sasaki S, Kawahara H, Uchida K, Yayama T, Baba H. Effect of compensation procedures for velocity on repeatability and variability of gait parameters in normal subjects. Clin Rehabil 2016; 20:239-45. [PMID: 16634343 DOI: 10.1191/0269215506cr935oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effects of a mathematical procedure that adjusts for gait velocity on the variability seen in gait analysis. Design: Evaluation before and after compensation. Setting: Gait laboratory, Fukui University Hospital, Japan. Subjects: Fourteen normal volunteers. Outcome measures: A computerized gait analysis system with two forceplates and a light source spot measuring device was used. Gait measurement in each subject was performed on three different days. Results: The gait parameters measured on three different days were significantly different, particularly step length, stride length, velocity, the components of floor-reaction forces and hip motion. In these parameters, intraclass correlation coefficient, ICC (1,1) was not high (range 0.05-0.71). However, there was a high correlation between these parameters and velocity and high repeatability was obtained following compensation for velocity (ICC (1,1), range 0.73-0.97). In contrast, compensation of parameters whose measurement was not significantly different before compensation did not improve ICC (1,1). Variability of all parameters was acceptable, however CV (an index of variability) improved significantly after compensation compared with that before compensation in six of 15 parameters. Conclusions: Our findings suggest that low repeatability in gait parameters should be considered even when the gait of normal subjects is measured on different days. A high repeatability and more acceptable variability were obtained when the data were compensated for velocity.
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Affiliation(s)
- Seiichiro Shimada
- Division of Physical Therapy and Rehabilitation Medicine, Fukui University Hospital, Japan.
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MacLean KF, Callaghan JP, Maly MR. Effect of obesity on knee joint biomechanics during gait in young adults. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1173778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kathleen F.E. MacLean
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Canada
| | - Jack P. Callaghan
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Canada
| | - Monica R. Maly
- Department of Rehabilitation Sciences, McMaster University, Room 435 Institutes of Applied Health Sciences, 1400 Main Street West, Hamilton, Ontario, Canada L8S 1C7
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