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Ling H, Roberts KL, Kao D, Balasubramanian R. Force-amplifying implant to improve key pinch strength in tendon transfer surgery: Cadaver model proof-of-concept. J Orthop Res 2023. [PMID: 36606426 DOI: 10.1002/jor.25511] [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: 08/10/2022] [Revised: 12/23/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
The brachioradialis (BR) to flexor pollicis longus (FPL) tendon transfer surgery is a common procedure used to restore key pinch grip for incomplete spinal cord injury patients. However, the procedure only restores 22% of the physiological grip strength, which is important for successfully grasping objects and minimizing fatigue. The purpose of this study was to evaluate the efficacy of using a novel force-amplifying pulley implant to modify the standard BR to FPL tendon transfer surgery to improve key pinch grip strength in a human cadaver forearm model. A total of eight cadaveric specimens were mounted onto a custom testbed where a torque-controlled motor actuated the BR tendon to produce key pinch grip. In each cadaver, two experimental groups were examined: a standard and an implant-modified BR to FPL tendon transfer surgery. A force sensor mounted to the thumb recorded isometric key pinch grip forces over a range of input BR forces (2 N-25 N) applied in a ramp-and-hold protocol. Across the range of input BR forces, the average improvement in key pinch grip strength in the implant-modified surgery compared to the standard surgery was 58 ± 7.1% (ranging from 41% to 64% improvement). Throughout the experiments, we observed that the implant did not hinder the movement of the BR or FPL tendons. These results suggest that a BR to FPL tendon transfer surgery utilizing a force-amplifying pulley implant to augment force transmission can provide additional functional strength restoration over the standard procedure that directly sutures two tendons together.
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Affiliation(s)
- Hantao Ling
- School of Mechanical, Industrial and Manufacturing Engineering, Oregon State University, Corvallis, Oregon, USA
| | - Kai L Roberts
- School of Mechanical, Industrial and Manufacturing Engineering, Oregon State University, Corvallis, Oregon, USA
| | - Dennis Kao
- Institute of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ravi Balasubramanian
- School of Mechanical, Industrial and Manufacturing Engineering, Oregon State University, Corvallis, Oregon, USA
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Waiteman MC, Chia L, Ducatti MHM, Bazett-Jones DM, Pappas E, de Azevedo FM, Briani RV. Trunk Biomechanics in Individuals with Knee Disorders: A Systematic Review with Evidence Gap Map and Meta-analysis. SPORTS MEDICINE - OPEN 2022; 8:145. [PMID: 36503991 PMCID: PMC9742076 DOI: 10.1186/s40798-022-00536-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The trunk is the foundation for transfer and dissipation of forces throughout the lower extremity kinetic chain. Individuals with knee disorders may employ trunk biomechanical adaptations to accommodate forces at the knee or compensate for muscle weakness. This systematic review aimed to synthesize the literature comparing trunk biomechanics between individuals with knee disorders and injury-free controls. METHODS Five databases were searched from inception to January 2022. Observational studies comparing trunk kinematics or kinetics during weight-bearing tasks (e.g., stair negotiation, walking, running, landings) between individuals with knee disorders and controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and evidence gap maps were created. RESULTS A total of 81 studies investigating trunk biomechanics across six different knee disorders were included (i.e., knee osteoarthritis [OA], total knee arthroplasty [TKA], patellofemoral pain [PFP], patellar tendinopathy [PT], anterior cruciate ligament deficiency [ACLD], and anterior cruciate ligament reconstruction [ACLR]). Individuals with knee OA presented greater trunk flexion during squatting (SMD 0.88, 95% CI 0.58-1.18) and stepping tasks (SMD 0.56, 95% CI 0.13-.99); ipsilateral and contralateral trunk lean during walking (SMD 1.36; 95% CI 0.60-2.11) and sit-to-stand (SMD 1.49; 95% CI 0.90-2.08), respectively. Greater trunk flexion during landing tasks in individuals with PFP (SMD 0.56; 95% CI 0.01-1.12) or ACLR (SMD 0.48; 95% CI 0.21-.75) and greater ipsilateral trunk lean during single-leg squat in individuals with PFP (SMD 1.01; 95% CI 0.33-1.70) were also identified. No alterations in trunk kinematics of individuals with TKA were identified. Evidence gap maps outlined the lack of investigations for individuals with PT or ACLD, as well as for trunk kinetics across knee disorders. CONCLUSION Individuals with knee OA, PFP, or ACLR present with altered trunk kinematics in the sagittal and frontal planes. The findings of this review support the assessment of trunk biomechanics in these individuals in order to identify possible targets for rehabilitation and avoidance strategies. TRIAL REGISTRATION PROSPERO registration number: CRD42019129257.
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Affiliation(s)
- Marina C. Waiteman
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
| | - Lionel Chia
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,Cleveland Guardians Baseball Company, Cleveland, OH USA
| | - Matheus H. M. Ducatti
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
| | - David M. Bazett-Jones
- grid.267337.40000 0001 2184 944XSchool of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH USA
| | - Evangelos Pappas
- grid.1007.60000 0004 0486 528XSchool of Medicine and Illawarra Health and Medical Research Institute, The University of Wollongong, Wollongong, NSW Australia
| | - Fábio M. de Azevedo
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
| | - Ronaldo V. Briani
- grid.410543.70000 0001 2188 478XDepartment of Physical Therapy, School of Science and Technology, Sao Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, Sao Paulo 19060-900 Brazil
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Ferreira AM, Salim R, Fogagnolo F, de Oliveira LFL, Riberto M, Kfuri M. The Value of a Standardized Knee Functional Assessment in Predicting the Outcomes of Total Knee Arthroplasty. J Knee Surg 2022; 35:1126-1131. [PMID: 33511585 DOI: 10.1055/s-0040-1722321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Questionnaires and physical tests are tools to determine the ability of an individual to perform tasks of the daily living. In our institution, a standardized knee performance evaluation including patient-reported outcome measures (PROMs) and physical performance tests has been applied to all patients undergoing total knee arthroplasty (TKA). Our goal was to identify which preoperative tools influence the outcomes of a TKA and if physical performance tests can be of value if used along with PROMs in predicting functional outcomes. Classification and regression tree was used to analyze which preoperative factors influence function after TKA. Western Ontario and McMaster Universities Arthritis Index (WOMAC) function (WOMAC-F), 6-minute walk test (6MWT), and timed up and go (TUG) test at the 12th postoperative month were the dependent variables. Age, body mass index, preoperative WOMAC function and pain score, muscle strength, 6MWT, and TUG test score were used as preoperative predictors of dependent variables. TUG ≤19.3 seconds and age <62 years were preoperative predictors of better scores in the WOMAC-F (5.5). Strength of extensor muscles of the nonoperated knee ≥99.43 N·m/kg and 6MWT> 328 m were preoperative predictors of a better postoperative 6MWT (499 m). TUG <12.3 seconds and 6MWT ≥421 m were preoperative predictors of better postoperative TUG (7.3 seconds). Preoperative performance in physical tests had an influence on postoperative outcome scores than PROMs after TKA. Less age, good muscular strength, greater capacity of walking, and smaller TUG times were associated with better outcomes.
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Affiliation(s)
- Aline Miranda Ferreira
- Departament of Health Care, Rehabilitation Center of the Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Rodrigo Salim
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Fabricio Fogagnolo
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Luciano Fonseca Lemos de Oliveira
- Departament of Health Care, Rehabilitation Center of the Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Marcelo Riberto
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Mauricio Kfuri
- Departament of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Van Criekinge T, Winnock de Grave P, Luyckx T, Claeys K. Trunk control, motion and alignment after total knee arthroplasty: a systematic review and meta-analysis. Gait Posture 2022; 94:173-188. [PMID: 35339965 DOI: 10.1016/j.gaitpost.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trunk control improves mobility, balance and quality of life early after total knee arthroplasty (TKA) and is therefore considered an important parameter during the recovery process. However, little is known about trunk control, motion and alignment after TKA. Increasing our understanding aids in optimizing treatment strategies to enhance functional mobility after TKA. RESEARCH QUESTION Does trunk control, motion and alignment return to normal after TKA and is this related to functional mobility? METHODS Five scientific databases were searched until July 2021. Eligibility criteria consisted of outcomes assessing trunk control and alignment in a population of adults undergoing TKA. Two reviewers independently screened studies and risk of bias was assessed by Mixed Methods Appraisal Tool (MMAT). Meta-analysis was performed for subgroups gait and alignment. RESULTS Of the 362 studies retrieved, 24 were included. Study designs were cohorts with mixed methods (pre-post treatment, case-control and case-case) and three randomized controlled trials. The mean MMAT score was 75%, corresponding to low bias. In total 1178 patients and 197 controls were included. Results showed that pre-operative trunk motion was characterized by increased amplitudes in all three planes and altered alignment which did not all return to normal after TKA. Frontal plane motion and alignment recovered faster than the sagittal and transversal plane. Although pelvic tilt improved after surgery, sagittal imbalance (anteriorly shifted trunk position) was still present. SIGNIFICANCE Recovery of trunk motion after TKA is time-, speed- and technique-dependent. The observed differences in trunk motion with the healthy controls persisted after TKA. This indicates that incorporating a full biomechanical chain approach, including trunk motion and gait-retraining exercises with a strong focus on postural alignment could improve functional mobility after TKA. Limited studies are available assessing trunk control and trunk motion during functional tasks besides walking which warrant further investigation.
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Affiliation(s)
- Tamaya Van Criekinge
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Bruges, Belgium.
| | | | - Thomas Luyckx
- Dept. Orthopedic Surgery, AZ Delta Roeselare, Roeselare, Belgium
| | - Kurt Claeys
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Bruges, Belgium
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Yoshida T, Ebiko J, Sasaki K, Uchiyama E, Kura H. Recovery process of the muscle activities during walking with efficient early quadriceps training and gait exercises after total knee arthroplasty. J Bodyw Mov Ther 2022; 29:49-53. [DOI: 10.1016/j.jbmt.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/27/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
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Bates AV, McGregor AH, Alexander CM. Comparing sagittal plane kinematics and kinetics of gait and stair climbing between hypermobile and non-hypermobile people; a cross-sectional study. BMC Musculoskelet Disord 2021; 22:712. [PMID: 34412618 PMCID: PMC8377885 DOI: 10.1186/s12891-021-04549-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 07/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background Joint Hypermobility Syndrome (JHS) presents with a range of symptoms including widespread joint hypermobility and chronic arthralgia. The study objective was to investigate whether impairments in JHS are due to hypermobility or another factor of JHS by identifying impairments in gait and stair-climbing tasks; an activity that is demanding and so may better show differences between the cohorts. Methods Sixty-eight adults participated; 23 JHS, 23 Generalised Joint Hypermobility (GJH), and 22 Normal Flexibility (NF). Inclusion criteria for JHS participants were a positive classification using the Brighton Criteria, for GJH a Beighton Score ≥ 4, and for NF a Beighton Score < 4 with no hypermobile knees. Participants were recorded with a 10-camera Vicon system whilst they performed gait and stair-climbing. Temporal-spatial, and sagittal plane kinematic and kinetic outcome measures were calculated and input to statistical analyses by statistical parametric mapping (SPM). Results During the gait activity JHS had significantly greater stride time and significantly lower velocity than NF, and significantly greater stride time, lower velocity, and lower stride length than GJH. SPM analysis showed no significant differences between groups in gait kinematics. There were significant differences between groups for gait moments and powers; people with JHS tended to have lower moments and generate less power at the ankle, and favour power generation at the knee. A similar strategy was present in stair ascent. During stair descent people with JHS showed significantly more hip flexion than people with NF. Conclusions As there was only one significant difference between GJH and NF we conclude that impairments cannot be attributed to hypermobility alone, but rather other factor(s) of JHS. The results show that both gait and stair-climbing is impaired in JHS. Stair-climbing results indicate that JHS are using a knee-strategy and avoiding use of the ankle, which may be a factor for clinicians to consider during treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04549-2.
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Affiliation(s)
- Alexander Vernon Bates
- Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Therapies, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK.
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Physiotherapy, Imperial College Healthcare NHS Trust, London, UK
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Kline PW, Jacobs CA, Duncan ST, Noehren B. Rate of torque development is the primary contributor to quadriceps avoidance gait following total knee arthroplasty. Gait Posture 2019; 68:397-402. [PMID: 30594013 PMCID: PMC6384120 DOI: 10.1016/j.gaitpost.2018.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Following rehabilitation for total knee arthroplasty, "quadriceps avoidance gait", defined by limited knee flexion angle excursion during walking, persists and contributes to poor long-term outcomes. Given the presence of several post-surgical impairments, identifying the contribution of multiple factors to knee flexion angle excursion is important to developing targeted interventions to improve recovery after total knee arthroplasty. RESEARCH QUESTIONS Which outcomes continue to improve following rehabilitation for total knee arthroplasty? What are the primary contributors to impaired knee flexion angle excursion during walking following total knee arthroplasty? METHODS Peak muscle strength and rate of torque development of the quadriceps, hip abductors, and hip external rotators, five-time sit-to-stand test, Knee Injury & Osteoarthritis Outcome Score, and gait mechanics were assessed in 24 participants at three and six months post-surgery. Paired sample t-tests or Wilcoxon Signed-Rank tests were used to compare outcomes between assessments. Stepwise multiple linear regression were used to assess the contribution of each measure to knee flexion angle excursion. RESULTS Significant improvements were noted in all outcomes except hip external rotation rate of torque development, gait speed, and knee flexion angle excursion. Quadriceps rate of torque development and knee pain significantly contributed to knee flexion angle excursion at three months (Adjusted R2 = 0.342), while quadriceps rate of torque development and peak hip external rotation strength significantly contributed at six months (Adjusted R2 = 0.436). SIGNIFICANCE While higher pain levels at three months and greater peak hip external rotation muscle strength at six months contribute to impaired knee flexion angle excursion, quadriceps rate of torque development was the primary contributor to knee flexion angle excursion at both three and six months after surgery. Implementing strategies to maximize quadriceps rate of torque development during rehabilitation may help to reduce quadriceps avoidance gait after total knee arthroplasty.
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Affiliation(s)
- Paul W. Kline
- Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA 40536-0200
| | - Cale A. Jacobs
- Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA 40536-0200,Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 125 E. Maxwell Street, Suite 201, Lexington, KY, USA 40508
| | - Stephen T. Duncan
- Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA 40536-0200,Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 125 E. Maxwell Street, Suite 201, Lexington, KY, USA 40508
| | - Brian Noehren
- Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA 40536-0200,Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 125 E. Maxwell Street, Suite 201, Lexington, KY, USA 40508,Division of Physical Therapy, College of Health Sciences, University of Kentucky, Room 204D Wethington Building, 900 South Limestone St, Lexington, KY, USA 40536
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Pozzi F, Marmon AR, Snyder-Mackler L, Zeni J. Lower leg compensatory strategies during performance of a step up and over task in patient six-months after total knee arthroplasty. Gait Posture 2016; 49:41-46. [PMID: 27362279 PMCID: PMC9148504 DOI: 10.1016/j.gaitpost.2016.06.018] [Citation(s) in RCA: 10] [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: 06/30/2015] [Revised: 05/27/2016] [Accepted: 06/12/2016] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to assess the ankle, knee, and hip joint contributions to the total support moment (TSM) and the activation patterns of muscles in the lower leg in patients after total knee arthroplasty (TKA) and healthy older adults during the step up and over task. Moreover, the relationship between quadriceps strength and knee contribution to TSM was measured. Twenty patients six-months after TKA and twenty healthy controls were recruited for this study. Motion and surface electromyographic (EMG) analyses were performed during a step up and over task. Biomechanics and EMG variables were compared between groups using ANCOVA models with movement speed as covariate. Patients after TKA had reduced contribution to the TSM from the knee joint, and greater contribution from the hip and ankle joints, possibly to compensate for the reduced contribution at the knee. No consistent differences of EMG activation or co-contraction were found between groups. Patients with stronger quadriceps had significantly higher knee contribution to TSM during the lowering phase of the task. The results of this study suggest that patients after TKA may use compensatory strategies at the hip and ankle joints to safely perform the step up and over task. Patients may rely on the force generating ability of the quadriceps during the lowering phase as they are not able to compensate with other joints of the lower extremity during this phase of the task.
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Affiliation(s)
- Federico Pozzi
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CPH 155, Los Angeles, CA 90266, United States.
| | - Adam R Marmon
- Department of Physical Therapy, University of Delaware, United States; Department of Orthopaedics and Rehabilitation Services, Christiana Health Care System, United States
| | | | - Joseph Zeni
- Department of Physical Therapy, University of Delaware, United States
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9
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Zahn RK, Fussi J, von Roth P, Perka CF, Hommel H. Postoperative Increased Loading Leads to an Alteration in the Radiological Mechanical Axis After Total Knee Arthroplasty. J Arthroplasty 2016; 31:1803-7. [PMID: 26923499 DOI: 10.1016/j.arth.2016.01.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/04/2016] [Accepted: 01/20/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Standing long-leg radiographs allow assessment of the mechanical axis in the frontal plane before and after total knee arthroplasty (TKA). An alteration in loading, and hence in the forces acting on the knee joint, occurs postoperatively. We therefore postulated that the mechanical axis measured in the long-leg standing radiograph would change within the first year after TKA. METHODS Standing long-leg radiographs of 156 patients were performed 7 days, 3 months, and 12 months after TKA with determination of mechanical axis of the lower limb. RESULTS Seven days after surgery, the mechanical axis amounted 0.8° ± 1.7° valgus. Three months after the operation, at 1.3° ± 1.3° varus, it was significantly different (P < .001) from the primary measurement. No further alteration in the mechanical axis occurred during the first year after TKA. This difference was even more pronounced (P < .001) in patients with a postoperative lack of complete extension. Seven days after surgery, they had a valgus axis deviation of 1.6° ± 1.6°; after 3 months, the measurement amounted 1.2° ± 1.3° varus. CONCLUSION Measured by a standing long-leg radiograph, the frontal mechanical axis after TKA changes over time. The predictive power of a standing long-leg radiograph in the first week after surgery is limited because limb loading is altered because of pain and is therefore nonphysiological. The actual mechanical axis resulting after TKA can only be assessed in a standing long-leg radiograph at physiological loading.
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Affiliation(s)
- Robert Karl Zahn
- Department of Orthopaedics and Traumatology, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jasmin Fussi
- Department of Orthopaedics and Traumatology, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp von Roth
- Department of Orthopaedics and Traumatology, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten F Perka
- Department of Orthopaedics and Traumatology, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hagen Hommel
- Orthopedic Department, Hospital Märkisch Oderland, Wriezen, Germany
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10
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Ardestani MM, Moazen M. How human gait responds to muscle impairment in total knee arthroplasty patients: Muscular compensations and articular perturbations. J Biomech 2016; 49:1620-1633. [DOI: 10.1016/j.jbiomech.2016.03.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
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Knee kinematics during stair descent 20 years following anterior cruciate ligament rupture with and without reconstruction. Clin Biomech (Bristol, Avon) 2016; 32:180-6. [PMID: 26690754 DOI: 10.1016/j.clinbiomech.2015.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Changes and asymmetries for walking gait have been explored extensively following injuries of anterior cruciate ligaments within ten years of injury or reconstruction. We examined longer term knee joint kinematics of reconstructed and non-reconstructed knees during stair descent compared to controls. METHODS Three-dimensional knee kinematics during stair descent were registered for 33 subjects with ACL reconstruction, 36 subjects with ACL rupture managed with physiotherapy only and 31 uninjured controls. Injured subjects were 23.5 (2.1) years following injury. Linear mixed models were used to compare temporal variables and knee kinematics during stance phase between groups and contralateral sides. FINDINGS Walking speed was slower for the both ACL-injured groups compared to controls and stance duration was longer for the injured than the uninjured sides of the physiotherapy-only group. Compared to controls, the physiotherapy-only group had significantly less adduction at initial foot contact of the injured and uninjured knees. The uninjured side of the physiotherapy-only group also had less flexion than controls at initial foot contact and during weight acceptance. Compared to the surgically-managed group, the injured sides of the physiotherapy-only groups had significantly less adduction at initial contact, peak adduction during weight acceptance, and peak flexion during propulsion. INTERPRETATION Independent of treatment, altered knee kinematics exist more than 20 years following ACL injury during stair descent. We suggest that future studies investigating short and long-term kinematic outcomes of ACL injury could evaluate stair descent with particular emphasis on weight acceptance of stance, and potential associations to perceived knee function.
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Smith JW, Marcus RL, Tracy BL, Foreman KB, Christensen JC, LaStayo PC. Stance time variability during stair stepping before and after total knee arthroplasty: A pilot study. Hum Mov Sci 2015; 45:53-62. [PMID: 26590484 DOI: 10.1016/j.humov.2015.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
The main objectives of this pilot study were to: (1) investigate stance time variability (STV) during stair stepping in older adults with osteoarthritis (OA) before and after total knee arthroplasty (TKA), and compare to an age- and sex-matched group of healthy controls with native knees and (2) evaluate the relationship between quadriceps strength and STV during stair stepping before and after TKA. A prospective, observational, pilot study was carried out on 13 individuals (15% male, mean age 62.71±6.84years) before and after TKA using an instrumented stairway, patient-reported outcomes, timed stair stepping test, and quadriceps strength measures. At 6-months post-operatively, STV during stair descent was significantly greater in the TKA-GROUP compared to the CONTROL-GROUP, but was not significantly different at 12-months compared to controls. There were no significant differences in STV for stair ascent between the pre- and post-operative visits, or compared to controls. There was a trend toward significance for the relationship between quadriceps strength and STV during stair ascent (P=0.059) and descent (P=0.073). Variability during stair stepping may provide an important, short-term rehabilitation target for individuals following TKA and may represent another parameter to predict declines in functional mobility.
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Affiliation(s)
- Jessica W Smith
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
| | - Robin L Marcus
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Department of Exercise and Sport Science, University of Utah, Salt Lake City, UT, USA
| | - Brian L Tracy
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - K Bo Foreman
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Jesse C Christensen
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Paul C LaStayo
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Department of Orthopedics, University of Utah, Salt Lake City, UT, USA; Department of Exercise and Sport Science, University of Utah, Salt Lake City, UT, USA
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Pötzelsberger B, Lindinger SJ, Stöggl T, Buchecker M, Müller E. Alpine Skiing With total knee ArthroPlasty (ASWAP): effects on gait asymmetries. Scand J Med Sci Sports 2015; 25 Suppl 2:49-59. [DOI: 10.1111/sms.12484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/28/2022]
Affiliation(s)
- B. Pötzelsberger
- Department of Sport Science and Kinesiology; University of Salzburg; Salzburg Austria
| | - S. J. Lindinger
- Department of Sport Science and Kinesiology; University of Salzburg; Salzburg Austria
| | - T. Stöggl
- Department of Sport Science and Kinesiology; University of Salzburg; Salzburg Austria
- Swedish Winter Sports Research Centre; Department of Health Sciences; Mid Sweden University; Östersund Sweden
| | - M. Buchecker
- Department of Sport Science and Kinesiology; University of Salzburg; Salzburg Austria
| | - E. Müller
- Department of Sport Science and Kinesiology; University of Salzburg; Salzburg Austria
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14
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Biomechanics of Lower Limbs during Walking among Candidates for Total Knee Arthroplasty with and without Low Back Pain. BIOMED RESEARCH INTERNATIONAL 2015; 2015:142562. [PMID: 26171387 PMCID: PMC4480238 DOI: 10.1155/2015/142562] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/02/2015] [Accepted: 05/20/2015] [Indexed: 12/01/2022]
Abstract
The effect of joint pathologies, such as unilateral knee osteoarthritis (UKOA) or low back pain (LBP), on bilateral gait symmetry has gained increased attention during the past decade. This study is the first to compare gait patterns between patients with UKOA and LBP in combination and with UKOA only. Temporal, kinematic, and kinetic variables were measured bilaterally during gait stance phase in 31 subjects with UKOA and LBP (Group I) and 11 subjects with only UKOA (Group II). Group I patients exhibited less hip rotation in the affected limb (A) than in the nonaffected (NA) limb during walking in contrast to Group II patients. Group I patients had minimal bilateral differences in hip abduction and flexion, but Group II patients displayed significantly larger values in the NA limb compared to the A limb for both parameters. Hip flexion patterns were significantly different between Groups I and II. Subjects in both groups adapted gait patterns that minimized vertical ground reaction force, knee flexion motion, and stance time on the UKOA affected limb. The distinct kinematic gait patterns that were revealed in this study may provide clinical value for assessment of patients with UKOA in conjunction with LBP.
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15
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Luder G, Schmid S, Stettler M, Mueller Mebes C, Stutz U, Ziswiler HR, Radlinger L. Stair climbing – An insight and comparison between women with and without joint hypermobility: A descriptive study. J Electromyogr Kinesiol 2015; 25:161-7. [DOI: 10.1016/j.jelekin.2014.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022] Open
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