Individual joint contributions to the total support moment during the sit-to-stand task differentiate mild and moderate knee osteoarthritis

Trunk Biomechanics in Individuals with Knee Disorders: A Systematic Review with Evidence Gap Map and Meta-analysis

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.

Altered lower extremity biomechanics following anterior cruciate ligament reconstruction during single-leg and double-leg stop-jump tasks: A bilateral total support moment analysis

BACKGROUND

Injury to the anterior cruciate ligament (ACL) can lead to long-lasting biomechanical alterations that put individuals at risk of a second ACL injury. Examining the total support moment may reveal between- and within-limb compensatory strategies.

METHODS

Twenty-six participants who were cleared to return to sport following ACL reconstruction were recruited. Each participant completed the single-leg and double-leg stop jump tasks. These tasks were analyzed using force plates and a 3D motion analysis system. The total support moment was calculated by summing the internal moments of the hip, knee and ankle at peak vertical ground reaction force.

FINDINGS

Internal knee extensor moment was lower in the involved limb compared to the uninvolved for both tasks (17.6%, P = 0.022; 18.4%, P = 0.008). No significant between-limb differences were found for the total support moment. The involved limb exhibited an 18.2% decrease in knee joint contribution (P = 0.01) and a 21.6% increase in ankle joint contribution (P = 0.016) to the total support moment compared to the uninvolved limb in the single-leg stop jump task.

INTERPRETATION

Compensation for the involved knee is likely due to altered biomechanics that redistributes load to the uninvolved knee or to adjacent joints of the same limb. A partial shift in joint contribution from the knee to the ankle during the single-leg stop jump task demonstrates a tendency to decrease load to the knee. Further studies are needed to investigate how these adaptations impact the prevalence of subsequent injury and poor joint health.

Validation of Smartphone Accelerometry for the Evaluation of Sit-To-Stand Performance and Lower-Extremity Function in Older Adults

This study tested the concurrent and construct validity of smartphone accelerometry measurement of sit-to-stand (STS) performance in individuals aged 65-89 years. Normal and fast STS times were recorded by smartphone accelerometer, force plate, and video motion systems concurrently, and isokinetic knee extension power and STS whole-body power were obtained. Normal and fast speed STS times from a smartphone accelerometer agreed closely with force plate and motion system methods (mean difference = 0.04 s). Normal and fast STS times were inversely related to isokinetic knee extension power (r = -.93, p < .001 and r = -.82, p < .001, respectively) and STS whole-body power (r = -.76, p < .001 and r = -.70, p < .001, respectively). The STS time obtained from a smartphone accelerometer was equivalent to the established, precise measures of STS time and was related to lower-extremity power, making it a potentially useful metric of lower-extremity function.

Kinetics, kinematics, and knee muscle activation during sit to stand transition in unilateral and bilateral knee osteoarthritis

BACKGROUND

The sit to stand transition (STS) is a task performed by those with knee osteoarthritis (KOA) with biomechanical modifications that may influence the lower limb load distribution. As a weight bearing task mainly performed in the sagittal plane, the presence of unilateral or bilateral KOA may lead to asymmetry during its performance.

RESEARCH QUESTION

Are the biomechanical and neuromuscular aspects of the sit to stand transition (STS) different between participants with unilateral and bilateral KOA?

METHODS

Twenty-eight participants were allocated as follows: unilateral KOA (OA_UNI; n = 12) and bilateral KOA (OA_BI; n = 16). All participants were evaluated by means of kinematics (Qualisys Motion Capture System, Qualisys Medical AB, SUE), kinetics (Bertec Corporation's model 4060-08 Mod., USA), and electromyography (TrignoTM Wireless System, DelSys Inc., USA) during the STS. The variables calculated were the symmetry indices of the total support moment (TSM) and ground reaction force (IS_GRF and IS_TSM, respectively), magnitude of the TSM, individual joint contribution to the TSM, peak trunk flexion, hip, knee, and ankle range of motion, duration in seconds, the magnitudes of activation of the extensor and flexor muscles, knee extensors: flexor co-contraction indices and isometric knee extensor peak torques. Participants also answered the WOMAC questionnaire and performed the 30-second STS test (STS₃₀).

RESULTS

The OA_BI got up from a chair with a lower TSM magnitude in the most affected limb (p = 0.040), used greater trunk flexion amplitude (p ≤ 0.034), and presented lower isometric KET (p = 0.039) and worse self-reported pain (p = 0.011) and physical function (p = 0.015).

SIGNIFICANCE

Participants with unilateral and bilateral KOA differ regarding lower limb kinetics and trunk kinematics while getting up from a chair, without modification in the lower limb intersegmental coordination or symmetry regarding ground reaction force or TSM distribution.

Association between hip extensor muscle weakness and disability of activities of daily living in patients with early-stage knee osteoarthritis

INTRODUCTION

This study aimed to investigate the association between hip extensor muscle weakness and performance of activities of daily living (ADL) including stair ambulation, sit-to-stand (STS), and walking in patients with early-stage knee osteoarthritis (OA).

METHODS

Community-dwelling older individuals (age ≥ 65 years and Kellgren-Lawrence grade 1-2) were recruited in this cross-sectional study. The ability to perform stair ambulation, STS, and walking was measured using the Japanese Knee Osteoarthritis Measure. The maximum isometric knee extensor and hip extensor muscle strengths were evaluated. To investigate the association between hip extensor muscle strength and performance on ADL, a multivariate logistic analysis was conducted, adjusting for age, sex, and knee extensor muscle strength.

RESULTS

A total of 161 participants were included in this study. Multivariate logistic analysis revealed a significant association between lower hip extensor muscle strength and higher presence of difficulty in stair ambulation [odds ratio (OR), 0.33; 95% confidence interval (CI), 0.11. 0.98; p < 0.05] and STS (OR, 0.32; 95% CI, 0.11. 0.92; p < 0.05). No significant association between hip extensor muscle strength and difficulty in walking was observed (OR, 0.47; 95% CI, 0.14. 1.62; p = 0.23).

CONCLUSIONS

Hip extensor muscle weakness was associated with difficulty during stair ambulation and STS in patients with early-stage knee OA, after adjusting for knee extensor muscle strength. The results suggest that hip extensor muscle strength may be important to improve or maintain ADL in patients with early-stage knee OA.