Association between quadriceps function, joint kinetics, and spatiotemporal gait parameters in young adults with and without obesity

Inter-joint coordination and lower limb support in those with ACL-reconstruction

Individuals with anterior cruciate ligament reconstruction (ACLR) adopt altered walking patterns that shift support demands away from the surgical knee which may necessitate compensatory ankle or hip action to provide sufficient support. It is unclear how those with ACLR adapt and coordinate inter-joint motions to redistribute support demands during walking. Here, we compared lower-limb support and inter-joint coordination during walking in those with ACLR. Treadmill walking was evaluated in 28 individuals with ACLR and 20 healthy controls at preferred speed. The sum of sagittal joint moments in ankle, knee and hip was used to calculate total support moment (TSM) and individual joint contributions (%) to the TSM. Inter-joint coordination of ankle-knee and knee-hip was evaluated using a modified vector coding technique during early, mid and late stance. Paired t-tests compared TSM and joint contributions between-limbs (α = 0.05). Wilcoxon signed-rank tests compared coordination patterns (α = 0.05). We observed smaller 1st peak TSM in the ACLR limb (p < 0.01) and 6 % greater hip contributions in ACLR limbs (p = 0.02). We observed greater ankle motions in early and midstance, and greater hip motions in mid-late stance in ACLR limbs relative to comparison limbs. Overall, the ACLR limb exhibited coordination alterations characterized by increased reliance on ankle and knee motions to accommodate rigid knee mechanics throughout stance compared to non-ACLR and control limbs. Together, these joint coordination strategies may reduce and/or redistribute support demands in the ACLR limb to lessen muscular requirements for support and propulsion.

Knee Extensor Structure and Function in Children, Adolescents, Adults, and Older Adults With Obesity: A Systematic Review and Meta-Analysis

OBJECTIVE

This study aims to evaluate the association between obesity and both absolute and relative measures of knee extensor muscle structure and contractile function across different age groups, including children, adolescents, adults, and older adults.

METHODS

A search for potential studies was performed in four electronic databases. Data were meta-analyzed using a random-effects model for our primary outcomes of knee extensor structure (muscle size and quality) and function (maximal force/torque, rapid torque, and fatigue) and compared between those with or without obesity in each age group.

RESULTS

The findings indicate that obesity significantly increases absolute measures of knee extensor maximal contractile function and muscle size. However, obesity was associated with a decrease in relative measures of maximal and rapid contractile function and muscle quality. The association of obesity with these muscle characteristics varied by age group, with the effects on knee extensor structure and function diminishing with age.

CONCLUSIONS

This systematic review and meta-analysis demonstrate that while obesity enhances absolute knee extensor muscle size and maximal force/torque, it detrimentally affects relative muscle function and quality, particularly related to activities of daily living. These effects are less pronounced in older adults, suggesting that age modulates the impact of obesity on muscle structure and function. The findings underscore the importance of interventions targeting the improvement of relative muscle function and quality in individuals with obesity. Further research is necessary to better understand these relationships and to develop more effective intervention strategies for obesity.

REGISTRATION

This protocol was prospectively registered in the Open Science Framework (DOI: 10.17605/OSF.IO/ZGUK6).

The difference in gait pattern between adults with obesity and adults with a normal weight, assessed with 3D-4D gait analysis devices: a systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis were performed following PRISMA 2020 guidelines to identify the difference in gait pattern between adults with obesity and adults with a normal bodyweight assessed with 3D-4D gait analysis (3D-4DGA) devices.

METHODS

Articles about the spatiotemporal parameters of adults with obesity compared with adults with a normal bodyweight using a 3DGA were sought on the 4th of October 2023 in three different databases (PubMed, Web of Science and IEEE). A total of 3371 articles were found: 2065 with PubMed, 1185 with Web of Science, and 121 with IEEE. The data was screened double-blind. Fourteen case control studies were included in the systematic review and meta-analysis, and for all of them, the risk of bias was determined. Obesity was defined using the BMI, with a range of 30 kg/m² until 54.06 kg/m². Participants from both sexes (35% men and 65% women) were included, and they had an age range of 18-65 years.

RESULTS AND DISCUSSION

The risk of bias was assessed with the Newcastle Ottowa Scale (NOS), and the certainty of evidence was assessed with the Evidence-Based Richtlijn Ontwikkeling (EBRO). The meta-analysis showed a decrease in gait speed and cadence and an increase in stance phase, double stance, and step width. No significant difference was found regarding stride length. In the systematic review, step length, step rate, and swing phase were found to have decreased. Regarding the single stance, step time, CoM, and CoP, no conclusions could be drawn.

CONCLUSION

There is a difference in gait parameters between adults with obesity and adults with a normal bodyweight. Namely, the gait speed, step rate, step length, swing phase is decreased in adults with obesity. However, there is an increase in step width, stance phase, and double stance phase.

Associations between Body Mass Index, Gait Mechanics and Trochlear Cartilage Thickness in Those with ACL Reconstruction

PURPOSE

High body mass index (BMI) is a strong predictor of posttraumatic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR). Altered gait mechanics are independently affected by BMI and ACLR, and influence OA risk. Yet, evidence directly assessing the impact of high BMI on gait or cartilage characteristics after ACLR are limited. Here, we evaluated if high BMI moderates associations between gait and trochlear cartilage structure in individuals with ACLR.

METHODS

Treadmill walking biomechanics were evaluated in 40 normal BMI and 24 high BMI participants with ACLR at self-selected speeds. Normalized and absolute peak and cumulative loads (i.e., impulse) were extracted for peak knee flexion and adduction moments (KFM, KAM) and vertical ground reaction force (GRF). Medial and lateral femoral cartilage thickness and medial/lateral thickness ratios were assessed via ultrasound.

RESULTS

Those with ACLR and high BMI walked with reduced normalized peak vertical GRFs, and greater absolute peak and cumulative loads compared with normal BMI individuals with ACLR. Those with ACLR and high BMI also exhibited thinner cartilage and greater medial/lateral ratios in ACLR limbs compared with contralateral limbs whereas normal BMI individuals with ACLR exhibited thicker ACLR limb cartilage. Lastly, greater peak KAM and KAM cumulative load were associated with thicker lateral cartilage and lesser medial/lateral thickness ratios, but only in the high BMI group.

CONCLUSIONS

We observed those with high BMI after ACLR exhibited trochlear cartilage structural alterations not observed in normal BMI patients, whereas differential associations between loading outcomes and cartilage thickness in ACLR knees were observed between groups. Those with high BMI after ACLR may require different therapeutic strategies to optimize joint health in this subset of patients.

Contributing factors to postural stability in Prader-Willi syndrome

BACKGROUND

Prader-Willi Syndrome (PWS) is a rare neurodevelopmental disorder affecting multiple functional parameters. This study examined postural stability and associated gait and neuromuscular factors in young adults with PWS.

METHODS

Participants included 10 adults with PWS [7 M/3F; Body Fat % 40.61 ± 7.79]; ten normal weight (NW) adults [7 M/3F; Body Fat % 23.42 ± 7.0]; ten obese (OB) adults [7 M/3F; Body Fat % 42.40 ± 5.62]. Participants completed the Sensory Organization Test (SOT)®. Condition (C) specific and a composite equilibrium score (CES) were calculated (maximum = 100). Quadriceps strength was assessed using an isokinetic dynamometer. Three-dimensional gait analyses were completed along a 10 m walkway using a motion capture system and two force plates. A gait stability ratio (GSR) was computed from gait speed and step length (steps/m).

RESULTS

The PWS group had lower scores for C1, C3, C4 and CES compared to the NW (p < .039 for all) and lower scores for C4 and CES than the OB (p < .019 for both) groups, respectively. In C5 (eyes closed, sway-referenced support) and C6 (sway-referenced vision and support), 33.3% of participants with PWS fell during the first trial in both conditions (X2 [2] 7.436, p = .024) and (X2 [2] 7.436, p = .024) but no participant in the other groups fell. Those with PWS showed higher GSR than participants with NW (p = .005) and those with obesity (p = .045).

CONCLUSION

Individuals with PWS had more difficulty maintaining standing balance when relying on information from the somatosensory (C3), visual-vestibular (C4) and vestibular systems (C5, C6). A more stable walk was related to shorter steps, slower velocity and reduced peak quadriceps torque. Participation in multisensory activities that require appropriate prioritization of sensory system(s) input for controlling balance in altered sensory environments should be routinely included. In addition, exercises targeting muscular force and power should be included as part of exercise programming in PWS.

Absent loading response knee flexion: The impact on gait kinetics and centre of mass motion in individuals with unilateral transfemoral amputation, and the effect of microprocessor controlled knee provision

BACKGROUND

Individuals with unilateral transfemoral amputation walk with increased levels of asymmetry, and this is associated with reduced gait efficiency, back pain and overuse of the intact limb. This study investigated the effect of walking with a unilateral absence of loading response knee flexion on the symmetry of anterior-posterior kinetics and centre of mass accelerations.

METHODS

A retrospective cohort study design was used, assessing three-dimensional gait data from individuals with unilateral transfemoral amputation (n = 56). The anterior-posterior gait variables analysed included; peak ground reaction forces, impulse, centre of mass acceleration, as well as rate of vertical ground reaction force increase in early stance. With respect to these variables, this study assessed the symmetry between intact and prosthetic limbs, compared intact limbs against a healthy unimpaired control group, and evaluated effect on symmetry of microprocessor controlled knee provision.

FINDINGS

Significant between-limb asymmetries were found between intact and prosthetic limbs across all variables (p < 0.0001). Intact limbs showed excessive loading when compared with control group limbs after speed normalisation across all variables (p < 0.0001). No improvement in kinetic symmetry following microprocessor controlled knee provision was found.

INTERPRETATION

The gait asymmetries for individuals with transfemoral amputation identified in this study suggest that more should be done by developers to address the resultant overloading of the intact limb, as this is thought to have negative long-term effects. The provision of microprocessor controlled knees did not appear to improve the asymmetries faced by individuals with transfemoral amputation, and clinicians should be aware of this when managing patient expectations.

Technological Solutions for Human Movement Analysis in Obese Subjects: A Systematic Review

Obesity has a critical impact on musculoskeletal systems, and excessive weight directly affects the ability of subjects to realize movements. It is important to monitor the activities of obese subjects, their functional limitations, and the overall risks related to specific motor tasks. From this perspective, this systematic review identified and summarized the main technologies specifically used to acquire and quantify movements in scientific studies involving obese subjects. The search for articles was carried out on electronic databases, i.e., PubMed, Scopus, and Web of Science. We included observational studies performed on adult obese subjects whenever reporting quantitative information concerning their movement. The articles must have been written in English, published after 2010, and concerned subjects who were primarily diagnosed with obesity, thus excluding confounding diseases. Marker-based optoelectronic stereophotogrammetric systems resulted to be the most adopted solution for movement analysis focused on obesity; indeed, wearable technologies based on magneto-inertial measurement units (MIMUs) were recently adopted for analyzing obese subjects. Further, these systems are usually integrated with force platforms, so as to have information about the ground reaction forces. However, few studies specifically reported the reliability and limitations of these approaches due to soft tissue artifacts and crosstalk, which turned out to be the most relevant problems to deal with in this context. In this perspective, in spite of their inherent limitations, medical imaging techniques-such as Magnetic Resonance Imaging (MRI) and biplane radiography-should be used to improve the accuracy of biomechanical evaluations in obese people, and to systematically validate less-invasive approaches.

Quadriceps strength is negatively associated with knee joint structural abnormalities-data from osteoarthritis initiative

OBJECTIVE

The aim of this study was to explore the longitudinal associations between baseline quadriceps strength and knee joint structural abnormalities in knee osteoarthritis (KOA).

METHODS

This study is a longitudinally observational study based on Osteoarthritis Initiative (OAI) cohort, including men and women aged 45-79. Quadriceps strength was measured by isometric knee extension testing at baseline. Knee joint structural abnormalities, including cartilage damage, bone marrow lesions (BMLs), effusion-synovitis and Hoffa-synovitis, were evaluated by Magnetic Resonance Imaging Osteoarthritis Knee Score (MOAKS) at baseline and 1-year follow-up. Generalized estimating equations were employed to examine the associations between quadriceps strength and knee structural abnormalities. All analyses were stratified by sex.

RESULTS

One thousand three hundred thirty-eight participants (523 men and 815 women) with a mean age of 61.8 years and a mean BMI of 29.4 kg/m² were included in this study. For men, no significantly longitudinal association of quadriceps strength with structural abnormalities was detected. In contrast, quadriceps strength was significantly and negatively associated with changes in cartilage damage and BMLs in lateral patellofemoral joint (PFJ) (cartilage damage: OR: 0.91, 95% CI 0.84 to 0.99, P = 0.023; BMLs: OR: 0.85, 95% CI 0.74 to 0.96, P = 0.011) and effusion-synovitis (OR = 0.88, 95% CI 0.78 to 0.99, P = 0.045) among females longitudinally. Higher quadriceps strength was significantly associated with less progression of lateral PFJ cartilage damage, BMLs and effusion-synovitis in females.

CONCLUSIONS

Higher quadriceps strength was associated with changes in cartilage damage and BMLs within the lateral PFJ and effusion-synovitis among females, suggesting the potential protective role of quadriceps strength on joint structures in women.

Kinematics predictors of spatiotemporal parameters during gait differ by age in healthy individuals

Joint biomechanics and spatiotemporal gait parameters change with age or disease and are used in treatment decision-making.

RESEARCH QUESTION

To investigate whether kinematic predictors of spatiotemporal parameters during gait differ by age in healthy individuals.

METHODS

We used an open dataset with the gait data of 114 young adults (M = 28.0 years, SD = 7.5) and 128 older adults (M = 67.5 years, SD = 3.8) walking at a comfortable self-selected speed. Linear regression models were developed to predict spatiotemporal parameters separately for each group using joint kinematics as independent variables.

RESULTS

In young adults, knee flexion loading response and hip flexion/extension were the common predictors of gait speed; hip flexion and hip extension contributed to explaining the stride length; hip flexion contributed to explaining the cadence and stride time. In older adults, ankle plantarflexion, knee flexion loading response, and pelvic rotation were the common predictors of the gait speed; ankle plantarflexion and knee flexion loading response contributed to explaining the stride length; ankle plantarflexion loading response and ankle plantarflexion contributed to explain the cadence, stride width and stride time.

SIGNIFICANCE

Our results suggest that the ability of joint kinematic variables to estimate spatiotemporal parameters during gait differs by age in healthy individuals. Particularly in older adults, ankle plantarflexion was the common predictor of the spatiotemporal parameters, suggesting the importance of the ankle for gait parameters in this age group. This provides insight for clinicians into the most effective evaluation and has been used by physical professionals in prescribing the most appropriate exercises to attenuate the effects produced by age-related neuromuscular changes.