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Carvalho C, Viadanna Serrão F, Felipe Martinez A, Da Silva Serrão PRM. Three-dimensional kinematics of the trunk, pelvis, hip, and knee during the single-leg squat and hip torque in subjects with isolated patellofemoral osteoarthritis compared to individually matched controls: Preliminary results. Arch Rheumatol 2024; 39:33-45. [PMID: 38774690 PMCID: PMC11104754 DOI: 10.46497/archrheumatol.2024.9814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/22/2023] [Indexed: 05/24/2024] Open
Abstract
Objectives: This study aimed to compare three-dimensional kinematic of the trunk, pelvis, hip, and knee during the single-leg squat and hip torque in individuals with and without isolated patellofemoral osteoarthritis (PFOA). Patients and methods: This cross-sectional study evaluated trunk, pelvis, hip, and knee kinematics at 30°, 45°, and 60° knee flexion during the single-leg squat using the Vicon motion capture and analysis system, the Nexus System 2.1.1, and 3D Motion Monitor software. Sixteen individuals (8 males, 8 females; mean age: 49.3±6.2 years; range 40 to 61 years) participated in the study, of which eight were PFOA patients and eight were healthy controls. Isometric hip abductor, extensor, and external rotator torques were evaluated using a handheld dynamometer. Results: The PFOA group exhibited greater hip adduction at 30° (p=0.008), 45° (p=0.005), and 60° (p=0.008) knee flexion in the descending phase of the single-leg squat, as well as at 60° (p=0.009) and 45° (p=0.03) knee flexion in the ascending phase. No significant differences were found between groups for other kinematic variables (p>0.05). The PFOA group exhibited lower isometric hip abductor (p=0.02), extensor (p <0.001), and external rotator (p=0.007) torques. Conclusion: Individuals with PFOA exhibited excessive hip adduction that could increase stress on the lateral patellofemoral joint at 30°, 45°, and 60° knee flexion during the single-leg squat and exhibited weakness of the hip abductors, extensors, and external rotators in comparison to healthy controls.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
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Suzuki Y, Ohkoshi Y, Kawakami K, Shimizu K, Chida S, Ukishiro K, Onodera T, Iwasaki K, Maeda T, Suzuki S, Kondo E, Iwasaki N. Assessing knee joint biomechanics and trunk posture according to medial osteoarthritis severity. Sci Rep 2023; 13:19186. [PMID: 37932370 PMCID: PMC10628121 DOI: 10.1038/s41598-023-46486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023] Open
Abstract
During progression of knee osteoarthritis (OA), gait biomechanics changes three-dimensionally; however, its characteristics and trunk posture according to OA severity remain unknown. The present study investigated three-dimensional knee joint biomechanics and trunk posture according to knee OA severity. Overall, 75 patients (93 knees) with medial knee OA [Kellgren-Lawrence grade ≥ 2, grade 2: 20 patients with 24 knees (mean 60.0 years old); grade 3: 25 with 28 knees (mean 62.0 years old); grade 4: 30 with 41 knees (mean 67.9 years old)] and 14 healthy controls (23 knees, mean 63.6 years old) underwent gait analysis using an optical motion capture system and point cluster technique. In grade 2 knee OA, the relative contribution of the knee adduction moment (KAM) increased significantly (P < 0.05), and that of the knee flexion moment decreased (P < 0.05) prior to significant progression of varus knee deformity. Grade 3 knee OA showed significant exacerbation of varus knee deformity (P < 0.01) and KAM increase (P < 0.001). The maximum knee extension angle decreased (P < 0.05) and trunk flexion increased during gait in grade 4 knee OA (P < 0.001). Our study clarified the kinematics and kinetics of medial knee OA with trunk flexion according to severity. Kinetic conversion occurred in grade 2 knees prior to progression of varus deformities, knee flexion contractures, and sagittal imbalance during gait in patients with severe knee OA.
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Affiliation(s)
- Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
- Department of Orthopedic Surgery, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan.
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Kensaku Kawakami
- Department of Production Systems Eng., National Institute of Technology, Hakodate College, Tokura-cho 14-1, Hakodate, Hokkaido, 042-8501, Japan
| | - Kenta Shimizu
- Department of Rehabilitation, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Shuya Chida
- Department of Rehabilitation, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Kengo Ukishiro
- Department of Rehabilitation, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Sho'ji Suzuki
- Department of Complex and Intelligent Systems, Future University Hakodate, Kamedanakano-cho 116-2, Hakodate, Hokkaido, 041-8655, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Kita 14 jo Nishi 5 chome, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Sacco ICN, Trombini-Souza F, Suda EY. Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: A 50-year perspective. J Biomech 2023; 154:111604. [PMID: 37159980 DOI: 10.1016/j.jbiomech.2023.111604] [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: 01/26/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
The pivotal role of biomechanics in the past 50 years in consolidating the basic knowledge that underpins prevention and rehabilitation measures has made this area a great spotlight for health practitioners. In clinical practice, biomechanics analysis of spatiotemporal, kinematic, kinetic, and electromyographic data in various chronic conditions serves to directly enhance deeper understanding of locomotion and the consequences of musculoskeletal dysfunctions in terms of motion and motor control. It also serves to propose straightforward and tailored interventions. The importance of this approach is supported by myriad biomechanical outcomes in clinical trials and by the development of new interventions clearly grounded on biomechanical principles. Over the past five decades, therapeutic interventions have been transformed from fundamentally passive in essence, such as orthoses and footwear, to emphasizing active prevention, including exercise approaches, such as bottom-up and top-down strengthening programs for runners and people with osteoarthritis. These approaches may be far more effective inreducing pain, dysfunction, and, ideally, incidence if they are based on the biomechanical status of the affected person. In this review, we demonstrate evidence of the impact of biomechanics and motion analysis as a foundation for physical therapy/rehabilitation and preventive strategies for three chronic conditions of high worldwide prevalence: diabetes and peripheral neuropathy, knee osteoarthritis, and running-related injuries. We conclude with a summary of recommendations for future studies needed to address current research gaps.
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Affiliation(s)
- Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Francis Trombini-Souza
- Department of Physical Therapy, University of Pernambuco, Petrolina, Pernambuco, Brazil; Master's and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Eneida Yuri Suda
- Postgraduate Program in Physiotherapy, Universidade Ibirapuera, São Paulo, Brazil
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Prebble M, Wei Q, Martin J, Eddo O, Lindsey B, Cortes N. Simulated Tibiofemoral Joint Reaction Forces for Three Previously Studied Gait Modifications in Healthy Controls. J Biomech Eng 2023; 145:041004. [PMID: 36196804 PMCID: PMC9791677 DOI: 10.1115/1.4055885] [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: 03/29/2022] [Revised: 09/07/2022] [Indexed: 12/30/2022]
Abstract
Gait modifications, such as lateral trunk lean (LTL), medial knee thrust (MKT), and toe-in gait (TIG), are frequently investigated interventions used to slow the progression of knee osteoarthritis. The Lerner knee model was developed to estimate the tibiofemoral joint reaction forces (JRF) in the medial and lateral compartments during gait. These models may be useful for estimating the effects on the JRF in the knee as a result of gait modifications. We hypothesized that all gait modifications would decrease the JRF compared to normal gait. Twenty healthy individuals volunteered for this study (26.7 ± 4.7 years, 1.75 ± 0.1 m, 73.4 ± 12.4 kg). Ten trials were collected for normal gait as well as for the three gait modifications: LTL, MKT, and TIG. The data were used to estimate the JRF in the first and second peaks for the medial and lateral compartments of the knee via opensim using the Lerner knee model. No significant difference from baseline was found for the first peak in the medial compartment. There was a decrease in JRF in the medial compartment during the loading phase of gait for TIG (6.6%) and LTL (4.9%) and an increasing JRF for MKT (2.6%). but none was statistically significant. A significant increase from baseline was found for TIG (5.8%) in the medial second peak. We found a large variation in individual responses to gait interventions, which may help explain the lack of statistically significant results. Possible factors influencing these wide ranges of responses to gait modifications include static alignment and the impacts of variation in muscle coordination strategies used, by participants, to implement gait modifications.
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Affiliation(s)
- Matt Prebble
- Sports Medicine, Assessment, Research, and Testing (SMART) Laboratory, School of Kinesiology, George Mason University, Manassas, VA 20109
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, VA 22030
| | - Joel Martin
- Sports Medicine, Assessment, Research, and Testing (SMART) Laboratory, School of Kinesiology, George Mason University, Manassas, VA 20109
| | - Oladipo Eddo
- Sports Medicine, Assessment, Research, and Testing (SMART) Laboratory, College of Education, School of Kinesiology, George Mason University, Manassas, VA 20109
| | - Bryndan Lindsey
- Human Performance and Biomechanics Group Applied Physics Laboratory, The Johns Hopkins University, Laurel, MD 20723
| | - Nelson Cortes
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex CO4 3SQ, UK
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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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Fukaya T, Mutsuzaki H, Mori K. Sway and Acceleration Changes of the Center of Mass during Walking Stance Phase before and after Total Knee Arthroplasty. Geriatrics (Basel) 2022; 8:geriatrics8010002. [PMID: 36648907 PMCID: PMC9844275 DOI: 10.3390/geriatrics8010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Elucidating the sway and changes in the acceleration of center of mass (COM) during walking is important for effective gait training and rehabilitation. The objective of this study was to verify the improvement in gait before and after total knee arthroplasty (TKA) from COM sway and the changes in the acceleration of COM during the stance phase of walking. This study included 13 patients (1 male and 12 females) with medial knee osteoarthritis who were hospitalized for TKA. The COM sway during the stance phase of walking was evaluated using root mean square (RMS) normalized by walking speed, and the changes in acceleration were further verified. Lateral and vertical RMS showed significant differences between preoperative and postoperative states and demonstrated low values after TKA. The lateral acceleration at the latter part of the early stance phase demonstrated a significant difference between preoperative and postoperative states. A significant difference was also observed in the lateral acceleration in the late stance phase between the two groups. Improvement in pain and alignment after TKA reduced the lateral sway of COM and the changes in acceleration during the gait stance phase, which is speculated to lead to improvement in gait and prevention of falls.
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Affiliation(s)
- Takashi Fukaya
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, 6-8-33 Manabe, Tsuchiura 300-0051, Japan
- Correspondence:
| | - Hirotaka Mutsuzaki
- Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Koichi Mori
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
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Boekesteijn RJ, van Gerven J, Geurts ACH, Smulders K. Objective gait assessment in individuals with knee osteoarthritis using inertial sensors: A systematic review and meta-analysis. Gait Posture 2022; 98:109-120. [PMID: 36099732 DOI: 10.1016/j.gaitpost.2022.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/16/2022] [Accepted: 09/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Objective assessment of gait using inertial sensors has shown promising results for functional evaluations in individuals with knee osteoarthritis (OA). However, the large number of possible outcome measures calls for a systematic evaluation of most relevant parameters to be used for scientific and clinical purposes. AIM This systematic review and meta-analysis aimed to identify gait parameters derived from inertial sensors that reflect gait deviations in individuals with knee OA compared to healthy control subjects (HC). METHODS A systematic search was conducted in five electronic databases (Medline, Embase, Web of Science, CINAHL, IEEE) to identify eligible articles. Risk of bias was assessed using a modified version of the Downs and Black scale. Data regarding study population, experimental procedures, and biomechanical outcomes were extracted. When a gait parameter was reported by a sufficient number of studies, a random-effects meta-analysis was conducted using the inverse variance method. RESULTS Twenty-three articles comparing gait between 411 individuals with knee OA and 507 HC were included. Individuals with knee OA had a lower gait speed than HC (standardized mean difference = -1.65), driven by smaller strides with a longer duration. Stride time variability was slightly higher in individuals with knee OA than in HC. Individuals with knee OA walked with a lower range of motion of the knee during the swing phase, less lumbar motion in the coronal plane, and a lower foot strike and toe-off angle compared to HC. SIGNIFICANCE This review shows that inertial sensors can detect gait impairments in individuals with knee OA. Large standardized mean differences found on spatiotemporal parameters support their applicability as sensitive endpoints for mobility in individuals with knee OA. More advanced measures, including kinematics of knee and trunk, may reveal gait adaptations that are more specific to knee OA, but compelling evidence was lacking.
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Affiliation(s)
- R J Boekesteijn
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - J van Gerven
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands.
| | - A C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - K Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands.
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Boekesteijn R, Smolders J, Busch V, Keijsers N, Geurts A, Smulders K. Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures. PeerJ 2022; 10:e14054. [PMID: 36193431 PMCID: PMC9526408 DOI: 10.7717/peerj.14054] [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: 05/02/2022] [Accepted: 08/24/2022] [Indexed: 01/20/2023] Open
Abstract
Background Inertial sensors hold the promise to objectively measure functional recovery after total knee (TKA) and hip arthroplasty (THA), but their value in addition to patient-reported outcome measures (PROMs) has yet to be demonstrated. This study investigated recovery of gait after TKA and THA using inertial sensors, and compared results to recovery of self-reported scores of pain and function. Methods PROMs and gait parameters were assessed before and at two and fifteen months after TKA (n = 24) and THA (n = 24). Gait parameters were compared with healthy individuals (n = 27) of similar age. Gait data were collected using inertial sensors on the feet, lower back, and trunk. Participants walked for two minutes back and forth over a 6m walkway with 180° turns. PROMs were obtained using the Knee Injury and Osteoarthritis Outcome Scores and Hip Disability and Osteoarthritis Outcome Score. Results Gait parameters recovered to the level of healthy controls after both TKA and THA. Early improvements were found in gait-related trunk kinematics, while spatiotemporal gait parameters mainly improved between two and fifteen months after TKA and THA. Compared to the large and early improvements found in of PROMs, these gait parameters showed a different trajectory, with a marked discordance between the outcome of both methods at two months post-operatively. Conclusion Sensor-derived gait parameters were responsive to TKA and THA, showing different recovery trajectories for spatiotemporal gait parameters and gait-related trunk kinematics. Fifteen months after TKA and THA, there were no remaining gait differences with respect to healthy controls. Given the discordance in recovery trajectories between gait parameters and PROMs, sensor-derived gait parameters seem to carry relevant information for evaluation of physical function that is not captured by self-reported scores.
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Affiliation(s)
- Ramon Boekesteijn
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands,Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José Smolders
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Vincent Busch
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander Geurts
- Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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Kim D, Lewis CL, Silverman AK, Gill SV. Changes in dynamic balance control in adults with obesity across walking speeds. J Biomech 2022; 144:111308. [PMID: 36150320 DOI: 10.1016/j.jbiomech.2022.111308] [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: 03/14/2022] [Revised: 08/19/2022] [Accepted: 09/13/2022] [Indexed: 11/27/2022]
Abstract
Adults with obesity have gait instability, leading to increased fall risks and decreased physical activity. Whole-body angular momentum (WBAM) is regulated over a gait cycle, essential to avoid a fall. However, how obese adults regulate WBAM during walking is unknown. The current study investigated changes in WBAM about the body's center of mass (COM) during walking in obese and non-obese adults across different walking speeds. Twenty-eight young adults with obesity and normal weight walked barefoot at a fixed walking speed (FWS, 1.25 m/s) and at five different speeds based on their preferred walking speed (PWS): 50, 75, 100, 125, and 150 % of PWS. Adults with obesity walked slower with shorter step length, wider step width, and longer double support time (p < 0.01). The ranges of frontal- and transverse-plane WBAM were greater in obese adults (p < 0.01). We also found that the range of frontal-plane WBAM did not significantly change with walking speed (p > 0.05), while the range of transverse-plane WBAM increased with walking speed (p < 0.01). The ranges of frontal- and transverse-plane WBAM increased with the mediolateral ground reaction force and mediolateral moment arm (p < 0.01), which may be most affected by lateral foot placement relative to the body's COM. Our findings suggest that controlling mediolateral stability during walking is more challenging in obese adults, independent of their slow walking speed. Understanding whole-body rotational dynamics observed in obese walking provides an insight into the biomechanical link between obesity and gait instability, which may help find a way to reduce fall risks and increase physical activity.
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Affiliation(s)
- Daekyoo Kim
- College of Health and Rehabilitation Science: Sargent College, 635 Commonwealth Avenue, Boston University, Boston, MA 02215, USA.
| | - Cara L Lewis
- College of Health and Rehabilitation Science: Sargent College, 635 Commonwealth Avenue, Boston University, Boston, MA 02215, USA
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, USA
| | - Simone V Gill
- College of Health and Rehabilitation Science: Sargent College, 635 Commonwealth Avenue, Boston University, Boston, MA 02215, USA
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Hutchison L, Grayson J, Hiller C, D'Souza N, Kobayashi S, Simic M. Relationship Between Knee Biomechanics and Pain in People With Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2022; 75:1351-1361. [PMID: 35997473 DOI: 10.1002/acr.25001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/25/2022] [Accepted: 08/16/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Our primary aim was to determine the cross-sectional relationship between knee biomechanics during gait and pain in people with medial knee osteoarthritis. Our secondary aim was to evaluate differences in knee biomechanics between symptomatic and asymptomatic participants with medial knee osteoarthritis. METHODS Four online databases were searched from inception to July 2021. Eligible studies included people with medial/nonspecific knee osteoarthritis and a reported relationship between knee biomechanics during gait and pain or biomechanics of symptomatic and asymptomatic participants. Two reviewers independently extracted data and evaluated risk of bias. Random-effects meta-analyses were performed when three or more studies reported the same biomechanical variable for pooling (knee adduction moment [KAM], KAM impulse, varus thrust, and peak knee flexion moment [KFM]). RESULTS Forty studies were included. Methodological quality ranged from 4 to 9/10. Forty-seven unique biomechanical variables were reported. For the KAM, there was no correlation with pain for peak values pooled (early stance and overall) (r = 0.00, 95% confidence interval [95% CI]: -0.12, 0.11, k = 16), a small negative correlation for early stance peak alone (r = -0.09, 95% CI -0.18, -0.002, k = 12), and a medium positive correlation for the overall peak during stance (r = 0.30, 95% CI 0.17, 0.42, k = 4). Metaregression identified that body mass index moderated the peak KAM-pain relationship (P < 0.001). KAM impulse had a small positive correlation with pain (r = 0.23, 95% CI 0.04, 0.40, k = 5), and people with varus thrust had 3.84 greater odds of reporting pain compared with people without (95% CI 1.72, 8.53, k = 3). Meta-analyses for the peak KFM and pain correlation and secondary aim were nonsignificant. CONCLUSION Some knee gait biomechanics were associated with pain in this cohort. Longitudinal studies are required to determine causality.
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Affiliation(s)
- Laura Hutchison
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Jane Grayson
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Claire Hiller
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Nicole D'Souza
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Kobayashi
- The University of Sydney, Camperdown, New South Wales, Australia, and Australian Catholic University, North Sydney, New South Wales, Australia
| | - Milena Simic
- The University of Sydney, Camperdown, New South Wales, Australia
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11
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Gupta D, Donnelly CJ, Reinbolt JA. Finding Emergent Gait Patterns May Reduce Progression of Knee Osteoarthritis in a Clinically Relevant Time Frame. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071050. [PMID: 35888138 PMCID: PMC9318542 DOI: 10.3390/life12071050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
A high contact force between the medial femoral condyle and the tibial plateau is the primary cause of medial compartment knee osteoarthritis (OA). A high medial contact force (MCF) during gait has been shown to be correlated to both the knee adduction moment (KAM) and knee flexion/extension moment (KFM). In this study, we used OpenSim Moco to find gait kinematics that reduced the peaks of the KAM, without increasing the peaks of the KFM, which could potentially reduce the MCF and, hence, the progression of knee OA. We used gait data from four knee OA participants. Our simulations decreased both peaks of the KAM without increasing either peak of the KFM. We found that increasing the step width was the primary mechanism, followed by simulations of all participants to reduce the frontal plane lever arm of the ground reaction force vector about the knee, in turn reducing the KAM. Importantly, each participant simulation followed different patterns of kinematic changes to achieve this reduction, which highlighted the need for participant-specific gait modifications. Moreover, we were able to simulate emerging gait patterns within 15 min, enhancing the relevance and potential for the application of developed methods in clinical settings.
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Affiliation(s)
- Dhruv Gupta
- Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee, Knoxville, TN 37996, USA
- Correspondence: (D.G.); (J.A.R.)
| | - Cyril John Donnelly
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore 308232, Singapore;
- School of Human Sciences (Health and Sport Sciences), The University of Western Australia, Crawley, WA 6009, Australia
| | - Jeffrey A. Reinbolt
- Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee, Knoxville, TN 37996, USA
- Correspondence: (D.G.); (J.A.R.)
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12
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Ulman S, Erdman A, Loewen A, Dressing M, Wyatt C, Oliver G, Butler L, Sugimoto D, Black AM, Janosky J. Concurrent Validity of Movement Screening Criteria Designed to Identify Injury Risk Factors in Adolescent Female Volleyball Players. Front Sports Act Living 2022; 4:915230. [PMID: 35813049 PMCID: PMC9263117 DOI: 10.3389/fspor.2022.915230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Anterior cruciate ligament (ACL) injuries in female adolescent athletes occur at disproportionately high levels compared to their male counterparts. However, limited prospective data exist on the validity of low-cost screening tools that can proactively identify ACL injury risk, specifically for female athletes. The purpose of this study was to assess the concurrent validity of a three-task injury risk factor assessment by comparing visually derived outcome scores from two-dimensional (2D) video data with dichotomized three-dimensional (3D) biomechanical variables collected using motion capture technology. A total of 41 female club volleyball athletes (14.7 ± 1.4 years) were tested and asked to perform three tasks: double-leg vertical jump (DLVJ), single-leg squat (SLS), and single-leg drop landing (SLDL). One rater was trained on the scoring criteria for the 2D data and independently scored one forward-facing and one side-facing video for each task. Risk factors identified included poor knee position, lateral trunk lean, and excessive trunk flexion/extension. In addition, 3D joint angles were calculated for the trunk and knee in the sagittal and frontal planes and converted to dichotomous variables based on biomechanical thresholds of injury risk. For comparison of 2D and 3D outcomes, percent agreement and Cohen's kappa were calculated for each risk factor individually. Overall, 2D scores were found to exhibit moderate to excellent percent agreement with 3D outcomes for trunk position (69.1–97.1%). Specifically, ipsilateral trunk lean during single-leg tasks exhibited the highest agreement (85.3–88.2%) with moderate reliability (κ = 0.452–0.465). In addition, moderate to substantial reliability was found for trunk flexion during double-leg tasks (κ = 0.521–0.653); however, an evaluation of single-leg tasks resulted in only fair reliability (κ = 0.354). Furthermore, 2D scores were not successful in identifying poor knee position as percent agreement fell below 50% for both the single-leg tasks and averaged 60% agreement across both the phases of the DLVJ. Kappa coefficients further emphasized these trends indicating no to slight concurrent validity (κ = −0.047–0.167) across tasks. Overall, these findings emphasize the potential for valid, low-cost screening tools that can identify high-risk movement patterns. Further study is needed to develop improved assessment guidelines that may be employed through visual assessment in sports environments.
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Affiliation(s)
- Sophia Ulman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- *Correspondence: Sophia Ulman
| | - Ashley Erdman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Alex Loewen
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Michael Dressing
- Department of Orthopedics, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Charles Wyatt
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gretchen Oliver
- Sports Medicine and Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Lauren Butler
- Department of Rehabilitation, Nicklaus Children's Hospital, Miami, FL, United States
| | - Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
| | - Amanda M. Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Joseph Janosky
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, United States
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13
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Kobsar D, Barden JM, Clermont C, Wilson JLA, Ferber R. Sex differences in the regularity and symmetry of gait in older adults with and without knee osteoarthritis. Gait Posture 2022; 95:192-197. [PMID: 35525152 DOI: 10.1016/j.gaitpost.2022.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Three-dimensional (3D) motion measured at the lower back during walking can describe the regularity and symmetry of gait that may be related to osteoarthritis (OA) and functional status. However, gait speed and inherent sex differences, regardless of the presence of OA, may confound these measures. Therefore, there is a need to understand the effect of OA separately among males and females, without the confounding influence of gait speed. OBJECTIVE To investigate the difference in 3D gait regularity and symmetry measures between gait speed-matched males and females with and without knee OA. METHOD Gait regularity and symmetry were computed as autocorrelations of pelvic accelerations during treadmill walking in four groups of older adults: healthy asymptomatic females (AsymF; n = 44), healthy asymptomatic males (AsymM; n = 45), females diagnosed with knee OA (OAF; n = 44), and males diagnosed with knee OA (OAM; n = 45). Data were obtained from a larger research database, allowing for the matching of gait speed between groups. The main effect of OA, sex, and interaction effect between them was examined for the 3D gait regularity and symmetry measures at an alpha level of 0.05. RESULTS There was no main effect of OA on any variable, but there was a significant main effect of sex on mediolateral and anteroposterior gait regularity measures. Specifically, females demonstrated significantly greater gait regularity, most notably in the mediolateral directions compared to males. CONCLUSION Older adult females were found to display significantly greater mediolateral gait regularity as compared to males, regardless of the presence of OA. Further, this difference exists among matched gait speeds, suggesting it is not the result of gait speed. Overall, these results highlight the importance of sex-specific analyses and considering gait speed when examining gait acceleration patterns near the center of mass for both cross sectional and longitudinal gait assessments.
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Affiliation(s)
- Dylan Kobsar
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Canada.
| | - John M Barden
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | | | - Janie L Astephen Wilson
- School of Biomedical Engineering, Faculties of Medicine and Engineering, Dalhousie University, Nova Scotia, Canada
| | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
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14
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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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15
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Carvalho C, Serrão FV, Pisani GK, Martinez AF, Serrão PRMDS. Frontal plane biomechanics during single-leg squat and hip strength in patients with isolated patellofemoral osteoarthritis compared to matched controls: A cross-sectional study. PLoS One 2022; 17:e0267446. [PMID: 35476842 PMCID: PMC9045627 DOI: 10.1371/journal.pone.0267446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/09/2022] [Indexed: 01/08/2023] Open
Abstract
The patellofemoral compartment of the knee is the most frequently affected by osteoarthritis. However, there is a lack of biomechanics studies on patellofemoral osteoarthritis (PFOA). This study’s purpose was to compare the frontal plane biomechanics of the trunk and lower limb during the single-leg squat and isometric hip abductor torque in individuals with isolated PFOA and controls. Frontal plane kinematics during the single-leg squat were evaluated using a three-dimensional (3-D) motion analysis system. Isometric hip abductor torque was determined using a handheld dynamometer. Twenty individuals participated in the study (10 with PFOA and 10 controls). No significant differences between groups were found regarding age (mean ± SD, PFOA group = 51.8 ± 6.9 versus control group = 47.8 ± 5.5; mean difference = 4, 95% confidence interval [CI] = -1.9 to 9.9, p = 0.20) or body mass index (PFOA group = 27.6 ± 2.2 versus control group = 25.5 ± 2.5; mean difference = 2.1, 95% confidence interval [CI] = -0.1 to 4.3, p = 0.06). Compared to control, the PFOA group presented greater hip adduction in the descending and ascending phases of the single-leg squat at 45° (mean difference [95% CI] = 6.44° [0.39–12.48°], p = 0.04; mean difference [95% CI] = 5.33° [0.24–10.42°], p = 0.045, respectively) and 60° (mean difference [95% CI] = 8.44° [2.15–14.73°], p = 0.01; mean difference [95% CI] = 7.58° [2.1–13.06°], p = 0.009, respectively) of knee flexion. No significant differences between groups were found for the frontal plane kinematics of the trunk, pelvis or knee (p > 0.05). The PFOA group exhibited lower isometric hip abductor torque (mean difference [95% CI] = -0.34 Nm/kg [-0.67 to -0.01 Nm/kg], p = 0.04). The individuals with PFOA presented greater hip adduction than the control group, which could increase lateral patellofemoral joint stress at 45° and 60° of knee flexion in the descending and ascending phases of the single-leg squat. These individuals also exhibited hip abductor weakness in comparison to healthy controls.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Adalberto Felipe Martinez
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
- * E-mail:
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16
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Kim AR, Park JH, Kim SH, Kim KB, Park KN. The Validity of Wireless Earbud-Type Wearable Sensors for Head Angle Estimation and the Relationships of Head with Trunk, Pelvis, Hip, and Knee during Workouts. SENSORS 2022; 22:s22020597. [PMID: 35062562 PMCID: PMC8780408 DOI: 10.3390/s22020597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 12/12/2022]
Abstract
The present study was performed to investigate the validity of a wireless earbud-type inertial measurement unit (Ear-IMU) sensor used to estimate head angle during four workouts. In addition, relationships between head angle obtained from the Ear-IMU sensor and the angles of other joints determined with a 3D motion analysis system were investigated. The study population consisted of 20 active volunteers. The Ear-IMU sensor measured the head angle, while a 3D motion analysis system simultaneously measured the angles of the head, trunk, pelvis, hips, and knees during workouts. Comparison with the head angle measured using the 3D motion analysis system indicated that the validity of the Ear-IMU sensor was very strong or moderate in the sagittal and frontal planes. In addition, the trunk angle in the frontal plane showed a fair correlation with the head angle determined with the Ear-IMU sensor during a single-leg squat, reverse lunge, and standing hip abduction; the correlation was poor in the sagittal plane. Our results indicated that the Ear-IMU sensor can be used to directly estimate head motion and indirectly estimate trunk motion.
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Affiliation(s)
- Ae-Ryeong Kim
- Department of Rehabilitation Science, Jeonju University, Jeonju 55069, Korea; (A.-R.K.); (J.-H.P.)
| | - Ju-Hyun Park
- Department of Rehabilitation Science, Jeonju University, Jeonju 55069, Korea; (A.-R.K.); (J.-H.P.)
| | - Si-Hyun Kim
- Department of Physical Therapy, Sangji University, Wonju 26339, Korea;
| | - Kwang Bok Kim
- Digital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan 31056, Korea;
| | - Kyue-Nam Park
- Department of Rehabilitation Science, Jeonju University, Jeonju 55069, Korea; (A.-R.K.); (J.-H.P.)
- Department of Physical Therapy, Jeonju University, Jeonju 55069, Korea
- Correspondence: ; Tel.: +82-33-220-4664
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17
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Philpott HT, Carter MM, Birmingham TB, Pinto R, Primeau CA, Giffin JR, Lanting BA, Appleton CT. Synovial tissue perivascular edema is associated with altered gait patterns in patients with knee osteoarthritis. Osteoarthritis Cartilage 2022; 30:42-51. [PMID: 34774789 DOI: 10.1016/j.joca.2021.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore mechanisms of mechanoinflammation, we investigated the association between the presence of knee synovial perivascular edema and gait biomechanics that serve as surrogate measures of knee load in patients with knee osteoarthritis (OA). DESIGN Patients with symptomatic, radiographic knee OA and neutral to varus alignment undergoing total knee arthroplasty or high tibial osteotomy participated in this cross-sectional analysis. All participants underwent 3D gait analysis prior to surgery. Synovial biopsies were obtained during surgery for histopathological assessment. The association between the presence of synovial perivascular edema (predictor) and the external knee moment (outcome) in each orthogonal plane was analyzed using multivariate linear regression and polynomial mixed effects regression models, while adjusting for age, sex, BMI, and gait speed. RESULTS Ninety-two patients with complete gait and histopathological data were included. When fitted over 100% of stance, regression models indicated substantial differences between patients with and without synovial perivascular edema for knee moments in frontal, sagittal and transverse planes. The knee adduction moment was higher in patients with edema from 16 to 74% of stance, with the largest difference at 33% of stance (β = 6.87 Nm [95%CI 3.02, 10.72]); whereas the knee flexion-extension moment differed from 15 to 92% of stance, with the largest difference in extension at 60% of stance (β = -10.80 Nm [95%CI -16.20, -5.40]). CONCLUSIONS In patients with knee OA, the presence of synovial perivascular edema identified by histopathology is associated with aberrant patterns of knee loading throughout stance, supporting the link between biomechanics and synovial inflammation.
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Affiliation(s)
- H T Philpott
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - M M Carter
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - T B Birmingham
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - R Pinto
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - C A Primeau
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - J R Giffin
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada.
| | - B A Lanting
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada.
| | - C T Appleton
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada.
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18
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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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19
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Trunk lean and toe out gait strategies impact on lower limb joints. J Biomech 2021; 129:110740. [PMID: 34627072 DOI: 10.1016/j.jbiomech.2021.110740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022]
Abstract
Gait retraining as a non-invasive prospective approach to restore mechanical loading at the knee joint and slowing down knee osteoarthritis (OA) progression shows great promise. However, the impact of gait modifications such as an increase in foot progression angle (FPA) or lateral trunk lean (LTL) on the ankle and hip is not yet well understood. Thus, the goal of this study is to provide insight on the impact of FPA and LTL on the sagittal and frontal external moments at the ankle and hip of healthy participants. We hypothesize that there is an optimum, for which an increase in FPA and/or LTL minimize the knee adduction moment (KAM) without increasing significantly the frontal and sagittal external moments at the ankle and hip during gait. To test this hypothesis, 23 participants performed walking trials with modified FPA and/or LTL angles following a real-time visual feedback. The hypothesis was not confirmed and while not all the gait modifications performed by the participants in this study reduced the KAM, they significantly increased the sagittal moment at the ankle and the frontal moment at the hip. This study highlights the importance to consider the biomechanical consequences of gait modifications on the ankle and hip before considering a clinical application of gait retraining approaches.
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20
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Gait Alterations in Knee Osteoarthritis. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Wada S, Murakami H, Tajima G, Maruyama M, Sugawara A, Oikawa S, Chida Y, Doita M. Analysis of characteristics required for gait evaluation of patients with knee osteoarthritis using a wireless accelerometer. Knee 2021; 32:37-45. [PMID: 34375906 DOI: 10.1016/j.knee.2021.07.002] [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: 02/13/2021] [Revised: 05/12/2021] [Accepted: 07/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is associated with reduced quality of life due to knee pain and gait disturbance. However, the evaluation of KOA is mainly based on images and patient-reported outcome measures (PROMs), which are said to be insufficient for functional evaluation. Recently, gait analysis using an accelerometer has been used for functional evaluation of KOA patients. Nevertheless, evaluation of the entire body motion is insufficient. The aim of this study was to clarify the gait characteristics of KOA patients using the distribution of scalar products and the interval time of heel contact during spontaneous walking and to compare them with healthy subjects. METHODS Participants wore a three-axis accelerometer sensor on the third lumbar vertebra and walked for 6 min on a flat path at a free walking speed. The sum of a composite vector (CV) scalar product and a histogram for distribution were used for body motion evaluation. The CV consisted of a synthesis of acceleration data from three axes. In addition to the summation of the CV, a histogram can be created to evaluate in detail the magnitude of the waves. The amount of variation was measured in the left-right and front-back directions. Variability was evaluated from the distribution of heel contact duration between both feet measured from the vertical acceleration. RESULTS KOA patients showed a smaller sum of CV that converged to small acceleration in the distribution when compared with healthy subjects. In the KOA group, the amount of variation in the forward and backward directions was greater than that in the forward direction. The variability of heel-ground interval time was greater in the KOA group than in healthy subjects. CONCLUSION KOA patients walked with less overall body movement, with limited movable range of the knee joint and pain-avoiding motion. The gait of the KOA group was considered unstable, with long time intervals between peaks. The increase in the amount of forward variation was thought to be due to the effect of trunk forward bending during walking. The clinical relevance of this study is that it was possible to evaluate KOA patients' gait quantitatively and qualitatively.
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Affiliation(s)
- Shuntaro Wada
- Department of Orthopedic Surgery, Iwate Medical University, 2-1-1 Odori, Yahaba, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Iwate Medical University, 2-1-1 Odori, Yahaba, Japan.
| | - Goro Tajima
- Department of Orthopedic Surgery, Iwate Medical University, 2-1-1 Odori, Yahaba, Japan
| | - Moritaka Maruyama
- Department of Orthopedic Surgery, Iwate Medical University, 2-1-1 Odori, Yahaba, Japan
| | - Atsushi Sugawara
- Department of Orthopedic Surgery, Iwate Medical University, 2-1-1 Odori, Yahaba, Japan
| | - Shinya Oikawa
- Department of Orthopedic Surgery, Iwate Medical University, 2-1-1 Odori, Yahaba, Japan
| | | | - Minoru Doita
- Department of Orthopedic Surgery, Iwate Medical University, 2-1-1 Odori, Yahaba, Japan
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Optimizing Whole-Body Kinematics During Single-Leg Jump Landing to Reduce Peak Abduction/Adduction and Internal Rotation Knee Moments: Implications for Anterior Cruciate Ligament Injury Risk. J Appl Biomech 2021; 37:432-439. [PMID: 34504045 DOI: 10.1123/jab.2020-0407] [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: 12/29/2020] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Abstract
Knee abduction/adduction moment and knee internal rotation moment are known surrogate measures of anterior cruciate ligament (ACL) load during tasks like sidestepping and single-leg landing. Previous experimental literature has shown that a variety of kinematic strategies are associated or correlated with ACL injury risk; however, the optimal kinematic strategies needed to reduce peak knee moments and ACL injury are not well understood. To understand the complex, multifaceted kinematic factors underpinning ACL injury risk and to optimize kinematics to prevent the ACL injury, a musculoskeletal modeling and simulation experimental design was used. A 14-segment, 37-degree-of-freedom, dynamically consistent skeletal model driven by force/torque actuators was used to simulate whole-body single-leg jump landing kinematics. Using the residual reduction algorithm in OpenSim, whole-body kinematics were optimized to reduce the peak knee abduction/adduction and internal/external rotation moments simultaneously. This optimization was repeated across 30 single-leg jump landing trials from 10 participants. The general optimal kinematic strategy was to bring the knee to a more neutral alignment in the transverse plane and frontal plane (featured by reduced hip adduction angle and increased knee adduction angle). This optimized whole-body kinematic strategy significantly reduced the peak knee abduction/adduction and internal rotation moments, transferring most of the knee load to the hip.
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Increased Trunk Kinetics Observed During Dose-Specific Trunk Lean Gait Modification. J Appl Biomech 2021; 37:425-431. [PMID: 34426557 DOI: 10.1123/jab.2020-0308] [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: 09/25/2020] [Revised: 05/03/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022]
Abstract
Trunk modification is associated with knee abduction moment reduction in both healthy groups and individuals with knee osteoarthritis. Ambulatory-related changes in trunk kinematics have been implicated in increased trunk moment. The purpose of this study was to investigate the effect of dose-specific lateral trunk lean on trunk kinetics during ipsilateral and contralateral stance phases. Nineteen healthy participants completed 10 baseline walking trials, followed by 10 trials employing lateral trunk lean. Trunk modification magnitudes were determined based on the average baseline trunk angle. Five trials of both small and large trunk modification magnitudes were completed. Visual real-time biofeedback was projected as a line graph displaying the trunk angle during stance, and a highlighted bandwidth was designated the target range. A 1-factor repeated-measures analysis of variance or Friedman test was used to assess differences between the conditions (P < .05) in trunk dependent measures. Trunk kinetics displayed significant increases, even during modest modifications to the trunk angle. The participants experienced increased peak frontal plane trunk moment and angular impulse during ipsilateral stance. The observed increase in the peak lateral joint reaction force is suggestive of a compromised loading environment at the spine. Implementing trunk modification might result in unintended secondary changes along the kinetic chain, but further investigation is required.
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Foucher KC, Aydemir B, Huang CH. Walking energetics and fatigue are associated with physical activity in people with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2021; 88:105427. [PMID: 34303950 PMCID: PMC9841508 DOI: 10.1016/j.clinbiomech.2021.105427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aberrant biomechanics may influence osteoarthritis-associated physical activity limitations. Our purpose was to evaluate the association of walking energetics, fatigue, and fatigability on physical activity in people with knee osteoarthritis. We hypothesized that using increased energy for walking, experiencing more fatigue, or being more fatigable are associated with less activity, and that fatigue and fatigability mediate the relationships between walking energetics and physical activity. METHODS We tested our hypothesis in 30 people with knee osteoarthritis (age 58 ± 9 years, 10 Male/20 Female). Physical activity was assessed using the University of California Los Angeles score. We used a six-minute walk test to predict VO2max. Next we used a portable oxygen exchange system to measure relative energy used (100 * VO2rate/VO2max) and VO2cost during walking at preferred speeds. We used the Knee injury and Osteoarthritis Outcome Score subscale to quantify pain, and the Patient Reported Outcome Measurement Instrument System Fatigue survey and a treadmill-based fatigability test to assess fatigue and fatigability. Spearman correlations, regression, and mediation analysis were used to test our hypotheses. FINDINGS Greater energy used during walking, fatigue, and fatigability were all associated with lower physical activity (rho = -0.585 to -0.379, P = 0.001 to 0.043). These associations persisted when incorporating pain into the models. Fatigue and fatigability mediated the associations between walking energetics and physical activity. INTERPRETATION Walking energetics could be a useful target to promote physical activity in people with osteoarthritis. Further, the effect of walking energetics on physical activity may work through its impact on fatigability.
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Affiliation(s)
- Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor St., 650 AHSB, Chicago, IL 60612, USA.
| | - Burcu Aydemir
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor St., 650 AHSB, Chicago, IL 60612, USA
| | - Chun-Hao Huang
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor St., 650 AHSB, Chicago, IL 60612, USA
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Lindsey BW, Xu J, Chiasson D, Shull P, Cortes N. Feasibility of Wearable Haptic Biofeedback Training for Reducing the Knee Abduction Moment During Overground Walking. J Biomech Eng 2021; 143:1086150. [PMID: 32793949 DOI: 10.1115/1.4048082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 11/08/2022]
Abstract
Gait modifications are effective in reducing the first peak knee abduction moment (PKAM), a surrogate for knee loading. Reliance on 3D motion capture currently restricts these modifications to the laboratory. Therefore, our purpose was to test the feasibility of a novel wearable biofeedback system to train (1) toe-in and trunk lean modifications and (2) combined toe-in and trunk lean modifications to reduce PKAM during overground walking outside of the laboratory. Twelve healthy participants practiced modifications in a university hallway directly after performing five normal walking trials. The wearable feedback system provided real-time haptic biofeedback during training trials to inform participants if they were within the prescribed modification range (7-12 deg greater than baseline). Participants were instructed to move to the next modification only once they felt comfortable and could perform it with minimal errors. Following training, five trials of each modification were immediately performed in the gait laboratory without feedback. All participants successfully modified their foot progression and trunk angle using the wearable system. At post-test, PKAM decreased from baseline by 62%, 55%, and 28% during combined, trunk leanand toe-in gait, respectively. The wearable feedback system was effective to modify participants' foot and trunk angle by the prescribed amount, resulting in reduced PKAM during all modifications at post-test. Participants were also able to perform a combined modification, although it took longer to report feeling comfortable doing so. This study demonstrates that a wearable feedback system is feasible to modify kinematic parameters and train gait modifications outside the laboratory.
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Affiliation(s)
- Bryndan W Lindsey
- School of Kinesiology, George Mason University, 10890 George Mason Circle, Katherine Johnson Hall 201E, MSN 4E5, Manassas, VA 20110; Sports Medicine Assessment, Research & Testing (SMART) Laboratory, 9438 Innovation Loop, Manassas, VA 20110
| | - Junkai Xu
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - David Chiasson
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Peter Shull
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Nelson Cortes
- School of Kinesiology; Sports Medicine Assessment, Research & Testing (SMART) Laboratory; George Mason University, 10890 George Mason Circle, Bull Run Hall 220, MSN 4E5, Manassas, VA 20110; Department of Bioengineering, George Mason University, 4400 University Dr, Fairfax, VA 22030; Institute for BioHealth Innovation, George Mason University, 10890 George Mason Circle, Bull Run Hall 220, MSN 4E5, Manassas, VA 20110
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Iwama Y, Harato K, Kobayashi S, Niki Y, Ogihara N, Matsumoto M, Nakamura M, Nagura T. Estimation of the External Knee Adduction Moment during Gait Using an Inertial Measurement Unit in Patients with Knee Osteoarthritis. SENSORS 2021; 21:s21041418. [PMID: 33670561 PMCID: PMC7922156 DOI: 10.3390/s21041418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 01/30/2023]
Abstract
Although the external knee adduction moment (KAM) during gait was shown to be a quantitative parameter of medial knee osteoarthritis (OA), it requires expensive equipment and a dedicated large space to measure. Therefore, it becomes a major reason to limit KAM measurement in a clinical environment. The purpose of this study was to estimate KAM using a single inertial measurement unit (IMU) during gait in patients with knee OA. A total of 22 medial knee OA patients (44 knee joints) performed conventional gait analysis using three-dimensional (3D) motion capture system. At the same time, we attached commercial IMUs to six body segments (sternum, pelvis, both thighs, and both shanks), and IMU signals during gait were recorded synchronized with the motion capture system. The peak-to-peak difference of acceleration in the lateral/medial axis immediately after heel contact was defined as the thrust acceleration (TA). We hypothesized that TA would represent the lateral thrust of the knee during the stance phase and correlate with the first peak of KAM. The relationship between the peak KAM and TA of pelvis (R = 0.52, p < 0.001), shanks (R = 0.57, p < 0.001) and thighs (R = 0.49, p = 0.001) showed a significant correlation. The root mean square error (RMSE) of linear regression models of pelvis, shanks, and thighs to estimate KAM were 0.082, 0.079, and 0.084 Nm/(kg·m), respectively. Our newly established parameter TA showed a moderate correlation with conventional KAM. The current study confirmed our hypothesis that a single IMU would predict conventional KAM during gait. Since KAM is known as an indicator for prognosis and severity of knee OA, this new parameter has the potential to become an accessible predictor for medial knee OA instead of KAM.
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Affiliation(s)
- Yu Iwama
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (Y.I.); (S.K.); (Y.N.); (M.M.); (M.N.)
| | - Kengo Harato
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (Y.I.); (S.K.); (Y.N.); (M.M.); (M.N.)
- Correspondence: ; Tel.: +81-3-5363-3812
| | - Shu Kobayashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (Y.I.); (S.K.); (Y.N.); (M.M.); (M.N.)
| | - Yasuo Niki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (Y.I.); (S.K.); (Y.N.); (M.M.); (M.N.)
| | - Naomichi Ogihara
- Department of Biological Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0032, Japan;
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (Y.I.); (S.K.); (Y.N.); (M.M.); (M.N.)
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (Y.I.); (S.K.); (Y.N.); (M.M.); (M.N.)
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
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Astephen Wilson JL, Kobsar D. Osteoarthritis year in review 2020: mechanics. Osteoarthritis Cartilage 2021; 29:161-169. [PMID: 33421562 DOI: 10.1016/j.joca.2020.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
The mechanical environment of the joint during dynamic activity plays a significant role in osteoarthritis processes. Understanding how the magnitude, pattern and duration of joint-specific loading features contribute to osteoarthritis progression and response to treatment is a topic of on-going relevance. This narrative review synthesizes evidence from recent papers that have contributed to knowledge related to three identified emerging subthemes: 1) the role of the joint mechanical environment in osteoarthritis pathogenesis, 2) joint biomechanics as an outcome to arthroplasty treatment of osteoarthritis, and 3) methodological trends for advancing our knowledge of the role of biomechanics in osteoarthritis. Rather than provide an exhaustive review of a broad area of research, we have focused on evidence this year related to these subthemes. New research this year has indicated significant interest in using biomechanics investigations to understand structural vs clinical progression of osteoarthritis, the role and interaction in the three-dimensional loading environment of the joint, and the contribution of muscle activation and forces to osteoarthritis progression. There is ongoing interest in understanding how patient variability with respect to gait biomechanics influences arthroplasty surgery outcomes, and subgroup analyses have provided evidence for the potential utility in tailored treatment approaches. Finally, we are seeing a growing trend in the application of translational biomechanics tools such as wearable inertial measurement units for improved integration of biomechanics into clinical decision-making and outcomes assessment for osteoarthritis.
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Affiliation(s)
- J L Astephen Wilson
- Department of Surgery, McMaster University, 1280 Main St West, Hamilton, ON, Canada.
| | - D Kobsar
- Department of Kinesiology, McMaster University, 1280 Main St West, Hamilton, ON, Canada.
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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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29
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Hart HF, Birmingham TB, Primeau CA, Pinto R, Leitch K, Giffin JR. Associations Between Cadence and Knee Loading in Patients With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 73:1667-1671. [PMID: 32741097 DOI: 10.1002/acr.24400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/21/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To test the hypothesis that higher walking cadence is associated with lower knee loading, while controlling for walking speed, in patients with medial compartment tibiofemoral osteoarthritis (OA). METHODS A total of 691 patients underwent quantitative gait analysis, including 3-dimensional knee moments and temporospatial parameters. Using multivariate linear regression, we tested the association of walking cadence with the knee adduction moment angular impulse (a surrogate measure of medial knee compartment load throughout the stance), while controlling for walking speed. We repeated the analysis while also adjusting for sex, age, body mass index, radiographic OA, knee pain, lateral trunk lean, foot progression angle, and mechanical axis angle, and while replacing the knee adduction moment angular impulse with other surrogate measures of knee loading. RESULTS While controlling for walking speed, we found that a lower cadence was associated with higher knee adduction moment angular impulse (standardized β = -0.396, P < 0.001), suggesting a 0.02% body weight × height × seconds (%BW × Ht × s) decrease in impulse for each step per minute increase in cadence (unstandardized β -0.020 %BW × Ht × s [95% confidence interval -0.027, -0.015]), and remained consistent after adjusting for covariates. A lower cadence was also associated with higher first (standardized β = -0.138, P = 0.010) and second peak knee adduction moment (standardized β = -0.132, P = 0.018), higher peak knee flexion moment (standardized β = -0.128, P = 0.049), and vertical ground reaction force (standardized β = -0.116, P = 0.035) in the adjusted analyses. CONCLUSION When controlling for walking speed, we found that a lower cadence is associated with higher knee loading per step in patients with medial tibiofemoral OA. Future research should investigate the potential beneficial biomechanical and clinical effects of increasing walking cadence in patients with knee OA.
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Affiliation(s)
- Harvi F Hart
- Fowler Kennedy Sport Medicine Clinic and Western University, London, Ontario, Canada
| | - Trevor B Birmingham
- Fowler Kennedy Sport Medicine Clinic and Western University, London, Ontario, Canada
| | - Codie A Primeau
- Fowler Kennedy Sport Medicine Clinic and Western University, London, Ontario, Canada
| | - Ryan Pinto
- Fowler Kennedy Sport Medicine Clinic and Western University, London, Ontario, Canada
| | - Kristyn Leitch
- Fowler Kennedy Sport Medicine Clinic and Western University, London, Ontario, Canada
| | - J Robert Giffin
- Fowler Kennedy Sport Medicine Clinic and Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Trombini-Souza F, Fuller R, Goldenstein-Schainberg C, Sacco ICN. Long-term use of minimal footwear in older adult women with knee osteoarthritis: Mechanisms of action in the knee adduction moment. J Biomech 2020; 108:109885. [PMID: 32635999 DOI: 10.1016/j.jbiomech.2020.109885] [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: 11/01/2019] [Revised: 05/20/2020] [Accepted: 06/06/2020] [Indexed: 11/28/2022]
Abstract
Studies have shown the short- and long-term effects of wearing minimalist footwear in reducing knee loads in patients with knee osteoarthritis (OA). This study aimed to investigate the mechanisms underpinning the reduction in external knee adduction moment (EKAM) in older adult women who wore this type of footwear through a randomized controlled trial. Fifty-six participants with medial compartment knee OA were equally allocated to either an intervention group (IG) that wore minimalist footwear (Moleca®) or to a control group (CG) that continued regular clinical treatment for OA for six months. The influence of lower limb joint kinematics and joint frontal moments, center of pressure displacement, and foot progression angle in predicting the reduction of EKAM were assessed after a six-month intervention. Surprisingly, none of the seven independent variables predicted the first peak EKAM in the multiple regression model for the IG. For the CG, the increase of one unit in the first peak of the hip adduction moment resulted in a 1.01 units increase in the first peak EKAM. Additionally, a one-unit reduction in the ankle eversion angle resulted in an increase of 0.16 units in the percent change in the first peak EKAM. Thus, wearing the Moleca® shoe for six months helped the participants keep a natural gait pattern without increasing the hip moment or the ankle inversion angle compared to the women who did not wear the Moleca® footwear. ClinicalTrials.gov (NCT01342458).
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Affiliation(s)
| | - Ricardo Fuller
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | - Isabel C N Sacco
- Faculdade de Medicina, Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, SP, Brazil
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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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Effect of Shoes Reducing Varus Instability of the Knee on Gait Parameters, Knee Pain, and Health-Related Quality of Life in Females With Medial Knee Osteoarthritis. TOPICS IN GERIATRIC REHABILITATION 2020. [DOI: 10.1097/tgr.0000000000000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Eddo OO, Lindsey BW, Caswell SV, Prebble M, Cortes N. Unintended Changes in Contralateral Limb as a Result of Acute Gait Modification. J Appl Biomech 2020; 36:13-19. [PMID: 31805536 DOI: 10.1123/jab.2019-0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 10/27/2023]
Abstract
Gait modification using real-time biofeedback is a conservative intervention associated with positive outcomes. Results from systematic reviews corroborate the effectiveness of various strategies employing real-time biofeedback for reducing estimated knee joint load. The effects on the nonmodified limb, however, remain unclear. Biomechanical changes to the nonmodified limb were investigated during unilaterally implemented medial knee thrust, lateral trunk lean, and toe-in foot progression. Nineteen healthy participants were recruited. Ten trials were completed for each gait condition including baseline. Assigned magnitude for each gait modification strategy was individualized based on the mean and SD of the gait parameter during baseline. Visual real-time biofeedback was provided. During medial knee thrust, participants' nonmodified limb presented with increased: first peak medial knee contact force, internal first peak knee extensor moment, as well as knee- and hip-flexion angles at internal first peak knee extensor moment. Observed biomechanical changes are elucidative of the body's attempt to attenuate increased external loads. These findings may carry significant implications for pathological populations. Load redistribution to the nonmodified side may result in unfavorable long-term outcomes particularly in patients with bilateral diagnosis. Future studies should explore acute and chronic changes in the nonmodified limb of individuals with knee osteoarthritis.
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Tateuchi H, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N. Gait kinematics of the hip, pelvis, and trunk associated with external hip adduction moment in patients with secondary hip osteoarthritis: toward determination of the key point in gait modification. BMC Musculoskelet Disord 2020; 21:8. [PMID: 31906926 PMCID: PMC6945754 DOI: 10.1186/s12891-019-3022-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/24/2019] [Indexed: 01/12/2023] Open
Abstract
Background A larger daily cumulative hip loading, which is the product of the external hip adduction moment (HAM) impulse during gait and the number of steps per day has been identified as a factor associated with the progression of secondary hip osteoarthritis (OA). The cause of the increased HAM impulse in patients with hip OA has not been identified. The purpose of this study was to identify the gait parameters associated with HAM impulse during gait in patients with secondary hip OA. Methods Fifty-five patients (age 22–65 years) with mild-to-moderate secondary hip OA participated in this cross-sectional study. The HAM impulse during gait was measured using a three-dimensional gait analysis system. To identify the gait parameters associated with HAM impulse, hierarchical multiple regression analysis was performed. The first model (basic model) included body weight and stance phase duration. The second models included gait parameters (gait speed; ground reaction force [GRF] in frontal plane; and hip, pelvic, and trunk angle in frontal plane) and hip pain in addition to the basic model. Results Body weight and stance phase duration explained 61% of the variance in HAM impulse. In the second model, which took into account body weight and stance phase duration, hip adduction angle (9.4%), pelvic tilt (6.5%), and trunk lean (3.2%) in addition to GRF explained the variance in the HAM impulse. Whereas larger hip adduction angle and pelvic tilt toward the swing limb were associated with a larger HAM impulse, larger trunk lean toward the stance limb was associated with smaller HAM impulse. Conclusion In patients with excessive hip adduction and pelvic tilt toward the swing limb during gait, gait modification may contribute to the reduction of hip joint loading.
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Affiliation(s)
- Hiroshige Tateuchi
- Department of Preventive Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka So
- Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Slater LV, Blemker SS, Hertel J, Saliba SA, Weltman AL, Hart JM. Sex affects gait adaptations after exercise in individuals with anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2020; 71:189-195. [PMID: 31770661 DOI: 10.1016/j.clinbiomech.2019.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteoarthritis after anterior cruciate ligament reconstruction has been linked with changes in gait. Individuals with reconstruction demonstrate gait changes after exercise, however there is no information on altered gait after exercise based on sex. The purpose of this study was to examine the association of sex on changes in running gait after exercise in individuals with reconstruction compared to healthy. METHODS Forty females (22 reconstructed) and 22 men (11 reconstructed) ran before and after exercise. Triplanar lower extremity kinematics and kinetics were measured on the involved limb. Data were reduced to 0-100% of gait. Change scores were calculated for each 1% with 90% confidence intervals. Mean differences were calculated for all significant differences. FINDINGS After exercise, females with reconstruction increased knee valgus (1.81°), knee external rotation (2.02°), lateral trunk flexion (1.24°) and trunk rotation (2.15°) compared to healthy females. Females with reconstruction increased knee extension moment (0.07 Nm/kg), knee abduction moment (0.08 Nm/kg), hip extension moment (0.14 Nm/kg) and hip internal rotation moment (0.04 Nm/kg) compared to healthy females. After exercise, males with reconstruction decreased knee varus (-4.83°), hip adduction (-1.99°), and hip internal rotation (-4.44°), however increased lateral trunk flexion (1.94°) compared to healthy males. Males with reconstruction increased knee extension moment (0.07 Nm/kg), knee adduction moment (0.31 Nm/kg), knee internal rotation moment (0.13 Nm/kg), hip flexion moment (0.17 Nm/kg), and hip external rotation moment (0.05 Nm/kg) compared to healthy males. INTERPRETATION Males with reconstruction increased hip loading while women with reconstruction increased trunk motion post-exercise. Sex should be considered when evaluating response to exercise after reconstruction.
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Affiliation(s)
- Lindsay V Slater
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA.
| | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Arthur L Weltman
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
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Changes in hip mechanics during gait modification to reduce knee abduction moment. J Biomech 2020; 99:109509. [DOI: 10.1016/j.jbiomech.2019.109509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/23/2022]
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Joint power distribution does not change within the contralateral limb one year after unilateral limb loss. Gait Posture 2019; 73:8-13. [PMID: 31299506 DOI: 10.1016/j.gaitpost.2019.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To assist with forward progression during gait, persons with unilateral lower-limb amputation typically perform more work within the unaffected versus affected limb. However, prior cross-sectional (>2years post-amputation) studies cannot necessarily elucidate the origin or evolution of these compensatory mechanics. RESEARCH QUESTION Do lower limb joint kinetics change during the initial stages of independent ambulation among persons with lower-limb amputation? METHODS Nine males with unilateral lower-limb amputation (6 transtibial; 3 transfemoral) completed instrumented gait analyses (speed = 1.2 m/s) at 2 and 12-months post-independent ambulation. Within the unaffected limb, sagittal and frontal plane total positive and negative work, peak power, average positive power, and percent contribution of each joint were compared between time points using paired t-tests. RESULTS No differences existed between time points in total positive or negative work, at any joint (p > 0.038) in either plane. Similarly, there were no differences in percent contribution by each joint to total average power by sagittal (p > 0.15) or frontal (p > 0.32) planes. SIGNIFICANCE Persons with unilateral lower-limb amputation do not alter power distribution among joints within the unaffected limb during initial independent ambulation. However, compared to previous cross-sectional reports, smaller peak powers in the unaffected hip and knee here suggest mechanical work increases with time since amputation. Future research should longitudinally monitor segment mechanics to determine when deleterious strategies develop, as these have implications for joint degeneration and pain.
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Zarei H, Bervis S, Piroozi S, Motealleh A. Added Value of Gluteus Medius and Quadratus Lumborum Dry Needling in Improving Knee Pain and Function in Female Athletes With Patellofemoral Pain Syndrome: A Randomized Clinical Trial. Arch Phys Med Rehabil 2019; 101:265-274. [PMID: 31465756 DOI: 10.1016/j.apmr.2019.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/09/2019] [Accepted: 07/08/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the effects of exercise therapy alone and exercise therapy plus gluteus medius (GM) and quadratus lumbarum (QL) dry needling on pain and function in female athletes with patellofemoral pain (PFP). DESIGN Single-blind randomized controlled trial with follow-up. SETTING Physiotherapy clinic. PARTICIPANTS Convenience sample of female athletes with PFP (N=40), who were randomly assigned to the exercise therapy (Ex group) or exercise-therapy+dry needling (Ex+DN group) group. INTERVENTIONS The Ex group received exercise therapy for 4 weeks, and the Ex+DN group received exercise therapy in combination with dry needling directed at GM and QL trigger points for 4 weeks. MAIN OUTCOME MEASURES In all participants, pain intensity, function (Kujala score, modified star excursion balance test, step-down test), and QL and GM pressure pain threshold (PPT) were recorded at baseline and at 4 and 6 weeks after the start of treatment. Analysis of variance (2 groups×3 times) was used to compare within- and between-group differences. RESULTS The group versus time interaction effect was significant for all variables (P<.05). Both groups showed significant improvements in pain, function, and PPT at weeks 4 and 6 compared to baseline (P<.05). Between-groups comparisons showed significantly greater improvements in pain, function, and PPT in the Ex+DN group (P<.05). CONCLUSIONS Targeting intervention to treat trigger points in the GM and QL muscles combined with exercise therapy had superior beneficial effects compared to exercise alone in managing PFP. Therefore, adding GM and QL muscle dry needling to exercise therapy may be advisable to enhance the effects of PFP rehabilitation.
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Affiliation(s)
- Hanieh Zarei
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Science, Shiraz, Iran
| | - Soha Bervis
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Science, Shiraz, Iran
| | - Soraya Piroozi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Motealleh
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Iijima H, Suzuki Y, Aoyama T, Takahashi M. Relationship Between Varus Thrust During Gait and Low Back Pain in Individuals With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2019; 72:1231-1238. [PMID: 31254449 DOI: 10.1002/acr.24020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To test the hypothesis that varus thrust visualized during gait is associated with a higher prevalence of low back pain (LBP) in individuals with knee osteoarthritis (OA). METHODS Individuals with knee OA (Kellgren/Lawrence grade ≥1) underwent a gait observation to assess varus thrust. The participants identified LBP and its severity using questionnaires. Logistic regression analyses were performed to examine the association between varus thrust and LBP. RESULTS We included 205 participants (mean age 68.19 years; 72.20% women). A total of 45 participants (22.0%) showed varus thrust in their painful knee, in whom 31 (68.89%) and 18 (40.00%) were identified as having any LBP and moderate-to-severe LBP (numerical rating scale ≥4 points), respectively. Patients with varus thrust demonstrated a 3.6-fold higher risk of the presence of moderate-to-severe LBP (95% confidence interval [95% CI] 1.62-8.10). In patients with LBP, the presence of varus thrust was associated with more severe LBP intensity (proportional odds ratio 2.25 [95% CI 1.02-4.96]). CONCLUSION This study highlights the novel relationship between varus thrust and LBP, which supports the idea of a biomechanical link, the so-called knee-spine syndrome. These findings provide new insight for clarifying the pathogenesis of LBP related to knee OA.
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Affiliation(s)
- Hirotaka Iijima
- Keio University, Yokohama, Japan, Kyoto University, Kyoto, Japan, Japan Society for the Promotion of Science, Tokyo, Japan, and University of Pittsburgh, Pittsburgh, Pennsylvania
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Tateuchi H. Gait- and postural-alignment-related prognostic factors for hip and knee osteoarthritis: Toward the prevention of osteoarthritis progression. Phys Ther Res 2019; 22:31-37. [PMID: 31289710 DOI: 10.1298/ptr.r0003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Osteoarthritis (OA) is a chronic progressive disease, and thus, prevention of this progression is an important issue. Currently, there is little evidence of the effect of exercise therapy for the prevention of hip and knee OA progression. An understanding of prognostic factors is the basis for the prevention of progression. Previous research indicates that in case of knee OA, abnormalities in knee alignment (varus or valgus) while standing, varus thrust during walking, increased knee flexion in the early stance phase, abnormal displacement of the femur in relation to the tibia, and an increase in knee adduction and flexion moment are risk factors for disease progression. At the same time, the prognostic factors in hip OA are anterior spinal inclination while standing, decreased mobility of the thoracolumbar spine, and increased cumulative hip loading during daily walking. Further research is required to investigate these prognostic factors, particularly the modifiable factors, to analyze the relationships between these factors, and to verify the structural and clinical efficacy of modifying these factors through interventions.
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Affiliation(s)
- Hiroshige Tateuchi
- Department of Preventive Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University
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Influence of foot progression angle on knee adduction and flexion moment during stair climbing in healthy individuals. Gait Posture 2019; 71:163-169. [PMID: 31071539 DOI: 10.1016/j.gaitpost.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/31/2019] [Accepted: 03/15/2019] [Indexed: 02/02/2023]
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Oka T, Asai T, Kubo H, Fukumoto Y. Association of fear of falling with acceleration-derived gait indices in older adults with knee osteoarthritis. Aging Clin Exp Res 2019; 31:645-651. [PMID: 30128664 DOI: 10.1007/s40520-018-1022-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) and fear of falling (FoF) are important factors contributing to trunk oscillation during walking. It is of a clinical importance to clarify the association of FoF with trunk oscillation during walking in older adults with knee OA (knee OA adults). AIM The purpose of this study was to investigate the association of FoF with trunk oscillation during walking in knee OA adults. METHODS Forty-one patients who met the criteria participated in the study and were classified into two groups based on their answer to a question on FoF. An accelerometer was attached at the level of the third lumbar vertebra (L3) and the seventh cervical vertebra (C7), and the accelerations at L3 and C7 were measured during a 10-m gait test. Using these data, the acceleration-derived gait indices, such as stride time variability (STV), root mean square (RMS), and autocorrelation at the trunk in the anteroposterior (AP) and mediolateral (ML) directions, were computed. RESULTS FoF was associated with a higher STV value and a smaller RMS value in the ML direction at L3. DISCUSSION The decreased trunk oscillation in the ML direction in knee OA adults with FoF may reflect a positive, compensatory adaptation for trunk control. CONCLUSION Knee OA adults with FoF decreased trunk oscillation during walking than those without FoF.
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Affiliation(s)
- Tomohiro Oka
- Department of Rehabilitation, Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan.
- Department of Community Health Sciences, Kobe University Graduate School of Health Science, 7-10-2, Tomogaoka, Suma-ku, Kobe City, Hyogo, 654-0142, Japan.
| | - Tsuyoshi Asai
- Department of Medical Rehabilitation, Faculty of Rehabilitation, Kobe Gakuin University, 518 Ikawadanicho, Arise, Nishi-ku, Kobe City, 651-2180, Japan
| | - Hiroki Kubo
- Faculty of Medical Rehabilitation, Kobe Gakuin University Graduate School, 518 Ikawadanicho, Arise, Nishi-ku, Kobe City, 651-2180, Japan
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Yoshihiro Fukumoto
- Department of Medical Rehabilitation, Faculty of Rehabilitation, Kobe Gakuin University, 518 Ikawadanicho, Arise, Nishi-ku, Kobe City, 651-2180, Japan
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Selistre LFA, Gonçalves GH, Nakagawa TH, Petrella M, Jones RK, Mattiello SM. The role of hip abductor strength on the frontal plane of gait in subjects with medial knee osteoarthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1779. [PMID: 31012216 DOI: 10.1002/pri.1779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/13/2019] [Accepted: 03/17/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship of hip abductor strength with external hip and knee adduction moments, pain and physical function, and trunk, pelvis, and hip kinematics in the frontal plane during walking in subjects with medial knee osteoarthritis. METHODS Twenty-five subjects with medial knee osteoarthritis were evaluated through an isokinetic strength test for hip abductor, three-dimensional gait analysis (kinetics and kinematics), and pain and physical function scores. Regression models were used to control the influence of other parameters such as pain, age, gender, severity, walking speed, mass, and height. RESULTS No relationship was found of hip abductor strength with peak of external knee adduction moment and knee adduction angular impulse. Hip abductor strength explained 17% of contralateral pelvic drop and 21% of hip adduction angle. In addition, hip abductor strength explained 4% and 1% of the variance in the WOMAC physical function score and 40-m fast paced walk test, respectively. CONCLUSION Considering the relationship of hip abductor strength with contralateral pelvic drop and hip adduction angle, specific exercises might improve physical function and lower limb dynamic alignment during gait.
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Affiliation(s)
| | | | | | - Marina Petrella
- Departamento de Fisioterapia, São Carlos, Universidade Federal de São Carlos, São Paulo, Brazil
| | - Richard Keith Jones
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
| | - Stela Márcia Mattiello
- Departamento de Fisioterapia, São Carlos, Universidade Federal de São Carlos, São Paulo, Brazil
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Khan SJ, Khan SS, Usman J, Mokhtar AH, Abu Osman NA. Combined effects of knee brace, laterally wedged insoles, and toe-out gait on knee adduction moment and fall risk in moderate medial knee osteoarthritis patients. Prosthet Orthot Int 2019; 43:148-157. [PMID: 30192706 DOI: 10.1177/0309364618796849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Knee osteoarthritis is a major contributor to the global burden of disease. There is a need of reducing knee joint load and to improve balance and physical function among knee osteoarthritis patients. OBJECTIVES: To test the hypothesis that toe-out gait will reduce second peak knee adduction moment further and increase fall risk when combined with knee brace and laterally wedged insole in knee osteoarthritis patients. STUDY DESIGN: Single visit study with repeated measures. METHODS: First and second peak knee adduction moments, fall risk and comfort level. First and second peak knee adduction moments were determined from three-dimensional gait analysis, completed under six randomized conditions: (1) natural, (2) knee brace, (3) knee brace + toe-out gait, (4) laterally wedged insole, (5) laterally wedged insole + toe-out gait, and (6) knee brace + laterally wedged insole + toe-out gait. Fall risk was assessed by Biodex Balance System using three randomized stability settings: (1) static, (2) moderate dynamic setting (FR12), and (3) high dynamic setting (FR8). RESULTS: The reduction in first peak knee adduction moment and second peak knee adduction moment was greatest (7.16% and 25.55%, respectively) when toe-out gait combine with knee brace and laterally wedged insole. Significant increase in fall risk was observed with knee brace + laterally wedged insole + toe-out gait (42.85%) at FR12. Similar significant balance reductions were found at FR8 condition for knee brace + toe-out gait (35.71%), laterally wedged insole + toe-out gait (28.57%), and knee brace + laterally wedged insole + toe-out gait (50%) as compared to natural. However, knee brace decreased fall risk at FR12 by 28.57%. CONCLUSION: There is a synergistic effect of toe-out when combined with knee brace and laterally wedged insole concurrently in second peak knee adduction moment reduction but with a greater degree of fall risk. Simultaneous use of conservative treatments also decreases comfort level. CLINICAL RELEVANCE Patients with mild and moderate knee osteoarthritis are usually prescribed conservative treatment techniques. This study will provide an insight whether or not a combination of these techniques have a synergistic effect in reducing knee joint load.
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Affiliation(s)
- Saad Jawaid Khan
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,2 Department of Biomedical Engineering, Riphah International University, Islamabad, Pakistan
| | - Soobia Saad Khan
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Juliana Usman
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,3 Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdul Halim Mokhtar
- 4 Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noor Azuan Abu Osman
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,3 Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia.,5 The Chancellery, University of Malaysia Terengganu, Terengganu, Malaysia
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Iijima H, Shimoura K, Ono T, Aoyama T, Takahashi M. Proximal gait adaptations in individuals with knee osteoarthritis: A systematic review and meta-analysis. J Biomech 2019; 87:127-141. [PMID: 30904334 DOI: 10.1016/j.jbiomech.2019.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/23/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
Clarifying proximal gait adaptations as a strategy to reduce knee joint loading and pain for individuals with knee osteoarthritis (OA) contributes to understanding the pathogenesis of multi-articular OA changes and musculoskeletal pain in other joints. We aimed to determine whether biomechanical alterations in knee OA patients during level walking is increased upper trunk lean in the frontal and sagittal planes, and subsequent alteration in external hip adduction moment (EHAM) and external hip flexion moment (EHFM). A literature search was conducted in PubMed, PEDro, CINAHL, and Cochrane CENTRAL through May 2018. Where possible, data were combined into a meta-analysis; pooled standardized mean differences (SMD) of between knee OA patients and healthy adults were calculated using a random-effect model. In total, 32 articles (2037 participants, mean age, 63.0 years) met inclusion criteria. Individuals with knee OA had significantly increased lateral trunk lean toward the ipsilateral limb (pooled SMD: 1.18; 95% CI: 0.59, 1.77) along with significantly decreased EHAM. These subjects also displayed a non-significantly increased trunk/pelvic flexion angle and EHFM. The GRADE approach judged all measures as "very low." These results may indicate that biomechanical alterations accompanying knee OA are associated with increased lateral trunk lean and ensuing alterations in EHAM. Biomechanical alterations in the sagittal plane were not evident. Biomechanical adaptations might have negative sequelae, such as secondary hip abductor muscle weakness and low back pain. Thus, investigations of negative sequelae due to proximal gait adaptations are warranted.
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Affiliation(s)
- Hirotaka Iijima
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan; Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Kanako Shimoura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Tomoko Ono
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Yokohama, Japan.
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Masaki Takahashi
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan.
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Wang S, Chan KHC, Lam RHM, Yuen DNS, Fan CKM, Chu TTC, Baur H, Cheung RTH. Effects of foot progression angle adjustment on external knee adduction moment and knee adduction angular impulse during stair ascent and descent. Hum Mov Sci 2019; 64:213-220. [PMID: 30784892 DOI: 10.1016/j.humov.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/19/2022]
Abstract
Foot progression angle adjustment was shown to reduce external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) during level ground walking. However, evidence on effects of foot progression angle adjustment on the above surrogate measures of medial knee loading during stair climbing is limited. Hence, this study examined the effects of toe-in and toe-out gait on EKAM and KAAI during stair ascent and descent. Kinematic and kinetic data were collected from thirty-two healthy adults during stair ascent and descent with toe-in, toe-out and natural gait. A repeated measures ANOVA indicated that toe-in gait significantly reduced the first EKAM peak (P < 0.001) and KAAI (P = 0.002), while toe-out gait significantly increased the first (P < 0.001) and second (P = 0.04) EKAM peaks and KAAI (P < 0.001) when compared with natural gait during stair ascent. During stair descent, toe-in gait significantly reduced the first (P < 0.001) and second (P = 0.032) EKAM peaks and KAAI (P < 0.001), whilst toe-out gait significantly increased the first EKAM peak (P = 0.022) and KAAI (P = 0.028) when compared with natural gait. In conclusion, toe-in gait was found to be a viable strategy in reducing medial knee loading during stair climbing.
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Affiliation(s)
- Sizhong Wang
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Kitty H C Chan
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Rachel H M Lam
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Daisy N S Yuen
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Carmen K M Fan
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Thomas T C Chu
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Heiner Baur
- Movement Laboratory, Health Department, Bern University of Applied Sciences, Switzerland
| | - Roy T H Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
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Nakagawa TH, Petersen RS. Relationship of hip and ankle range of motion, trunk muscle endurance with knee valgus and dynamic balance in males. Phys Ther Sport 2018; 34:174-179. [DOI: 10.1016/j.ptsp.2018.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/14/2018] [Accepted: 10/14/2018] [Indexed: 12/14/2022]
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Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1629-1635. [PMID: 29204861 DOI: 10.1007/s00167-017-4788-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Knee adduction moment (KAM) has been recognized as a good clinical surrogate for medial tibiofemoral joint loading and is associated with implant durability after total knee arthroplasty (TKA). This study aimed to examine the effects of joint line obliquity in kinematically aligned TKA (KA-TKA) on KAM during gait. METHODS The study enrolled 21 knees from 18 patients who underwent cylindrical axis reference KA-TKA and a matched group of 21 knees from 18 patients who underwent mechanically aligned (MA)-TKA as controls. Gait analyses were performed the day before TKA and at an overall mean of 2.6 years postoperatively. First peak KAM and variables associated with frontal knee kinetics were determined and compared between groups. RESULTS In KA-TKA, the proximal tibia was resected with 3.4° ± 1.5° of varus in relation to the mechanical axis, and the final femorotibial shaft axis was 176.7° ± 3.8° with KA-TKA and 174.4° ± 3.0° with MA-TKA. KAM was significantly smaller with KA-TKA than with MA-TKA (p < 0.032). Regarding variables affecting KAM, significant differences were evident between the two TKAs for knee adduction angle (p = 0.0021), lever arm (p = 0.028), and Δlever arm (p = 0.0001). CONCLUSIONS In KA-TKA, joint line obliquity reduced peak KAM during gait, despite slight varus limb alignment, and this reduced KAM in KA-TKA can tolerate constitutional varus alignment. In clinical settings, KA-TKA thus represents a promising technical option for patients with large coronal bowing of the shaft carrying a risk of increased KAM after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yasuo Niki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Katsuya Nagai
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Timing of Frontal Plane Trunk Lean, Not Magnitude, Mediates Frontal Plane Knee Joint Loading in Patients with Moderate Medial Knee Osteoarthritis. Adv Orthop 2018; 2018:4526872. [PMID: 29755793 PMCID: PMC5884293 DOI: 10.1155/2018/4526872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/14/2018] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to examine the influence of trunk lean and contralateral hip abductor strength on the peak knee adduction moment (KAM) and rate of loading in persons with moderate medial knee osteoarthritis. Thirty-one males (17 with osteoarthritis, 14 controls) underwent 3-dimensional motion analysis, strength testing of hip abductors, and knee range of motion (ROM) measures, as well as completing the knee osteoarthritis outcome score (KOOS). No differences were found between groups or limbs for gait cycle duration, but the osteoarthritis group had longer double-limb support during weight acceptance (p < 0.001) and delayed frontal plane trunk motion towards the stance limb (p < 0.01). This was reflected by a lower rate of loading for the osteoarthritis group compared to controls (p < 0.001), whereas no differences were found for peak KAM. Trunk angle, contralateral hip abductor strength, and BMI explained the rate of loading at the involved knee (p < 0.001), an association not found for the contralateral knee or control knees. Prolonged trunk lean over the stance limb may help lower peak KAM values. Rate of frontal plane knee joint loading may partly be mediated by the contralateral limb's abductor strength, accentuating the importance of bilateral lower limb strength for persons with knee osteoarthritis.
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Gait strategies to reduce the dynamic joint load in the lower limbs during a loading response in young healthy adults. Hum Mov Sci 2018. [PMID: 29524851 DOI: 10.1016/j.humov.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Reducing external joint moments during gait can lead to a reduction in dynamic joint load. There has yet to be a detailed investigation of gait strategies that can reduce external joint moments by decreasing the magnitude of ground reaction force (GRF) without reducing the walking speed. The objectives of this study were to verify whether it is possible to reduce external joint moments by decreasing the GRF magnitude without reducing the walking speed and to identify the alternative walking strategy involved in young healthy adults. This study included 14 young healthy subjects. They performed two types of walking: normal and impact reduction walking. For impact reduction walking, the subjects walked in a manner that reduced the impact upon foot contact. Cadence and step length were unified between the two conditions. The walking speed, peak value of vertical GRF, braking-accelerating force, loading rate, joint angle, and external joint moments of the two conditions were recorded and compared. No significant difference was noted in the walking speed. However, the first peak of vertical GRF, braking force, and loading rate during loading response were significantly reduced during impact reduction walking, and external joint moments in the hip, knee, and ankle joints were reduced. In contrast, the second peak of vertical GRF, hip extension angle, and external ankle dorsiflexion moment were significantly increased during terminal stance. Our data imply that the ankle joint function during the terminal stance is important in reducing the dynamic joint load in the contralateral leg during the loading response.
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