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Dynamic joint stiffness in individuals with femoroacetabular impingement syndrome pre- and post-hip arthroscopy. Clin Biomech (Bristol, Avon) 2024; 112:106187. [PMID: 38280259 DOI: 10.1016/j.clinbiomech.2024.106187] [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] [Received: 09/26/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Patients with hip-related pain often fail to return to their desired level of activity following hip arthroscopy. Lasting biomechanics alterations may be one potential explanation. Dynamic joint stiffness assesses the mechanistic controls of the lower limb during high impact movements, and thus, may provide valuable clinical targets to improving movement and optimizing return to activity after surgery. METHODS Twenty-five participants (13 females) with hip-related pain underwent 3D motion capture during a drop jump task before surgery and six months post-operatively. Nineteen healthy controls (9 females) were collected for comparison. Sagittal plane dynamic joint stiffness was calculated during the initial landing phase. Baseline and 6-month dynamic joint stiffness data were compared 1) between males and females with hip-related pain and 2) between individuals with hip-related pain and controls using Wilcoxon Signed-Rank and Mann Whitney U tests. Sexes were analyzed separately. FINDINGS From baseline to 6 months post-operatively, females with hip-related pain demonstrated decreased dynamic ankle stiffness (2.26 Nm/deg. [0.61] to 1.84 Nm/deg. [0.43]) (p = .005) and males with hip-related pain demonstrated increased dynamic hip stiffness (2.73 [0.90] to 3.88 [1.73]) (p = .013). There were no differences in dynamic stiffness at any joint between individuals with hip-related pain at either timepoint when compared to controls (p ≥ .099). INTERPRETATION Females and males with hip-related pain may demonstrate unique changes in dynamic joint stiffness after surgery, indicating return to activity may follow different trajectories for each sex. Additional work should examine the relationship between hip joint stiffness and treatment outcomes and identify additional movement-related rehabilitation targets.
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Inter-joint coordination variability is associated with pain severity and joint loading in persons with knee osteoarthritis. J Orthop Res 2023; 41:2610-2616. [PMID: 37132504 PMCID: PMC10622325 DOI: 10.1002/jor.25592] [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: 11/21/2022] [Revised: 02/14/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023]
Abstract
As the lower extremity is a linked-joint system, the contribution of movements at the hip and ankle, in addition to the knee, to gait patterns should be considered for persons with knee osteoarthritis (OA). However, the relationships of joint coordination variability to OA symptoms, particularly knee pain, and joint loading is unknown. The purpose of this study was to determine the relationship of joint coordination variability to knee pain severity and joint loading in persons with knee OA. Thirty-four participants with knee OA underwent gait analysis. Vector coding was used to assess coordination variability during the early, mid, and late stance phase. Hip-knee coupling angle variability (CAV) during midstance was associated with Knee Injury and Osteoarthritis Outcome Score (KOOS) pain (r = -0.50, p = 0.002) and Visual Analog Scale pain (r = 0.36, p = 0.04). Knee-ankle CAV during midstance was associated with KOOS pain (r = -0.34, p = 0.05). Hip-knee CAV during early and midstance were associated with knee flexion moment (KFM) impulses (r = -0.46, p = 0.01). Knee-ankle CAV during early and midstance were associated with peak KFM (r = -0.51, p < 0.01; r = -0.70, p < 0.01). Moreover, knee-ankle CAV during early, mid, and late stance phase were associated with KFM impulses (r = -0.53, p < 0.01; r = -0.70, p < 0.01; r = -0.54, p < 0.01). These findings suggest that joint coordination variability may be a factor that influences pain and knee joint loading in persons with knee OA. Statement of Clinical Significance: Movement coordination of the hip, knee, and ankle should be considered in the clinical management and future research related to knee OA.
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Lower-limb sagittal joint angles during gait can be predicted based on foot acceleration and angular velocity. PeerJ 2023; 11:e16131. [PMID: 37744216 PMCID: PMC10512936 DOI: 10.7717/peerj.16131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background and purpose Continuous monitoring of lower-limb movement may help in the early detection and control/reduction of diseases (such as the progression of orthopedic diseases) by applying suitable interventions. Therefore, it is invaluable to calculate the lower-limb movement (sagittal joint angles) while walking daily for continuous evaluation of such risks. Although cameras in a motion capture system are necessary for calculating lower-limb sagittal joint angles during gait, the method is unrealistic considering the setting is difficult to achieve in daily life. Therefore, the estimation of lower-limb sagittal joint angles during walking based on variables, which can be measured using wearable sensors (e.g., foot acceleration and angular velocity), is important. This study estimates the lower-limb sagittal joint angles during gait from the norms of foot acceleration and angular velocity using machine learning and validates the accuracy of the estimated joint angles with those obtained using a motion capture system. Methods Healthy adults (n = 200) were asked to walk at a comfortable speed (10 trials), and their lower-limb sagittal joint angles, foot accelerations, and angular velocities were obtained. Using these variables, we established a feedforward neural network and estimated the lower-limb sagittal joint angles. Results The average root mean squared errors of the lower-limb sagittal joint angles during gait ranged between 2.5°-7.0° (hip: 7.0°; knee: 4.0°; and ankle: 2.5°). Conclusion These results show that we can estimate the lower-limb sagittal joint angles during gait using only the norms of foot acceleration and angular velocity, which can help calculate the lower-limb sagittal joint angles during daily walking.
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Effect of toe-out gait modification on patellofemoral joint loading. Gait Posture 2023; 104:135-139. [PMID: 37419054 DOI: 10.1016/j.gaitpost.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Toe-out gait has been proposed as a conservative treatment to reduce medial tibiofemoral joint loading. However, patellofemoral joint loading during toe-out gait is not yet understood. RESEARCH QUESTION Does the toe-out gait modification affect patellofemoral joint loading? METHODS Sixteen healthy adults were enrolled in this study. The natural gait and toe-out gait were measured using a three-dimensional motion analysis and a force plate. The knee flexion angle and external knee flexion moment during the stance phase were calculated. Thus, dynamic knee joint stiffness, a proxy of patellofemoral joint loading, was defined as a linear regression of the knee flexion moment and knee flexion angle during the early stance. Additionally, the peak patellofemoral compressive force during the early stance was calculated using a musculoskeletal simulation. A paired t-test was used to compare these biomechanical parameters during the natural gait and toe-out gait. RESULTS The toe-out gait significantly increased the peak patellofemoral compressive force (mean difference = 0.37 BW, P = 0.017) and dynamic knee joint stiffness (mean difference = 0.07%BW*Ht/°, P = 0.001). The 1st peak of the knee flexion moment also significantly increased in the toe-out gait (mean difference = 1.01%BW*Ht, P = 0.003); however, the knee flexion angle did not change significantly (initial contact: mean difference = 1.7°, P = 0.078; peak: mean difference = 1.3°, P = 0.224). SIGNIFICANCE Toe-out gait increased the patellofemoral compressive force and dynamic knee joint stiffness because of increasing knee flexion moment, but not the knee flexion angle. When the toe-out gait is adapted, clinicians should pay attention to an increase in the patellofemoral joint loading.
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Passive stiffness of the quadriceps predicts the incidence of clinical knee osteoarthritis in twelve months. Eur J Phys Rehabil Med 2023; 59:65-74. [PMID: 36598343 PMCID: PMC10037105 DOI: 10.23736/s1973-9087.22.07634-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Quadriceps weakness is a known risk factor for the onset of knee osteoarthritis (OA). In addition to muscle weakness, increased passive stiffness of the quadriceps may affect knee biomechanics and hence contribute to the pathogenesis of knee OA. However, the association between quadriceps stiffness and the risk of knee OA development has not been prospectively investigated. AIM The aim of this study was to investigate how baseline quadriceps passive stiffness predicts the incidence of clinical knee OA at the 12-month follow-up. DESIGN Prospective cohort study. SETTING University laboratory. POPULATION Community-dwelling adults aged 60-80 years were recruited. We excluded participants with: 1) knee pain or known arthritis; 2) knee injury; 3) knee or hip joint replacement, 4) cognitive impairment; or 5) neurological conditions. METHODS At baseline, passive stiffness of the three superficial quadriceps muscle heads (rectus femoris [RF], vastus lateralis [VL], and vastus medialis oblique [VMO]) was evaluated using shear-wave ultrasound elastography. Knee muscle (quadriceps and hamstrings) strength was tested using a Cybex dynamometer. Knee OA was defined based on clinical criteria 12 months after baseline measurements. Generalized estimating equations were used to examine the associations of quadriceps stiffness and knee muscle strength with the risk of knee OA, controlling for age, sex, Body Mass Index, comorbidities, and activity level. RESULTS The analyses included 158 knees (58.2% females, age: 65.6±4.1 years). Twenty-eight knees (17.7%) were classified as having clinical OA at 12 months. Compared with the lowest stiffness tertiles, the highest stiffness tertiles of the RF (relative risk =5.31, 95% CI: 1.34-21.0), VMO (4.15, 1.04-16.6), and total superficial quadriceps (6.35, 1.48-27.3) at baseline were significantly associated with a higher risk of knee OA at the follow-up. The highest strength tertile of quadriceps has a trend of association with a lower risk of knee OA than the lowest tertile (0.18, 0.03-1.25, P=0.083). CONCLUSIONS Greater passive stiffness of the quadriceps at baseline was associated with a higher risk of clinical knee OA incidence at the 12-month follow-up. CLINICAL REHABILITATION IMPACT Interventions for reducing the passive stiffness of the quadriceps should be included in preventative training programs for older adults.
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Dynamic knee stiffness during walking is increased in individuals with anterior cruciate ligament reconstruction. J Biomech 2023; 146:111400. [PMID: 36469997 DOI: 10.1016/j.jbiomech.2022.111400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/22/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
Abstract
Individuals with anterior cruciate ligament (ACL) reconstruction often display abnormal gait mechanics reflective of a "stiff-knee" gait (i.e., reduced knee flexion angles and moments). However, dynamic knee stiffness, which is the dynamic relationship between the position of the knee and the moment acting on it, has not been directly examined during walking in individuals with ACL reconstruction. Here, we aimed to evaluate dynamic knee stiffness in the involved compared to the uninvolved limb during weight-acceptance and mid-stance phases of walking. Twenty-six individuals who underwent ACL reconstruction (Age: 20.2 ± 5.1 yrs., Time post-op: 7.2 ± 0.9 mo.) completed an overground walking assessment using a three-dimensional motion capture system and two force plates. Dynamic knee stiffness (Nm/°) was calculated as the slope of the regression line during weight-acceptance and midstance, obtained by plotting the sagittal plane knee angle versus knee moment. Paired t-tests with Bonferroni corrections were used to compare differences in dynamic stiffness, knee excursions, and moment ranges between limbs during both stance phases. Greater dynamic knee stiffness was found in the involved compared with the uninvolved limb during weight-acceptance and mid-stance (p < 0.01). Knee flexion and extension excursions were reduced in the involved limb during both weight-acceptance and mid-stance, respectively (p < 0.01). Sagittal plane knee moment ranges were not different between limbs during weight-acceptance (p = 0.1); however, the involved limb moment range was reduced relative to the uninvolved limb during mid-stance (p < 0.01). These results indicate that individuals with ACL reconstruction walk with a stiffer knee throughout stance, which may influence knee contact forces and could contribute to the high propensity for post-traumatic knee osteoarthritis development in this population.
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Biomechanical variations in children who are overweight and obese during high-impact activities: A systematic review and meta-analysis. Obes Rev 2022; 23:e13431. [PMID: 35112792 DOI: 10.1111/obr.13431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Abstract
Youth who are obese or overweight demonstrate evidence of poor lower extremity joint health and alterations in gait characteristics compared with youth who are healthy weight. However, there is no consensus if altered movement patterns are still present during high-impact activities. The purpose of this review was to determine if spatiotemporal and kinematic and kinetic variables during high-impact activities were significantly different between youth who are overweight and obese compared with youth who are healthy weight. An electronic search of five databases was conducted, and a meta-analysis and qualitative evidence synthesis was performed to determine the level of evidence, analyzing three tasks: running, jumping, and hopping. The findings of this review include the following: (1) overweight/obese (OW/OB) had higher stance phase time during running, (2) OW/OB had decreased hip flexion angles during running and stationary running, (3) OW/OB had decreased knee flexion angles during landing phase of jumping and hopping, and (4) OW/OB had increased hip abduction moments during running and jumping. These altered kinematic and kinetic variables at the hip and knee may result in mechanical inefficiency with high-impact activities, as well as potentially increased risk of joint degradation and poor joint health into adulthood.
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Are biomechanics during gait associated with the structural disease onset and progression of lower limb osteoarthritis? A systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:381-394. [PMID: 34757028 DOI: 10.1016/j.joca.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/12/2021] [Accepted: 10/23/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate if gait biomechanics are associated with increased risk of structurally diagnosed disease onset or progression of lower limb osteoarthritis (OA). METHOD A systematic review of Medline and Embase was conducted from inception to July 2021. Two reviewers independently screened records, extracted data and assessed risk of bias. Included studies reported gait biomechanics at baseline, and either structural imaging or joint replacement occurrence in the lower limb at follow-up. The primary outcome was the Odds Ratio (OR) (95% confidence interval (CI)) of the association between biomechanics and structural OA outcomes with data pooled for meta-analysis. RESULTS Twenty-three studies reporting 25 different biomechanical metrics and 11 OA imaging outcomes were included (quality scores ranged 12-20/21). Twenty studies investigated knee OA progression; three studies investigated knee OA onset. Two studies investigated hip OA progression. 91% of studies reported a significant association between at least one biomechanical variable and OA onset or progression. There was an association between frontal plane biomechanics with medial tibiofemoral and hip OA progression and sagittal plane biomechanics with patellofemoral OA progression. Meta-analyses demonstrated increased odds of medial tibiofemoral OA progression with greater baseline peak knee adduction moment (KAM) (OR: 1.88 [95%CI: 1.08, 3.29]) and varus thrust presence (OR: 1.97 [95%CI: 1.32, 2.96]). CONCLUSION Evidence suggests that certain gait biomechanics are associated with an increased odds of OA onset and progression in the knee, and progression in the hip. REGISTRATION NUMBER PROSPERO CRD42019133920.
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Load Carriage During Walking Increases Dynamic Stiffness at Distal Lower Limb Joints. J Appl Biomech 2021; 37:373-379. [PMID: 34111842 DOI: 10.1123/jab.2020-0346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/10/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
The addition of a load during walking requires changes in the movement pattern. The investigation of the dynamic joint stiffness behavior may help to understand the lower limb joints' contribution to these changes. This study aimed to investigate the dynamic stiffness of lower limb joints in response to the increased load carried while walking. Thirteen participants walked in two conditions: unloaded (an empty backpack) and loaded (the same backpack plus added mass corresponding to 30% of body mass). Dynamic stiffness was calculated as the linear slope of the regression line on the moment-angle curve during the power absorption phases of the ankle, knee, and hip in the sagittal plane. The results showed that ankle (P = .002) and knee (P < .001) increased their dynamic stiffness during loaded walking compared with unloaded, but no difference was observed at the hip (P = .332). The dynamic stiffness changes were different among joints (P < .001): ankle and knee changes were not different (P < .992), but they had a greater change than hip (P < .001). The nonuniform increases in lower limb joint dynamic stiffness suggest that the ankle and knee are critical joints to deal with the extra loading.
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Increased knee flexion and varus moments during gait with high-heeled shoes: A systematic review and meta-analysis. Gait Posture 2021; 85:117-125. [PMID: 33548909 DOI: 10.1016/j.gaitpost.2021.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/25/2020] [Accepted: 01/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND High-heeled shoes have been thought to alter lower extremity joint mechanics during gait, however its effects on the knee remain unclear. RESEARCH QUESTION This systematic review and meta-analysis aimed to determine the effects of high-heeled shoes on the sagittal- and frontal-plane knee kinetics/kinematics during gait. METHODS 1449 studies from 6 databases were screened for the following criteria: 1) healthy adult females, 2) knee joint kinematics/kinetics reported for the early stance phase during gait under varying shoe heel heights (including barefoot). Excluded studies included those mixing different shoe styles in addition to altering the heel heights. A total of 14 studies (203 subjects) met the selection criteria, resulting in 51 and 21 Cohen's d effect sizes (ESs) comparing the differences in knee sagittal- (flexion) and frontal-plane (varus) moment/angle, respectively, between shoes with higher heels and shoes with lower heels/barefoot. RESULTS Meta-analyses yielded a significant medium-to-large effect of higher heels compared to lower heels on increasing knee flexion moment (overall ES = 0.83; P < 0.01), flexion angle (overall ES=0.46; P < 0.01), and varus moment (overall ES=0.52; P < 0.01) during the early stance phase of gait. The results of meta-regressions used to explore factors explaining the heterogeneity among study ESs revealed that a greater ES in the knee flexion moment was associated with an elevated heel height of the high-heeled shoes (P = 0.02) and greater body mass of the individuals (P = 0.012). A greater ES in the knee varus moment during high-heeled gait was associated with a greater body height (P = 0.003) and mass (P = 0.006). SIGNIFICANCE Given the association between increased knee flexion/varus moments and risk of developing knee osteoarthritis (OA), women who wear high-heel shoes frequently and for a long period may be more susceptible to knee OA. Preventive treatments, such as lower extremity muscle strengthening, may help improve shock absorption to decrease knee loading in high-heel users.
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The influence of body mass index and sex on frontal and sagittal plane knee mechanics during walking in young adults. Gait Posture 2021; 83:217-222. [PMID: 33171375 DOI: 10.1016/j.gaitpost.2020.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/11/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Obesity and female sex are independent risk factors for knee osteoarthritis and also influence gait mechanics. However, the interaction between obesity and sex on gait mechanics is unclear, which may have implications for tailored gait modification strategies. RESEARCH QUESTION The purpose of this study was to examine the influence of obesity and sex on sagittal and frontal plane knee mechanics during gait in young adults. METHODS Forty-eight individuals with (BMI = 33.03 ± 0.59; sex:50 % female; age:21.9 ± 2.6 years) and 48 without obesity (BMI:21.59 ± 0.25; sex:50 % female; age:22.9 ± 3.57 years) matched on age and sex completed over-ground gait assessments at a self-selected speed. Two (BMI) by two (sex) analysis of variance was used to compare knee biomechanics during the first half of stance in the sagittal (knee flexion moment [KFM] and excursion [KFE]) and frontal plane (first peak knee adduction moment [KAM], knee varus velocity [KVV]). RESULTS We observed a BMI by sex interaction for normalized KFM (P = 0.03). Females had smaller normalized KFM compared to males (P = 0.03), but only in individuals without obesity. Males without obesity had larger normalized KFM compared to males with obesity (P = 0.01), while females did not differ between BMI groups. We observed main effects of sex and BMI group, where females exhibited greater normalized KAM (P < 0.01) and KVV (P < 0.01) compared to males, and individuals with obesity walked with greater KVV compared to those without obesity (P < 0.01). All absolute joint moments were greater in individuals with obesity (all P<0.01) and males had greater absolute KFM compared to females (P < 0.01). SIGNIFICANCE We observed sex differences in gait mechanics, however, KFM differences between males and females were only evident in individuals without obesity. Further, females and individuals with obesity had a larger KAM and KVV, which may contribute to larger medial compartment joint loading.
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Using Cumulative Load to Explain How Body Mass Index and Daily Walking Relate to Worsening Knee Cartilage Damage Over Two Years: The MOST Study. Arthritis Rheumatol 2020; 72:957-965. [PMID: 31785075 DOI: 10.1002/art.41181] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Knee cartilage damage is often linked to mechanical overloading. However, cartilage requires mechanical load to remain healthy, suggesting that underloading may be detrimental. This study was undertaken to examine knee overloading and underloading by defining cumulative load as the joint effects of body mass index (BMI) and daily walking, and examine the relationship between cumulative load and worsening cartilage damage over 2 years. METHODS We used data from the Multicenter Osteoarthritis Study. Steps/day, measured by accelerometry, and BMI were calculated at the 60-month visit. Cartilage damage on magnetic resonance imaging was semiquantitatively scored using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) at the 60-month and 84-month visits; worsening damage was defined as increased WORMS between visits. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated using binomial regression, with adjustment for potential confounders. RESULTS Our study included 964 participants, 62% of whom were female, with a mean ± SD age of 66.9 ± 7.5 years. Participants had a mean ± SD BMI of 29.7 ± 4.8 kg/m2 and walked a mean ± SD of 7,153 ± 2,591 steps/day. Participants who walked a moderate number of steps/day (6,000-7,900) or a high number of steps/day (>7,900) and had a high BMI (>31 kg/m2 ) had a greater risk of worsening medial tibiofemoral (TF) damage (RR 2.83 [95% CI 1.46-5.48] and RR 2.61 [95% CI 1.50-4.54], respectively) compared with those who walked similar steps/day and had a low BMI (18-27 kg/m2 ). Participants with a low number of steps/day (<6,000) and a low BMI had a greater risk of worsening medial TF and lateral patellofemoral (PF) damage (RR 2.03 [95% CI 1.06-3.92] and RR 2.28 [95% CI 1.06-4.85], respectively) compared with those who walked a high number of steps/day and had a low BMI. Effect estimates for other compartments of the knee did not reach statistical significance. CONCLUSION This study provides preliminary evidence that both overloading and underloading may be detrimental to medial TF cartilage, and underloading may be detrimental to lateral PF cartilage.
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Quadriceps Impairment Is Associated with Gait Mechanics in Young Adults with Obesity. Med Sci Sports Exerc 2019; 51:951-961. [DOI: 10.1249/mss.0000000000001891] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Shoe-mounted accelerometers should be used with caution in gait retraining. Scand J Med Sci Sports 2019; 29:835-842. [PMID: 30693580 DOI: 10.1111/sms.13396] [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: 07/12/2018] [Revised: 12/27/2018] [Accepted: 01/22/2019] [Indexed: 01/30/2023]
Abstract
Real-time biofeedback gait retraining has been reported to be an effective intervention to lower the impact loading during gait. While many of the previous gait retraining studies have utilized a laboratory-based setup, some studies used accelerometers affixed at the distal tibia to allow training outside the laboratory environment. However, many commercial sensors for gait modification are shoe-mounted. Hence, this study sought to compare impact loading parameters measured by shoe-mounted and tibia sensors in participants before and after a course of walking or running retraining using signal source from the shoe-mounted sensors. We also compared the correlations between peak positive acceleration measured at shoe (PPAS ) and tibia (PPAT ) and vertical loading rates, as these loading rates have been related to injury. Twenty-four and 14 participants underwent a 2-week visual biofeedback walking and running retraining, respectively. Participants in the walking retraining group experienced lower PPAS following the intervention (P < 0.005). However, they demonstrated no change in PPAT (P = 0.409) nor vertical loading rates (P > 0.098) following the walking retraining. In contrast, participants in the running retraining group experienced a reduction in the PPAT (P = 0.001) and vertical loading rates (P < 0.013) after running retraining. PPAS values were four times that of PPAT for both walking and running suggesting an uncoupling of the shoe with tibia. As such, PPAS was not correlated with vertical loading rates for either walking or running, while significant correlations between PPAT and vertical loading rates were noted. The present study suggests potential limitations of the existing commercial shoe-mounted sensors.
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Imaging of Osteoarthritis by Conventional Radiography, MR Imaging, PET–Computed Tomography, and PET–MR Imaging. PET Clin 2019; 14:17-29. [DOI: 10.1016/j.cpet.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Local associations between knee cartilage T 1ρ and T 2 relaxation times and patellofemoral joint stress during walking: A voxel-based relaxometry analysis. Knee 2018; 25:406-416. [PMID: 29681528 PMCID: PMC6049815 DOI: 10.1016/j.knee.2018.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/22/2017] [Accepted: 02/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to utilize voxel-based relaxometry (VBR) to examine local correlations between patellofemoral joint (PFJ) stress during gait and PFJ cartilage relaxation times. METHODS Eighty-three subjects with and without PFJ osteoarthritis (OA) underwent knee magnetic resonance (MR) images using fast spin-echo, T1ρ and T2 relaxation time sequences. Patellar and trochlear cartilage relaxation times were computed for each voxel. Peak PFJ stress was computed during the stance phase from three-dimensional gait analysis. Statistical Parametric Mapping was used to perform VBR analyses. Pearson partial correlations were used to evaluate the associations between peak PFJ stress and cartilage relaxation times while controlling for age, sex, and body mass index. RESULTS A higher percentage of the trochlear cartilage (15.9-29.1%) showed significant positive correlations between PFJ stress and T1ρ and T2 than the patellar cartilage (7.4-13.6%). Average correlation coefficient (R) of the voxels showing significant positive correlations ranged from 0.27 to 0.29. Subcompartment analysis revealed a higher percentage of lateral compartment cartilage (trochlea: 30.2-34.7%, patella: 8.1-14.8%) showed significant correlations between peak PFJ stress and T1ρ and T2 than the medial compartment cartilage (trochlea: 7.1-27.2%, patella: 5.5-5.9%). Subgroup analysis showed that larger percentages of PFJ cartilage demonstrated significant positive correlations with PFJ stress in subjects with PFJ OA than those without PFJ OA. CONCLUSIONS The findings of this study suggest that peak PFJ stress has a greater influence on the biochemical composition of the trochlear than the patellar cartilage, and the lateral than the medial PFJ compartment.
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Imaging of osteoarthritis-recent research developments and future perspective. Br J Radiol 2018; 91:20170349. [PMID: 29271229 DOI: 10.1259/bjr.20170349] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In osteoarthritis research, imaging plays an important role in clinical trials and epidemiological observational studies. In this narrative review article, we will describe recent developments in imaging of osteoarthritis in the research arena, mainly focusing on literature evidence published within the past 3 years (2014-2017). We will primarily focus on MRI including advanced imaging techniques that are not currently commonly used in routine clinical practice, although radiography, ultrasound and nuclear medicine (radiotracer) imaging will also be discussed. Research efforts to uncover the disease process of OA as well as to discover a disease modifying OA drug continue. MRI continues to play a large role in these endeavors, while compositional MRI techniques will increasingly become important due to their ability to assess "premorphologic" biochemical changes of articular cartilage and other tissues in and around joints. Radiography remain the primary imaging modality for defining inclusion/exclusion criteria as well as an outcome measure in OA clinical trials, despite known limitations for visualization of OA features. Compositional MRI techniques show promise for predicting structural and clinical outcomes in OA research. Ultrasound can be a useful adjunct to radiography and MRI particularly for evaluation of hand OA. Newer imaging techniques such as hybrid PET/MRI may have a potential but require further research and validation.
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