Normalization influences knee abduction moment results: Could it influence ACL-injury research, too?

Allometric Scaling Hip Joint Moments Optimally Reduces Anthropometric Differences in Males and Females

Running biomechanics are scaled to reduce the effects of anthropometric differences between participants. Ratio scaling has limitations, and allometric scaling has not been applied to hip joint moments. The aim was to compare raw, ratio and allometrically scaled hip joint moments. Sagittal and frontal plane moments of 84 males and 47 females were calculated while running at 4.0 m/s. Raw data were ratio scaled by body mass (BM), height (HT), leg length (LL) and BM multiplied by HT (BM*HT) and LL (BM*LL). Log-linear (for BM, HT and LL individually) or log-multilinear regression (BM*HT and BM*LL) exponents were calculated. Correlations and r2 values assessed the effectiveness of each scaling method. Eighty-five per cent of raw moments were positively correlated to the anthropometrics with r2 values of 10-19%. In ratio scaling, 26-43% were significantly correlated to the moments and a majority were negative, indicating overcorrections. The most effective scaling procedure was the allometric BM*HT, as the mean shared variance between the hip moment and anthropometrics was 0.1-0.2% across all sexes and moments and none had significant correlations. Allometric scaling of hip joint moments during running are advised if the goal is to remove the underlying effects of anthropometrics across male and female participants.

Test-retest reliability and longitudinal validity of drop vertical jump biomechanics during rehabilitation after ACL reconstruction

Hip and knee biomechanics measured during a drop vertical jump (DVJ) can be used to assess patients undergoing rehabilitation after anterior cruciate ligament (ACL) reconstruction. To confidently interpret such data for use as outcome measures, additional information about reliability and validity is required. Therefore, the objective of this study was to estimate the test-retest reliability and longitudinal validity of selected lower limb biomechanics assessed during a DVJ in patients undergoing rehabilitation after ACL reconstruction. Biomechanical analysis of the DVJ in primary unilateral ACL reconstruction patients (22.3 ± 5.5y) were tested twice within 1 week at 6 months post-surgery (n = 46), and again at 12 months post-surgery (n = 36). Peak and initial contact knee angles and moments, hip impulse, vertical ground reaction forces (VGRF), isokinetic knee extension and flexion strength, and global ratings of change (GRC) were assessed. Reliability was evaluated based on the 6-month post-surgery data using intraclass correlation coefficients (ICC2,1), standard errors of measurement and minimum detectable change. Longitudinal validity was evaluated by assessing change from 6 to 12 months, using standardized response means (SRM), and by assessing the correlation (Pearson's r) of change in landing biomechanics with change in strength, and GRC. ICCs ranged from 0.58 to 0.90 for peak knee abduction and flexion moments, 0.44-0.85 for knee flexion and abduction angles, 0.82-0.93 for VGRFs, and 0.42-0.65 for hip impulse. SRMs and correlations of change ranged from 0.00 to 0.50. Reliability and longitudinal validity of DVJ measures varied, ranging from poor-to-excellent; the present results assist in their interpretation when assessed during rehabilitation after ACL reconstruction.

Evaluation of spinal force normalization techniques

Division normalization is commonly used in biomechanics studies to remove the effect of anthropometric differences (e.g., body weight) on kinetic variables, facilitating comparison across a population. In spine biomechanics, spinal forces are commonly divided by the body weight or the intervertebral load during a standing posture. However, it has been suggested that offset and power curve normalization are more appropriate than division normalization for normalizing kinetic variables such as ground reaction forces during walking and running. The present study investigated, for the first time, the effectiveness of four techniques for normalizing spinal forces to remove the effect of body weight. Spinal forces at all lumbar levels were estimated using a detailed OpenSim musculoskeletal model of the spine for 11 scaled models (50-100 kg) and during 13 trunk flexion tasks. Pearson correlations of raw and normalized forces against body weight were used to assess the effectiveness of each normalization technique. Body weight and standing division normalization could only successfully normalize L₄L₅ spinal forces in three tasks, and L₅S₁ loads in five and three tasks, respectively; however, offset and power curve normalization techniques were successful across all lumbar spine levels and all tasks. Offset normalization successfully removed the effect of body weight and maintained the influence of flexion angle on spinal forces. Thus, we recommend offset normalization to account for anthropometric differences in studies of spinal forces.

The Effects of Gluteal Strength and Activation on the Relationship Between Femoral Alignment and Functional Valgus Collapse During a Single-Leg Landing

CONTEXT

A bias toward femoral internal rotation is a potential precursor to functional valgus collapse. The gluteal muscles may play a critical role in mitigating these effects.

OBJECTIVE

Determine the extent to which gluteal strength and activation mediate associations between femoral alignment measures and functional valgus collapse.

DESIGN

Cross-sectional.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Forty-five females (age = 20.1 [1.7] y; height = 165.2 [7.6] cm; weight = 68.6 [13.1] kg) and 45 males (age = 20.8 [2.0] y; height = 177.5 [8.7] cm; weight = 82.7 [16.5] kg), healthy for 6 months prior.

INTERVENTION(S)

Femoral alignment was measured prone. Hip-extension and abduction strength were obtained using a handheld dynamometer. Three-dimensional biomechanics and surface electromyography were obtained during single-leg forward landings.

MAIN OUTCOME MEASURES

Forward stepwise multiple linear regressions determined the influence of femoral alignment on functional valgus collapse and the mediating effects of gluteus maximus and medius strength and activation.

RESULTS

In females, less hip abduction strength predicted greater peak hip adduction angle (R2 change = .10; P = .02), and greater hip-extensor activation predicted greater peak knee internal rotation angle (R2 change = .14; P = .01). In males, lesser hip abduction strength predicted smaller peak knee abduction moment (R2 change = .11; P = .03), and the combination of lesser hip abduction peak torque and lesser gluteus medius activation predicted greater hip internal rotation angle (R2 change = .15; P = .04). No meaningful mediation effects were observed (υadj < .01).

CONCLUSIONS

In females, after accounting for femoral alignment, less gluteal strength and higher muscle activation were marginally associated with valgus movement. In males, less gluteal strength was associated with a more varus posture. Gluteal strength did not mediate femoral alignment. Future research should determine the capability of females to use their strength efficiently.

Evaluating Performance During Maximum Effort Vertical Jump Landings

The ability to rapidly complete a jump landing has received little attention in the literature despite the need for rapid performance in a number of sports. As such, our purpose was to investigate differences between groups of individuals who land quickly (FAST) and slowly (SLOW) relative to peak vertical ground reaction forces (vGRFs), loading rates, rates of vGRF attenuation, contributions to lower extremity mechanical energy absorption at the involved joints, and the onsets of preparatory joint flexion/dorsiflexion. Twenty-four healthy adults (26.1 [3.3] y, 75.7 [18.9] kg, 1.7 [0.1] m) were stratified into FAST and SLOW groups based on landing time across 8 jump-landing trials. Independent t tests (α = .05) and effect sizes (ESs; large ≥ 0.8) compared differences between groups. A greater rate of vGRF attenuation (P = .02; ES = 0.95) was detected in the FAST group. The FAST group also exhibited greater contributions to lower extremity energy absorption at the ankle (P = .03; ES = 0.98) and knee (P = .03; ES = 0.99) during loading and attenuation, respectively. The SLOW group exhibited greater contributions to energy absorption at the hip during loading (P = .02; ES = 1.10). Results suggest that individuals who land quickly utilize different energy absorption strategies than individuals who land slowly. Ultimately, the FAST group’s strategy resulted in superior landing performance (more rapid landing time).