Investigation of normal knees kinematics in walking and running at different speeds using a portable motion analysis system

The knee kinematic patterns and associated factors in healthy Thai adults

BACKGROUND

Reference values for normal knee kinematics were limited in Asian population and were influenced by race and other factors. This study was aimed to establish the reference values and identify the factors associated with knee kinematics in healthy Thai adults, aged 18-40 years.

METHODS

A retrospective cohort study was conducted between 2016 and 2020. Healthy Thai adults aged 18-40 years old with body mass index (BMI) between 18.5 and 24.9 kg/m2 were included. All eligible participants were attached with reflective markers. Their walking was captured by 8-digital cameras, and assessed by motion analysis software. The primary outcomes were average knee kinematic data (degrees) in three dimensional planes as valgus-varus, flexion-extension, and internal-external rotation. Paired t-test and multiple linear regression were applied to compare the outcomes and to determine their associated factors.

RESULTS

Ninety-eight participants (60 females and 38 males) were included with mean age 28.5 ± 5.4 years, and BMI 21.1 ± 2.0 kg/m2. Knee kinematics showed slight adduction during the swing phase, flexion during the stance phase, and obvious external rotation throughout the gait cycle, with a peak of 30-31 degrees during mid-swing. Right knee was significantly more adducted, flexed and externally rotated than the left side, particularly at mid-stance (P = 0.047, 0.017, and < 0.001, respectively). Females had more knee abduction, flexion and external rotation than males. Age, sex, and BMI were significantly correlated with knee abduction at terminal stance (correlation coefficient - 0.12, 95% confidence interval (CI) -0.23, -0.01; -1.37, 95%CI -2.54, -0.20; and - 0.32, 95%CI -0.61, -0.39, respectively), and rotation at mid-swing (correlation coefficient - 0.36, 95%CI -0.69, -0.02; -7.37, 95%CI -10.82, -3.92; and 0.89, 95%CI 0.01, 1.78, respectively).

CONCLUSION

Knee kinematics demonstrates external tibial rotation throughout the gait cycle, significant side differences, and are associated with age, sex, and BMI. Reference values from this study will be useful for functional gait assessment in healthy Thais. However, further comprehensive knee kinetic study including spatio-temporal parameter is recommended.

High-demand tasks show that ACL reconstruction is not the only factor in controlling range of tibial rotation: a preliminary investigation

BACKGROUND

Excessive range of tibial rotation (rTR) may be a reason why athletes cannot return to sports after ACL reconstruction (ACLR). After ACLR, rTR is smaller in reconstructed knees compared to contralateral knees when measured during low-to-moderate-demand tasks. This may not be representative of the amount of rotational laxity during sports activities. The purpose of this study is to determine whether rTR is increased after ACL injury compared to the contralateral knee and whether it returns to normal after ACLR when assessed during high-demand hoptests, with the contralateral knee as a reference.

METHODS

Ten ACL injured subjects were tested within three months after injury and one year after reconstruction. Kinematic motion analysis was conducted, analysing both knees. Subjects performed a level-walking task, a single-leg hop for distance and a side jump. A paired t-test was used to detect a difference between mean kinematic variables before and after ACL reconstruction, and between the ACL-affected knees and contralateral knees before and after reconstruction.

RESULTS

RTR was greater during high-demand tasks compared to low-demand tasks. Pre-operative, rTR was smaller in the ACL-deficient knees compared to the contralateral knees during all tests. After ACLR, a greater rTR was seen in ACL-reconstructed knees compared to pre-operative, but a smaller rTR compared to the contralateral knees, even during high-demand tasks.

CONCLUSION

The smaller rTR, compared to the contralateral knee, seen after a subacute ACL tear may be attributed to altered landing technique, neuromuscular adaptation and fear of re-injury. The continued reduction in rTR one year after ACLR may be a combination of this neuromuscular adaptation and the biomechanical impact of the reconstruction.

TRIAL REGISTRATION

The trial was registered in the Dutch Trial Register (NTR: www.trialregister.nl , registration ID NL7686).

Effects of Dynamic IMU-to-Segment Misalignment Error on 3-DOF Knee Angle Estimation in Walking and Running

The inertial measurement unit (IMU)-to-segment (I2S) alignment is an important part of IMU-based joint angle estimation, and the accurate estimation of the three degree of freedom (3-DOF) knee angle can provide practical support for the evaluation of motions. In this paper, we introduce a dynamic weight particle swarm optimization (DPSO) algorithm with crossover factor based on the joint constraint to obtain the dynamic alignment vectors of I2S, and use them to perform the quaternion-based 3-DOF knee angle estimation algorithm. The optimization algorithm and the joint angle estimation algorithm were evaluated by comparing with the optical motion capture system. The range of 3-DOF knee angle root mean square errors (RMSEs) is 1.6°-5.9° during different motions. Furthermore, we also set up experiments of human walking (3 km/h), jogging (6 km/h) and ordinary running (9 km/h) to investigate the effects of dynamic I2S misalignment errors on 3-DOF knee angle estimation during different motions by artificially adding errors to I2S alignment parameters. The results showed differences in the effects of I2S misalignment errors on the estimation of knee abduction, internal rotation and flexion, which indicate the differences in knee joint kinematics among different motions. The IMU to thigh misalignment error has the greatest effect on the estimation of knee internal rotation. The effect of IMU to thigh misalignment error on the estimation of knee abduction angle becomes smaller and then larger during the two processes of switching from walking to jogging and then speeding up to ordinary running. The effect of IMU to shank misalignment error on the estimation of knee flexion angle is numerically the largest, while the standard deviation (SD) is the smallest. This study can provide support for future research on the accuracy of 3-DOF knee angle estimation during different motions.