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Rostami M, Sedaghati P, Daneshmandi H. The effectiveness of the STOP-X training program on the knee valgus angle and balance in female basketball players with dynamic knee valgus: a randomized controlled trial. BMC Sports Sci Med Rehabil 2024; 16:52. [PMID: 38383435 PMCID: PMC10882901 DOI: 10.1186/s13102-024-00844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Dynamic knee valgus (DKV) accompanied by poor balance is the cause of anterior cruciate ligament (ACL) injury in athletes, and the identification and correction of these factors are always of interest to researchers. Therefore, the purpose of this research was to investigate the effect of the STOP-X program on the knee valgus angle and static and dynamic balance in female basketball players with DKV defects. METHODS The present study was a quasi-experimental study. Thirty female basketball players with DKV defects were purposefully identified by the single-leg landing (SLL) test and were randomly assigned to two control (n = 15) and experimental (n = 15) groups. Static balance status was evaluated with the BASS STICK test, and dynamic balance status was evaluated with the Y-balance test (YBT). The experimental group performed the STOP-X program for 25-40 min for eight weeks (three times per week), and the control group performed their traditional warm-up program. Data were analyzed by means of 2 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of (P < 0.05) with SPSS version 26. RESULTS The results showed that with the use of the STOP-X program, there was a significant difference between the experimental and control groups in variables of the static balance (F = 56.45; P = 0.001; ES = 0.66, PC=↑59.64%), total dynamic balance score (F = 107.57; P = 0.001; ES=↑0.79, PC=↑19.84%), and knee valgus angle (F = 119.46; P = 0.001; ES = 0.81, PC=↓34.36%). CONCLUSION In addition to reducing the knee valgus angle, applying the STOP-X injury prevention program can improve static and dynamic balance in female basketball players with DKV defects. Therefore, it can be recommended that sports trainers benefit from these advantages by adding STOP-X training to routine basketball exercises.
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Affiliation(s)
- Mohadeseh Rostami
- Department of Sport Injury and Corrective Exercise, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
| | - Parisa Sedaghati
- Department of Sport Injury and Corrective Exercise, Faculty of Sport Sciences, University of Guilan, Rasht, Iran.
| | - Hassan Daneshmandi
- Department of Sport Injury and Corrective Exercise, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
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Alrayani H, Herrington L, Liu A, Jones R. Frontal plane projection angle predicts patellofemoral pain: Prospective study in male military cadets. Phys Ther Sport 2023; 59:73-9. [PMID: 36525739 DOI: 10.1016/j.ptsp.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a major source of knee pain. Identifying who may develop PFP is of paramount importance. PURPOSE To assess whether Frontal plane projection angles (FPPA) and hand held dynamometry (HHD) strength measures can predict development of PFP. STUDY DESIGN Prospective evaluation of individuals undertaking a military training programme. METHODS Male military recruits were enrolled and prospectively followed up from enrolment to completion of 12-weeks training. Lower limb kinematics (FPPA, Q-angle, hip adduction angle, knee flexion, ankle dorsiflexion, and rearfoot eversion angle) measured during running, single leg squatting (SLS), and single leg landing (SLL) and isometric muscle strength of hip abductors and knee extensors. RESULTS Body mass, hip abductor muscle strength, Q-angle during SLS and SLL, FPPA during SLL all significantly different between the PFP and non-injured groups and predicted PFP, highest predictor variable was FPPA during SLL (Odds Ratio = 1.13, P = 0.01). A FPPA≥5.2° during SLL predicting PFP with a sensitivity of 70% and a specificity of 70%. CONCLUSION Participants who developed PFP had a number of physical factors significantly different than the non-injured group, most predictive was a larger FPPA during SLL, with angles greater than 5.2° associated with a 2.2x greater risk. CLINICAL RELEVANCE Assessing FPPA during SLL could be used to determine who was predisposed to PFP.
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Zou J, Zhang X, Zhang Y, Li J, Jin Z. Prediction on the medial knee contact force in patients with knee valgus using transfer learning approaches: Application to rehabilitation gaits. Comput Biol Med 2022; 150:106099. [PMID: 36150250 DOI: 10.1016/j.compbiomed.2022.106099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/21/2022] [Accepted: 09/10/2022] [Indexed: 11/03/2022]
Abstract
The Knee contact force (KCF) is a key factor in evaluating knee joint function of patients with knee osteoarthritis. In vivo measurement of KCF based on the instrumented implants is limited due to the ethical issues and technical complexities. Machine learning can be used to predict tibiofemoral compartment contact forces. However, anthropometric differences between individuals make the accurate predictions challenging. The purpose of this study was to develop transfer learning models to predict the medial KCF of patients with knee valgus in rehabilitation gaits. Four subjects with instrumented tibial prostheses were considered, including one with knee valgus and three with normal knee joint alignment. Two transfer learning models were proposed: a fine-tuning model and an adaptive model. In particular, a synchronization method for extracting experimental data in a complete gait cycle was developed, since different types of experimental data have different sampling frequencies. The transfer learning models were pre-trained by the experiment data of patients with normal knee joint alignment, and re-trained by the data of the patient with knee valgus. Predictions of the transfer learning models and traditional machine learning model were validated against the in vivo measurements. The proposed transfer learning models were tested within two levels: the single subject (Level 1) and multiple subjects (Level 2). The results show that the two transfer learning models could more accurately predict the medial KCF of patients with knee valgus than the traditional machine learning model. The performance of the fine-tuning model is better than that of the adaptive model. Compared with the traditional machine learning and inverse dynamics analysis, transfer learning represents a much easier and more accurate method. It can be introduced to help clinicians validate and adjust the rehabilitation gait for specific patients.
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Affiliation(s)
- Jianjun Zou
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Xiaogang Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China.
| | - Yali Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Junyan Li
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Zhongmin Jin
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China; School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710049, China; School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
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Unuvar E, Guney-Deniz H, Akinoglu B, Kocahan T, Nyland J. Frontal plane lower extremity alignment in adolescent athletes with chronic hip adductor-related groin injury symptoms: A case-control study. Phys Ther Sport 2022; 57:53-60. [PMID: 35921782 DOI: 10.1016/j.ptsp.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare trunk and lower extremity frontal plane projection angles (FPPA) during single leg squat (SLS) performance, perceived hip and groin function and symptoms, and isometric hip strength of adolescent athletes with chronic hip adductor-related groin injury (HARGI) symptoms and age, gender, and sport-matched healthy subjects. DESIGN Case-control study. SETTING Junior Olympic Development Training Centre. PARTICIPANTS Twenty-six athletes at 59.1 ± 60 weeks (range = 12-208 weeks) post-index grade II HARGI injury who had continued sport training (injury group) and 26 control group subjects. MAIN OUTCOME MEASURES SLS trunk, hip, and knee FPPA, isometric hip strength standardized to bodyweight, and Copenhagen Hip and Groin Outcome Scores (HAGOS). RESULTS The injury group had greater bilateral knee FPPA, and greater injury side hip FPPA during maximum SLS. Injury group HAGOS subscale scores were lower than control group scores. Hip abductor, adductor, external rotator, and internal rotator strength was lower at the injury side of the injury group compared to the matched control group limb. Forward stepwise multiple regression analysis of the injury group found that 50% of injury side knee FPPA was predicted by hip internal rotator strength and time post-index HARGI; and 47% of injury side hip FPPA was predicted by other side hip flexor strength and the HAGOS function, sport and recreation subscale score (p = 0.002). CONCLUSIONS Greater injury side hip and bilateral knee FPPA during maximum SLS, lower self-reported hip symptom and function scores, and less injury side hip abductor, adductor, external rotator and internal rotator strength suggests that adolescent athletes with chronic HARGI symptoms are at an increased risk for sustaining a non-contact knee injury. Impaired hip internal rotator strength at the side of the chronic HARGI was related to increased knee FPPA, and impaired hip flexor strength at the other side of the HARGI was related to increased hip FPPA. Findings support using SLS performance testing in this athlete group to help determine safe return to sport training readiness.
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Affiliation(s)
- Ezgi Unuvar
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Musculoskeletal Physiotherapy and Rehabilitation, 06100, Ankara, Turkey
| | - Hande Guney-Deniz
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Musculoskeletal Physiotherapy and Rehabilitation, 06100, Ankara, Turkey
| | - Bihter Akinoglu
- Ankara Yıldırım Beyazıt University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Etlik, Ankara, Turkey
| | - Tugba Kocahan
- University of Health Sciences, Gulhane Faculty of Medicine, Sports Medicine Department, Ankara, Turkey
| | - John Nyland
- Spalding University, Kosair Charities College of Health and Natural Sciences, Louisville, KY, USA.
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Kiminski R, Williams C, Heinert B, Mills O, Cluppert K, Rutherford D, Kernozek T. Transfer of post-trial feedback on impacts during drop landings in female athletes. Sports Biomech 2022:1-15. [PMID: 36039917 DOI: 10.1080/14763141.2022.2114931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022]
Abstract
Increased vertical ground reaction force (vGRF) and dynamic knee valgus contribute to non-contact anterior cruciate ligament (ACL) injuries. We examined feedback's influence during landing and transfer to a game-specific drill, measured by deceleration. Thirty-one female athletes performed 30 drop landings with augmented feedback and dual-task conditions, with a game-specific drill before and after. Differences were shown across time (baseline, feedback, post-feedback) and between conditions (with or without dual-task) in peak vGRF and knee to ankle ratio (K:A ratio). K:A ratio is the ratio of the frontal plane distance between the knees relative to the frontal plane distance between the ankles. This measure serves as a surrogate for knee valgus where a ratio closer to 1 indicates less knee valgus. There were reductions in peak vGRF (p < 0.05) and improvements in K:A ratio (p < 0.05) across time, improvements in K:A ratio across time and by condition (p < 0.05), and reduction in deceleration during landing in a game-specific drill (p < 0.05). Feedback may improve landing mechanics and transfer to a game-specific drill that can influence ACL injury in sport.
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Affiliation(s)
- Rachel Kiminski
- Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Cori Williams
- Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Becky Heinert
- Winona State University, Department of Health, Exercise and Rehabilitative Science, Winona, MN, USA
| | - Owen Mills
- Gundersen Health System, Sports Medicine Department, La Crosse, WI USA
| | - Kyle Cluppert
- Viterbo University, Athletics Department, La Crosse, WI USA
| | - Drew Rutherford
- Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Thomas Kernozek
- Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, USA
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Mansfield CJ, Rethman KK, Stephens J, Di Stasi S, Vanetten L, Briggs MS. The association and reliability of the frontal plane projection angle during the lateral step down test on knee function in patients with patellofemoral pain. Knee 2022; 36:87-96. [PMID: 35561562 DOI: 10.1016/j.knee.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The lateral step-down test is used by physical therapists (PT) to identify movement faults in patients with patellofemoral pain (PFP). The FPPA is a measure of knee valgus and PTs have access to open source video analysis software and high quality smart phones and video cameras to implement 2D video analysis into practice. The purpose of our study was to determine the reliability of PTs measuring the frontal plane projection angle (FPPA) during the lateral step-down test, and to determine if the FPPA was associated with pain, self-reported knee function and fear of movement. METHODS Twenty-two subjects (mean age[SD] = 27.8 [6.6] years, females n = 14, males n = 8) with PFP were analyzed by six PTs using 2D video analysis software. The FPPA was measured during the lateral step down test. Numeric Pain Rating Scale (NPRS), Anterior Knee Pain Scale (AKPS) and the Tampa Scale of Kinesiophobia (TSK) were collected. Intraclass correlation (ICC) was used to assess for PT measurement reliability. Correlations between outcomes were calculated using Spearman correlation coefficient and standard error of measurement (SEM) and minimal detectable change (MDC) were reported. RESULTS Reliability amongst PTs measuring the FPPA was good (ICC [95 %CI] = 0.85 [0.72-0.93]; SEM = 3.33°, MDC = 9.20°). There were no significant correlations (p > 0.05) between FPPA and NPRS(ρ = -0.046), AKPS(ρ = 0.066), or TSK(ρ = -0.204). CONCLUSIONS Although reliability measuring FPPA was good, the large SEM and MDC associated with this measurement may limit its clinical utility in those with PFP.
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Taniguchi S, Ishida T, Yamanaka M, Ueno R, Ikuta R, Chijimatsu M, Samukawa M, Koshino Y, Kasahara S, Tohyama H. Sex difference in frontal plane hip moment in response to lateral trunk obliquity during single-leg landing. BMC Sports Sci Med Rehabil 2022; 14:70. [PMID: 35428336 PMCID: PMC9013173 DOI: 10.1186/s13102-022-00460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lateral trunk obliquity during landing is a characteristic of anterior cruciate ligament (ACL) injuries in female athletes and affects their knee and hip kinetics and kinematics. However, it is unclear whether these effects differ between females and males. The purpose of this study was to compare the effects of lateral trunk obliquity on knee and hip kinetics and kinematics in females and males during single-leg landing. METHODS Eighteen female (aged 22.1 ± 1.5 years) and 18 male participants (aged 21.8 ± 1.1 years) performed single-leg landings under two conditions: (1) without any instructions about trunk position (natural) and (2) with leaning their trunks laterally 15° from the vertical line (trunk obliquity). The kinetics and kinematics of their hip and knee were analyzed using a three-dimensional motion analysis with a force plate. Two-way repeated-measures ANOVA (sex × trunk obliquity) and Bonferroni pairwise comparisons were conducted. RESULTS The trunk obliquity angle at initial contact was significantly greater in the trunk-obliquity landing condition than in the natural landing condition (natural 4.0 ± 2.2°, trunk-obliquity 15.1 ± 3.6°, P < 0.001) with no sex difference (95% CI - 1.2 to 2.2°, P = 0.555). The peak knee abduction moment was significantly larger in the trunk-obliquity landing condition than in the natural landing condition (trunk-obliquity, 0.09 ± 0.07 Nm/kg/m; natural, 0.04 ± 0.06 Nm/kg/m; P < 0.001), though there was no sex or interaction effect. A significant interaction between sex and landing condition was found for the peak hip abduction moment (P = 0.021). Males showed a significantly larger peak hip abduction moment in the trunk-obliquity landing condition than in the natural landing condition (95% CI 0.05 to 0.13 Nm/kg/m, P < 0.001), while females showed no difference in the peak hip abduction moment between the two landing conditions (95% CI - 0.02 to 0.06 Nm/kg/m, P = 0.355). CONCLUSIONS The knee abduction moment increased with a laterally inclined trunk for both female and male participants, while the hip abduction moment increased in males but not in females. It may be beneficial for females to focus on frontal plane hip joint control under lateral trunk-obliquity conditions during single-leg landing.
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Affiliation(s)
- Shohei Taniguchi
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan.,Rehabilitation Center, NTT Medical Center Sapporo, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan.
| | - Masanori Yamanaka
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Ryo Ueno
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Ryohei Ikuta
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Masato Chijimatsu
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan.,Rehabilitation Center, NTT Medical Center Sapporo, Sapporo, Japan
| | - Satoshi Kasahara
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, West 5, North 12, Kitaku, Sapporo, 060-0812, Japan
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Llurda-Almuzara L, Perez-Bellmunt A, Labata-Lezaun N, López-de-Celis C, Canet-Vintró M, Cadellans-Arroniz A, Moure-Romero L, Aiguadé-Aiguadé R. Relationship between lower limb EMG activity and knee frontal plane projection angle during a single-legged drop jump. Phys Ther Sport 2021; 52:13-20. [PMID: 34365085 DOI: 10.1016/j.ptsp.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess a relationship between lower limb muscle activity and the frontal plane knee kinematics during a single-legged drop jump. DESIGN Correlation study; SETTING: Functional Anatomy Laboratory. PARTICIPANTS 35 healthy collegiate male athletes. MAIN OUTCOME MEASURES Muscle activity (%MVIC) of gluteus maximus, gluteus medius, biceps femoris, semitendinosus, vastus medialis quadriceps, vastus lateralis quadriceps, medial gastrocnemius and lateral gastrocnemius; peak knee frontal plane projection angle; and Pearson's correlation coefficients between muscle activity and peak knee frontal plane projection angle. All outcomes were assessed for both dominant and non-dominant limbs. RESULTS Significant correlations (r = 0.46-0.60, P < 0.05) were found between the muscle activities of the gluteus maximus, gluteus medius, biceps femoris, and semitendinosus, when compared to the knee frontal plane projection angle. CONCLUSION Gluteal muscles and hamstring muscles are associated with the peak knee frontal plane projection angle during a single-legged drop jump test. Thus, gluteal and hamstring muscle activities should be considered when developing rehabilitation or injury prevention programs.
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Affiliation(s)
- Luis Llurda-Almuzara
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Albert Perez-Bellmunt
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain.
| | - Noé Labata-Lezaun
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Carlos López-de-Celis
- ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Max Canet-Vintró
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Aida Cadellans-Arroniz
- ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Lourdes Moure-Romero
- Nursing and Physiotherapy Department, University of Lleida, 25198, St. Lleida, Spain
| | - Ramón Aiguadé-Aiguadé
- Nursing and Physiotherapy Department, University of Lleida, 25198, St. Lleida, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198, St. Lleida, Spain
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Hummer ET, Murphy EN, Suprak DN, Brilla LR, San Juan JG. Movement direction impacts knee joint kinematics during elliptical exercise at varying incline angles. Knee 2021; 29:201-207. [PMID: 33640619 DOI: 10.1016/j.knee.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/08/2021] [Accepted: 02/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Elliptical trainers are a popular cardiovascular exercise for individuals with injuries or those post-operation. There is currently limited data on the impacts of direction while on elliptical trainers for knee joint kinematic risk factors. This study compared lower extremity kinematics between the forward and reverse direction at varying inclines on an elliptical trainer modified with converging footpath and reduced inter-pedal distance. METHODS Twenty-four college age participants exercised on the modified elliptical in both directions at four ramp inclines: 6°, 12°, 25°, and 35°. Three-dimensional kinematics were collected for each direction and ramp incline. A 2 × 4 (direction × incline) repeated measures analysis of variance was run with an alpha of 0.05. Simple effects analysis was run with Bonferroni correction for significant interaction or main effect of ramp incline. RESULTS The reverse direction had significantly greater peak knee valgus at 6° incline (mean difference [MD] = 1.35°, p < 0.014, d = 0.31) and 12° (MD = 2.41°, p < 0.001, d = 0.55), peak hip abduction at 6° (MD = 2.86°, p = 0.002, d = 0.49) and 12° (MD = 2.91°, p < 0.001, d = 0.51), but decreased peak knee flexion angles (p = 0.032) at all inclines. CONCLUSIONS Individuals with knee pathologies such as knee osteoarthritis or anterior knee pain should exercise in the reverse direction at lower inclines. However, switching to the forward direction and/or increasing incline may increase quadriceps strength during a safe activity such as elliptical trainers.
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Affiliation(s)
- Erik T Hummer
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Eryn N Murphy
- Department of Human Biology and Kinesiology, Colorado College, 14 E, W Cache La Poudre St, Colorado Springs, CO 80903, USA
| | - David N Suprak
- Health and Human Development, Western Washington University, 516 High St, Bellingham, WA 98225-9067, USA
| | - Lorrie R Brilla
- Health and Human Development, Western Washington University, 516 High St, Bellingham, WA 98225-9067, USA
| | - Jun G San Juan
- Health and Human Development, Western Washington University, 516 High St, Bellingham, WA 98225-9067, USA.
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10
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Dinis R, Vaz JR, Silva L, Marta S, Pezarat-Correia P. Electromyographic and kinematic analysis of females with excessive medial knee displacement in the overhead squat. J Electromyogr Kinesiol 2021; 57:102530. [PMID: 33607358 DOI: 10.1016/j.jelekin.2021.102530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/15/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Dynamic knee valgus is a multi-planar motion that has been associated with anterior cruciate ligament injuries and patellofemoral pain syndrome. Clinical assessment of dynamic knee valgus is usually performed through visual appearance of medial knee displacement (MKD) during the overhead squat. The aim of this study is to identify the kinematic and neuromuscular parameters associated with MKD. Twenty-two females performed an overhead squat and were assigned to the control group (n = 14) or the MKD group (n = 8). Electromyography and kinematic data of the lower extremity were collected. We observed MKD to exhibit greater muscle activity in the following muscles: adductor magnus, biceps femoris, vastus lateralis and vastus medialis muscles during the eccentric phase of the overhead squat. No group differences were observed during the concentric phase. Regarding the kinematics, the MKD group showed higher knee internal rotation and, knee abduction and ankle abduction, compared to controls. The combined information from the muscle activity results and kinematics of squat helps to explain the occurrence of excessive medial knee displacement and, hence, providing relevant information for health professionals to address this injury risk factor.
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Affiliation(s)
- Ricardo Dinis
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - João R Vaz
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal; CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.
| | - Luís Silva
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal; Instituto Piaget de Almada, Almada, Portugal
| | - Sérgio Marta
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Pezarat-Correia
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal; CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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11
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Cannon J, Cambridge EDJ, McGill SM. Increased core stability is associated with reduced knee valgus during single-leg landing tasks: Investigating lumbar spine and hip joint rotational stiffness. J Biomech 2021; 116:110240. [PMID: 33494012 DOI: 10.1016/j.jbiomech.2021.110240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Knee valgus during landing has been identified as a strong correlate of ACL injury. Inappropriate trunk control during landing contributes to high knee valgus, with neuromuscular factors related to core stability postulated as the mechanism. This investigation probed the influence of trunk and hip mechanics, including joint stiffness, on knee mechanics, particularly high knee valgus. Specifically, this study quantified lumbar spine and hip joint rotational stiffness (a proxy for mechanical joint stability) during single-leg landing tasks known to be associated with injury risk, particularly in females. Kinematics, kinetics, and 24 channels of electromyography spanning the trunk and hip musculature were measured in 18 healthy female participants. Anatomically detailed EMG-driven musculoskeletal models quantified lumbar spine and hip joint rotational stiffness. The links between peak knee abduction angle and moment with lumbar spine and hip joint rotational stiffness were measured. Hip joint rotational stiffness influenced knee abduction across tasks (correlation coefficient ranging from -0.48 to -0.70, p < 0.05) to reduce valgus deviation. Similarly, transverse plane hip joint rotational stiffness during landings reduced knee abduction moment (R = -0.50, P = 0.03; R = -0.49, P = 0.04), and lumbar spine joint rotational stiffness reduced knee abduction angle and moment but did not consistently reach statistical significance. The control system uses stiffness to control motion. This study demonstrates the importance of proximal (lumbar spine and hip) joint rotational stiffness (i.e. core control stability) during single-leg landing to prevent knee abduction motion. Instantaneous core stability is achieved with the coordinated activation and stiffness of both trunk and hip muscles.
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Affiliation(s)
- Jordan Cannon
- Spine Biomechanics Laboratory, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada; Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA.
| | - Edward D J Cambridge
- Spine Biomechanics Laboratory, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Stuart M McGill
- Spine Biomechanics Laboratory, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
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12
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Jafarnezhadgero A, Ghorbanloo F, Fatollahi A, Dionisio VC, Granacher U. Effects of an elastic resistance band exercise program on kinetics and muscle activities during walking in young adults with genu valgus: A double-blinded randomized controlled trial. Clin Biomech (Bristol, Avon) 2021; 81:105215. [PMID: 33203537 DOI: 10.1016/j.clinbiomech.2020.105215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/30/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND This double-blinded randomized-controlled-trial aimed to identify the effects of an elastic band resistance training on walking kinetics and muscle activities in young adults with genu valgus. METHODS Forty-two male young adults aged 22.5(2.7) years with genu valgus were randomly allocated to two experimental groups. The intervention group (n = 21) conducted a 14-weeks elastic band resistance training. The control group was passive during the intervention period and received the same treatment after the post-tests. Pre and post training, ground reaction forces and lower limb muscle activities were recorded during walking. FINDINGS Results revealed significant group-by-time interactions for peak medial ground reaction force and time-to-peak for posterior ground reaction force in favor of the intervention group (p < 0.012; d = 0.83-3.76). Resistance training with elastic bands resulted in significantly larger peak medial ground reaction force (p < 0.001; d = 1.45) and longer time-to-peak for posterior ground reaction force (p < 0.001; d = 1.85). Finding showed significant group-by-time interactions for peak positive free moment amplitudes in favor of the intervention group (p < 0.001; d = 1.18-2.02). Resistance training resulted in a lower peak positive free moment amplitude (p = 0.001; d = 1.46). With regards to muscle activities, the analysis revealed significant group-by-time interactions for rectus femoris and gluteus medius activities during the push-off phase in favor of the intervention group (p < 0.038; d = 0.68-0.89). Resistance training induced higher rectus femoris (p = 0.038; d = 0.84) and gluteus medius (p = 0.007; d = 0.54) activities. INTERPRETATION This study proved the effectiveness of resistance training using elastic bands on kinetics and muscle activities during walking in male adults with genu valgus disorder. Given that this training regime is low cost, effective, and easy-to-administer, we suggest that it should be implemented as a rehabilitative or preventive means for young adults with genu valgus.
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Haines M, Murray AM, Glaviano NR, Gokeler A, Norte GE. Restricting ankle dorsiflexion does not mitigate the benefits of external focus of attention on landing biomechanics in healthy females. Hum Mov Sci 2020; 74:102719. [PMID: 33232855 DOI: 10.1016/j.humov.2020.102719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Restricted ankle dorsiflexion can promote aberrant biomechanics associated with risk for knee injury during dynamic activities. Attentionally focused instructions have been used to improve high-risk knee biomechanics during landing tasks. Yet, it is unknown whether attentionally focused instruction can effectively improve landing patterns in the presence of a mechanical restriction on the ankle. Therefore, our purpose was to determine whether restricting ankle dorsiflexion by use of bracing mitigated the effects of attentional foci on landing biomechanics in healthy females. METHODS We used a crossover design to investigate lower extremity biomechanics in 19 healthy females between the ages of 18-35 during a series of jump-landing tasks. Participants completed 6 blocks of 3 jump-landings on separate force platforms in a randomized order based on brace condition (brace, no brace) and mode of attentional foci (neutral, internal focus [IF], external focus [EF]). Attentionally focused instructions were provided immediately prior to 3 practice jump-landings, followed by 5 test jump-landings with self-controlled feedback only. RESULTS Ankle bracing decreased peak dorsiflexion and sagittal range of motion (ROM) (mean difference: 5.7-5.8°), and peak inversion and frontal ROM (mean difference: 2.4-3.0°). However, hip flexion ROM (mean difference: 1.8°) increased compared to the no brace condition. Regardless of ankle bracing, EF instruction increased peak hip flexion (mean difference: 4.9°) and hip flexion range of motion (mean difference: 3.8-4.6°), while decreasing peak knee valgus (mean difference: 0.8-1.0°) and knee valgus moment (mean difference: 0.04 Nm/kg). Additionally, EF instruction increased peak hip abduction to a similar degree when braced (mean difference: 3.6-4.0°) and not braced (mean difference: 2.1-2.5°). Lastly, EF instruction increased hip abduction ROM only when braced (mean difference: 2.3-2.4°), but decreased peak knee valgus power only when not braced (mean difference: 0.18 W/kg). CONCLUSIONS Our findings indicate that mechanically restricting ankle dorsiflexion does not mitigate the ability of EF instruction to enhance jump-landing performance by means of improving hip and knee biomechanics in healthy females. However, our findings suggest an improved ability to control the rate of knee valgus loading when not braced. Therefore, we conclude that EF instruction remains a viable clinical strategy to improve landing patterns in the presence of restricted ankle dorsiflexion, yet this approach may be ineffective to reduce the rate of knee joint loading.
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Assi C, Mansour J, Samaha C, Kouyoumdjian P, Yammine K. Angular limit for coronal joint deformity correction using intramedullary guidance in total knee arthroplasty. A pilot study. SICOT J 2020; 6:22. [PMID: 32579106 PMCID: PMC7313387 DOI: 10.1051/sicotj/2020019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/02/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Post-operative misalignment of the lower limb mechanical axis following total knee arthroplasty (TKA) is thought to be associated with clinical failure. In a balanced knee, a neutral global mechanical axis following the use of intra-medullary (IM) guidance does not necessarily imply a horizontal TKA joint line. Using femoral and tibial axes separately would be more accurate in evaluating TKA alignment. Thus, the aim of the study is to define a pre-operative mechanical tibial and/or femoral angle threshold value for post-operative optimal alignment correction using IM guides. METHODS This single-center prospective continuous pilot study included 50 patients treated with a TKA for primitive osteoarthritis. Femoral and tibial cuts were performed using intramedullary (IM) guide. Three angles were calculated and analyzed pre and post-operatively on standing antero-posterior views using long-leg radiographs: femorotibial angle (FTA), mechanical femoral angle (MFA), and mechanical tibial angle (MTA). Statistical analysis was performed for the whole sample and for the three following FTA subgroups; normo-axial, varus and valgus. RESULTS The pre-operative MTA is the only parameter for which a threshold value was observed; when pre-operative MTA exceeded the value of 94°, an optimal correction might not be obtained post-operatively. DISCUSSION Our results suggest that the bony correction obtained via IM guiding depends exclusively on the primary deformation of the tibia. In cases of a varus of more than 94°, the IM guide was found to yield sub-optimal corrections. Thus, other solutions need to be investigated.
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Affiliation(s)
- Chahine Assi
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Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | - Jad Mansour
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Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | - Camille Samaha
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Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
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Department of Orthopedic Surgery, Middle East Institute of Health Bsalim Lebanon
| | - Pascal Kouyoumdjian
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Chirurgie Orthopédique et de la Colonne Vertébrale, Centre Hospitalo-Universitaire de Nîmes Nîmes France
| | - Kaissar Yammine
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Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
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Center for Evidence-based Anatomy, Sports & Orthopedic Research Jdeideh Lebanon
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15
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Taylor JB, Nguyen AD, Shultz SJ, Ford KR. Hip biomechanics differ in responders and non-responders to an ACL injury prevention program. Knee Surg Sports Traumatol Arthrosc 2020; 28:1236-1245. [PMID: 30259145 DOI: 10.1007/s00167-018-5158-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 09/17/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the differences in demographic, anthropometric, biomechanical, and/or performance variables between those that do (responders) and do not (non-responders) exhibit reductions in knee abduction moments after an anterior cruciate ligament injury prevention program (ACL-IPP). METHODS Forty-three adolescent female athletes completed biomechanical (3D motion analysis of a drop vertical jump) and performance testing before and after randomization into a 6-week ACL-IPP. Participants were classified into responders and non-responders based on their level of reduction of knee abduction moment from pre- to post-test. RESULTS Compared to non-responders, responders exhibited increased hip adduction excursion at baseline (p = 0.02) and trended towards attending more training sessions (p = 0.07) and participating in soccer and not basketball (p = 0.07). Responders also showed greater improvements in hip flexion angles (p = 0.02) and moments (p < 0.001), and knee abduction angles (p < 0.001) and excursions (p = 0.001). There were no significant differences in age or experience with prior injury prevention programs (n.s.). CONCLUSIONS After an ACL-IPP, athletes that exhibit the greatest reduction in knee abduction moments exhibit greater hip adduction excursion at baseline and show corresponding improvements in hip flexion and knee abduction kinematics and hip flexion moments. These results can help clinicians prospectively identify individuals that may not respond to an ACL-IPP and target individualized training for those at risk of injury. LEVEL OF EVIDENCE I. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT02530333.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, One University Parkway, High Point, NC, 27268, USA. .,Department of Kinesiology, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - Anh-Dung Nguyen
- Department of Athletic Training, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Sandra J Shultz
- Department of Kinesiology, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Kevin R Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, One University Parkway, High Point, NC, 27268, USA
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Lloyd RS, Oliver JL, Myer GD, Croix MDS, Read PJ. Seasonal variation in neuromuscular control in young male soccer players. Phys Ther Sport 2020; 42:33-39. [PMID: 31869753 PMCID: PMC9892782 DOI: 10.1016/j.ptsp.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Determine how lower limb neuromuscular control changes over the course of a competitive soccer season. DESIGN Repeated measures. SETTING Academy soccer club. PARTICIPANTS 43 male youth soccer players (age 13.1 ± 2.2 yr; height 160.1 ± 15.7 cm; body mass 49.4 ± 14.3 kg; maturity offset 0.2 ± 1.9 yr). MAIN OUTCOME MEASURES Pre-, mid- and end of season assessments of peak landing forces during single leg 75% horizontal hop and stick (75%HOP) and a single leg countermovement jump (SLCMJ), single leg hop for distance (SLHD), knee valgus during the tuck jump assessment (TJA) and inter-limb symmetries. RESULTS Hop distance increased significantly. Absolute peak landing forces in the left leg during the SLCMJ and 75%HOP increased significantly, with significant increases also present in the same leg for SLCMJ relative peak landing force. TJA knee valgus score was reduced in the right leg, but remained at a 'moderate' level in the left knee. CONCLUSION Neuromuscular control, as evidenced by increased absolute and relative peak landing forces, appears to reduce over the course of a competitive season. Young soccer players should engage in neuromuscular training throughout the season to offset any decrements in neuromuscular control and to facilitate appropriate landing strategies.
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Affiliation(s)
- Rhodri S. Lloyd
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand,Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand,Corresponding author. School of Sport, Cardiff Metropolitan University Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK. (R.S. Lloyd)
| | - Jon L. Oliver
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics and Orthopaedic Surgery, College of Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,The Micheli Center for Sports Injury Prevention, Boston, MA, USA
| | - Mark De Ste Croix
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Paul J. Read
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK,Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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17
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Rees D, Younis A, MacRae S. Is there a correlation in frontal plane knee kinematics between running and performing a single leg squat in runners with patellofemoral pain syndrome and asymptomatic runners? Clin Biomech (Bristol, Avon) 2019; 61:227-232. [PMID: 30634094 DOI: 10.1016/j.clinbiomech.2018.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 11/23/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee kinematics when running, specifically knee valgus, have been linked to patellofemoral pain syndrome. Assessing running biomechanics requires skill, equipment and time. Clinically, the single leg squat is used to make inferences about knee kinematics during running. No evidence supports this practice. METHODS Sixteen asymptomatic runners and sixteen runners with patellofemoral pain syndrome were recruited. Asymptomatic runners were sub-divided by dominant and non-dominant leg and runners with patellofemoral pain syndrome by painful and non-painful leg. This gave four groups. Participants were videoed performing single leg squats and running on a treadmill. Frontal plane knee kinematics were calculated using the frontal plane projection angle. Correlation in frontal plane projection angle between running and single leg squat were calculated using Pearson's correlation coefficient. Differences in frontal plane projection angle between groups for running and single leg squat were calculated using multiple independent t-tests with Bonferroni correction. FINDINGS Correlation in frontal plane projection angle between running and the single leg squat was not statistically significant for the painful leg group (p = 0.19) but was for the remaining groups (p < 0.05). There was no statistically significant difference in frontal plane projection angle between the four groups when running. Single leg squat frontal plane projection angle was significantly larger for the painful leg group (10.3°) than the dominant leg (-0.2° (p = 0.003)) and non-dominant leg (-0.4° (p = 0.004)) in the asymptomatic runners group. INTERPRETATION The single leg squat cannot be used to make inferences about frontal plane knee kinematics in running gait in patellofemoral pain syndrome sufferers.
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Affiliation(s)
- David Rees
- School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, a partnership between Kingston University and St George's, University of London, SW17 0RE, United Kingdom.
| | - Ahmed Younis
- School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, a partnership between Kingston University and St George's, University of London, SW17 0RE, United Kingdom.
| | - Siân MacRae
- College of Health and Life Sciences, Brunel University London, Mary Seacole Building, Kingston Lane, Uxbridge UB8 3PH, United Kingdom; Therapy Department, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd, London SW10 9NH, United Kingdom.
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18
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Simon M, Parizek C, Earl-Boehm JE, Bazett-Jones DM. Quantitative and qualitative assessment of frontal plane knee motion in males and females: A reliability and validity study. Knee 2018; 25:1057-1064. [PMID: 30414788 DOI: 10.1016/j.knee.2018.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/29/2018] [Accepted: 09/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim was to determine reliability and validity of frontal plane projection angle (FPPA) and visual assessments (VA) in both males and females. METHODS Fifty-four participants (30 females) performed lateral step-downs while kinematics were recorded by two-dimensional and three-dimensional analyses. Two raters viewed the videos, extracted images, and measured the FPPA (quantitative). Using the videos, the raters also categorized (qualitative VA) each participant's motion as demonstrating dynamic valgus (>10° valgus), dynamic varus (>10° varus), or no change. Reliability was assessed for FPPA and VA using intraclass correlation coefficients and Kappa, respectively. Validity was determined by comparing the FPPA to three-dimensional measures (Pearson correlations) and comparing the VA to both FPPA and standard reference 3D kinematics (Kappa). RESULTS FPPA showed good-excellent reliability (ICC = 0.850-0.998). VA showed minimal-moderate reliability (κ = 0.370-0.766). The FPPA showed large correlations (r = -0.514-0.531) with hip adduction in both sexes but only a moderate relationship with knee abduction in males (r = 0.427-0.445). VA showed no-weak (κ = 0.153-0.475) and weak-moderate (κ = 0.455-0.698) agreement compared to FPPA and no-weak (κ = -0.300-0.183) and no-minimal (κ = -0.078-0.027) disagreement compared to the reference standard 3D kinematics in males and females, respectively. CONCLUSION The quantitative FPPA is more reliable and valid than qualitative VA of frontal knee plane motion.
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Affiliation(s)
| | - Chloe Parizek
- Carroll University, 100 N East Ave, Waukesha, WI, USA
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Augustsson SR, Tranberg R, Zügner R, Augustsson J. Vertical drop jump landing depth influences knee kinematics in female recreational athletes. Phys Ther Sport 2018; 33:133-138. [PMID: 30103177 DOI: 10.1016/j.ptsp.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine whether different vertical drop jump (VDJ) landing depth (small versus deep) and stance width (wide versus narrow) may alter movement biomechanics in female recreational athletes. The purpose was also to identify whether leg muscle strength is a predictive factor for knee control during a VDJ. DESIGN Cross-sectional. SETTING Biomechanics laboratory. PARTICIPANTS Eighteen women aged between 18 and 30 years. MAIN OUTCOME MEASURES Three VDJ tests were used for biomechanical analysis: 1) small "bounce" jump (BJ), 2) deep "countermovement" jump with wide (CMJW) and 3) narrow foot position (CMJN). Subjects also performed an isometric knee-extension strength test, dichotomized to 'weak' versus 'strong' subjects according to median and quartiles. RESULTS There were greater knee valgus angles during landing for both the CMJW and CMJN test compared to the BJ test (p ≤ 0.05). Differences in knee valgus between weak and strong subjects were significant for the BJ test (p = 0.044) but not for any of the other tests. CONCLUSIONS VDJ landing depth influences knee kinematics in women. Landing depth may therefore be considered when screening athletes using the VDJ test. Also, muscle strength seems to influence the amount of knee valgus angles, but the difference was not statistically significant (except for the BJ test) in this small cohort.
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Affiliation(s)
| | - Roy Tranberg
- The Institute of Clinical Sciences/Department of Orthopaedics, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Roland Zügner
- The Institute of Clinical Sciences/Department of Orthopaedics, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Jesper Augustsson
- Department of Sport Science at the Faculty of Social Sciences, Linnaeus University, Kalmar, Sweden
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20
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Lee SS, Lee H, Lee DH, Moon YW. Slight under-correction following total knee arthroplasty for a valgus knee results in similar clinical outcomes. Arch Orthop Trauma Surg 2018; 138:1011-1019. [PMID: 29770878 DOI: 10.1007/s00402-018-2957-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Restoration of correct coronal alignment is one of the main goals of total knee arthroplasty (TKA). Traditionally, TKA has been considered successful when a neutral mechanical hip-knee-ankle (HKA) axis within 3° is achieved. Recent studies have reported no differences or improved clinical outcomes following a slight under-correction of the HKA axis for a varus knee. However, the influence of under-correction of a valgus knee has not been reported. This study investigated the influence of post-operative HKA alignment in TKA patients with valgus deformity on clinical outcomes. METHODS Ninety-three knees (93 patients) with pre-operative valgus alignment were evaluated with a mean follow-up period of 60 months. All patients were classified into three groups based on post-operative HKA alignment: neutral (0 ± 3°), mild valgus (3°-6°), and severe valgus (> 6°). These groups were compared using the Western Ontario and McMaster Universities osteoarthritis (WOMAC) index, the Knee Society (KS) knee score, KS function score, α-angle, β-angle, patella tilt angle, and the congruence angle. RESULTS Sixty-nine knees were included in the neutral group, seventeen knees in the mild valgus group, and seven knees in the severe valgus group. In all cases, post-operative clinical and functional scores significantly improved compared to pre-operative scores. There were no differences between the three groups in post-operative clinical and functional scores. More post-operative patellar tilt angle outliers (> 10°) and congruence angle outliers (> 16°) were apparent in the severe valgus group (patellar tilt angle, 13 vs. 17 vs. 57.1%, p = 0.022; congruence angle, 32 vs. 47 vs. 71%, p = 0.035). CONCLUSIONS Slight under-correction following TKA for a valgus knee resulted in similar clinical outcomes. A residual valgus angle of more than 6° can induce patellar maltracking. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, Seoul, 06351, South Korea
| | - Hyeon Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, Seoul, 06351, South Korea
| | - Dae-Hee Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, Seoul, 06351, South Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, Seoul, 06351, South Korea.
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21
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Numata H, Nakase J, Kitaoka K, Shima Y, Oshima T, Takata Y, Shimozaki K, Tsuchiya H. Two-dimensional motion analysis of dynamic knee valgus identifies female high school athletes at risk of non-contact anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2018; 26:442-447. [PMID: 28840276 DOI: 10.1007/s00167-017-4681-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/16/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Female athletes are at greater risk of non-contact ACL injury. Three-dimensional kinematic analyses have shown that at-risk female athletes have a greater knee valgus angle during drop jumping. The purpose of this study was to evaluate the relationship between knee valgus angle and non-contact ACL injury in young female athletes using coronal-plane two-dimensional (2D) kinematic analyses of single-leg landing. METHODS Two hundred ninety-one female high school athletes newly enrolled in basketball and handball clubs were assessed. Dynamic knee valgus was analysed during single-leg drop jumps using 2D coronal images at hallux-ground contact and at maximal knee valgus. All subjects were followed up for 3 years for ACL injury. Twenty-eight (9.6%) of 291 athletes had ACL rupture, including 27 non-contact ACL injuries. The injured group of 27 knees with non-contact ACL injury was compared with a control group of 27 randomly selected uninjured knees. The relationship between initial 2D movement analysis results and subsequent ACL injury was investigated. RESULTS Dynamic knee valgus was significantly greater in the injured group compared to the control group at hallux-ground contact (2.1 ± 2.4 vs. 0.4 ± 2.2 cm, P = 0.006) and at maximal knee valgus (8.3 ± 4.3 vs. 5.1 ± 4.1 cm, P = 0.007). CONCLUSION The results of this study confirm that dynamic knee valgus is a potential risk factor for non-contact ACL injury in female high school athletes. Fully understanding the risk factors that increase dynamic knee valgus will help in designing more appropriate training and interventional strategies to prevent injuries in at-risk athletes. LEVEL OF EVIDENCE Prognostic studies, Level II.
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Affiliation(s)
- Hitoaki Numata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Katsuhiko Kitaoka
- Department of Orthopaedic Surgery, Kijima Hospital, Kanazawa, Ishikawa, 920-0011, Japan
| | - Yosuke Shima
- Department of Orthopaedic Surgery, KKR Hokuriku Hospital, Kanazawa, Ishikawa, 921-8035, Japan
| | - Takeshi Oshima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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22
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Guo CJ, Liu J, Niu DS, Ma J, Kou B, Zhang HJ, Xu SW, Mu XD, Yang LL, Zhang H. Clinical application of different operative approach of total knee replacement in knee valgus patients. Retrospective cohort study. Int J Surg 2017; 49:80-83. [PMID: 29247814 DOI: 10.1016/j.ijsu.2017.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/03/2017] [Accepted: 12/08/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE According to the severity of knee valgus, different operative approaches were applied in total knee replacement. Hence, we assessed the safety and efficacy of different operative approaches in the level IV study. METHODS From May 2011 to March 2014, a retrospectively analysis was conducted among 31 patients with knee valgus (mild in 10 cases, moderate in 8 cases and severe in 13 cases based on Keblish grade). Medial approach trip knee replacement was performed in mild and moderate patients, which were assigned as medial approach group. Lateral approach was performed in severe patients, which was assigned as lateral approach group. Relevant results were compared between medial approach group and lateral approach group, including valgus corrected angle, postoperative knee joint activity and Kss score. Furthermore, operative time, postoperative blood loss, patellar trajectory and anterior knee pain were also compared between the two groups. RESULTS All operations were successful without obvious complications. In medial approach group, postoperative knee valgus angle was (7 ± 1)°. Three months after operation, degree of knee joint activity was (85.2 ± 5.2)°, and KSS score of knee joint was (80.1 ± 5.2). Significant differences were detected in these compared with preoperative data (all P < .05). Moreover, similar results were found in lateral approach group with postoperative knee valgus angle as (8.2 ± 2.3)°, degree of knee joint activity three months after operation as (85.2 ± 5.3)°, and KSS score of knee joint as (80.3 ± 3.2). However, no significant differences were found among these three groups in operative time, postoperative blood loss, patellar trajectory or anterior knee pain. CONCLUSIONS Different operative approaches in total knee replacement according to the severity of knee valgus were proved as effective and safe procedures, which deserved further application.
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Affiliation(s)
- Chong-Jun Guo
- First Department of Orthopaedics, Ningxia People's Hospital, Yinchuan 750001, China
| | - Jun Liu
- Department of Hand & Foot Surgery and Reparative & Reconstructive Surgery, Orthopaedic Hospital, The Second Hospital of Jinlin University, Jilin 130000, China
| | - Dong-Sheng Niu
- First Department of Orthopaedics, Ningxia People's Hospital, Yinchuan 750001, China
| | - Jun Ma
- First Department of Orthopaedics, Ningxia People's Hospital, Yinchuan 750001, China
| | - Bo Kou
- Department of Orthopaedics, The First Hospital of Shizuishan, Shizuishan 753200, China
| | - Hai-Jiao Zhang
- First Department of Orthopaedics, Ningxia People's Hospital, Yinchuan 750001, China
| | - Shao-Wei Xu
- Northwest University for Nationalities, Lanzhou 730030, China
| | - Xiao-Di Mu
- Ningxia Medical University, Yinchuan 750004, China
| | - Lv-Lin Yang
- First Department of Orthopaedics, Ningxia People's Hospital, Yinchuan 750001, China
| | - Hua Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
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23
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Milandri G, Posthumus M, Small TJ, Bothma A, van der Merwe W, Kassanjee R, Sivarasu S. Kinematic and kinetic gait deviations in males long after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2017; 49:78-84. [PMID: 28892671 DOI: 10.1016/j.clinbiomech.2017.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biomechanical deviations long (approx. 5years) after anterior cruciate ligament reconstruction have not been quantified in males, despite their distinct risk profile as compared to females. These deviations can indicate altered joint loading during chronic, repetitive motions. METHODS Cross-sectional study, comparing kinematic and kinetic variables between 15 male anterior cruciate ligament reconstructed patients and 15 healthy controls. During walking and running gait, measurements were taken of impact dynamics, knee and hip sagittal plane angles and moments, and knee varus angles and adduction moments. FINDINGS Comparing affected limbs to control limbs, significantly lower maximum (P=0.001) and initial (P=0.003) loading rates were found during running, but not in walking. Hip angles were lower for affected limbs of patients compared to the control group (P=0.039) in walking, but not during running. Between-limb comparisons showed important differences in symmetry of the affected patients. Maximum force during running was higher in the unaffected limb (P=0.015), which was linked with a higher loading rate (P=0.008). Knee flexion angle was reduced by 2° on average for the affected limb during running (P=0.010), and both walking and running knee and hip moments showed differences. Knee varus angle showed a 1° difference during walking (P<0.001), but not during running. Knee adduction moment was significantly lower (more valgus) during both walking and running. INTERPRETATION Male anterior cruciate ligament reconstructed patients demonstrate persistent, clinically important gait asymmetries and differences from healthy controls long after surgery in kinematics, kinetics, and impact biomechanics.
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Affiliation(s)
- Giovanni Milandri
- Orthopaedic Biomechanics Lab, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, South Africa
| | - Mike Posthumus
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Sports Science Institute of South Africa, Boundary Road, Newlands, South Africa.
| | - T J Small
- Sports Science Orthopaedic Clinic, Boundary Road, Newlands, Cape Town, South Africa
| | - Adam Bothma
- Sports Science Orthopaedic Clinic, Boundary Road, Newlands, Cape Town, South Africa
| | - Willem van der Merwe
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Sports Science Institute of South Africa, Boundary Road, Newlands, South Africa; Sports Science Orthopaedic Clinic, Boundary Road, Newlands, Cape Town, South Africa
| | - Reshma Kassanjee
- Department of Statistical Sciences, PD Hahn Building Level 5, Upper Campus, University of Cape Town, South Africa
| | - Sudesh Sivarasu
- Orthopaedic Biomechanics Lab, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, South Africa
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24
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Lima YL, Ferreira VMLM, de Paula Lima PO, Bezerra MA, de Oliveira RR, Almeida GPL. The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis. Phys Ther Sport 2017; 29:61-69. [PMID: 28974358 DOI: 10.1016/j.ptsp.2017.07.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 06/30/2017] [Accepted: 07/15/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this systematic review was to evaluate the association between ankle dorsiflexion (ADF) and dynamic knee valgus (DKV). METHODS Electronic searches were conducted in MEDLINE, EMBASE, CINAHL and SPORTDiscus. A modified Downs and Black checklist was used for quality assessment and meta-analysis was performed to compare standardised mean differences (SMD) of ADF. RESULTS Seventeen studies met the inclusion criteria. Meta-analysis showed that reduced ADF is associated with participants presenting with DKV compared to controls (SMD -0.65, 95% CI -0.88 to -0.41). Subgroup analysis showed consistent results regarding different forms of ADF measurement; restriction in ADF measured in weight-bearing position (SMD -1.25, 95% CI -2.24 to -0.25), non-weight-bearing with knee flexed (SMD -0.56, 95% CI -0.97 to -0.16) or non-weight-bearing with knee extended (SMD -0.54, 95% CI -0.80 to -0.28) was significantly associated with DKV. CONCLUSION The meta-analysis results provide evidence that reduced ADF is correlated with DKV. The assessment of ADF in the clinical setting is important, as it may be related to harmful movement patterns of the lower limbs.
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Affiliation(s)
- Yuri Lopes Lima
- Department of Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, Brazil
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25
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Abstract
Background Knee valgus and varus morbidity is at the second top place in children lower limb deformity diseases. It may cause abnormal stress distribution. The magnitude and location of contact forces on tibia plateau during gait cycle have been indicated as markers for risk of osteoarthritis. So far, few studies reported the contact stress and force distribution on tibial plateau of valgus knee of children. Methods To estimate the contact stresses and forces on tibial plateau of an 8-year old obese boy with valgus knee and a 7-year old healthy boy, three-dimensional (3D) finite element (FE) models of their left knee joints were developed. The valgus knee model has 36,897 nodes and 1,65,106 elements, and the normal knee model has 78,278 nodes and 1,18,756 elements. Paired t test was used for the comparison between the results from the 3D FE analysis method and the results from traditional kinematic measurement methods. Results The p value of paired t test is 0.12. Maximum stresses shifted to lateral plateau in knee valgus children while maximum stresses were on medial plateau in normal knee child at the first peak of vertical GRF of stance phase. The locations of contact centers on medial plateau changed 3.38 mm more than that on lateral plateau, while the locations of contact centers on medial plateau changed 1.22 mm less than that on lateral plateau for healthy child from the first peak to second peak of vertical GRF of stance phase. Conclusions The paired t test result shows that there is no significant difference between the two methods. The results of FE analysis method suggest that knee valgus malalignment could be the reason for abnormal knee load that may cause knee problems in obese children with valgus knee in the long-term. This study may help to understand biomechanical mechanism of valgus knees of obese children.
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Affiliation(s)
- Jun Sun
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Songhua Yan
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Yan Jiang
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Jizhou Zeng
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China. .,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
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Slater LV, Hart JM. The influence of knee alignment on lower extremity kinetics during squats. J Electromyogr Kinesiol 2016; 31:96-103. [PMID: 27768963 DOI: 10.1016/j.jelekin.2016.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 09/27/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022] Open
Abstract
The squat is an assessment of lower extremity alignment during movement, however there is little information regarding altered joint kinetics during poorly performed squats. The purpose of this study was to examine changes in joint kinetics and power from altered knee alignment during a squat. Thirty participants completed squats while displacing the knee medially, anteriorly, and with neutral alignment (control). Sagittal and frontal plane torques at the ankle, knee, and hip were altered in the descending and ascending phase of the squat in both the medial and anterior malaligned squat compared to the control squat. Ankle and trunk power increased and hip power decreased in the medial malaligned squat compared to the control squat. Ankle, knee, and trunk power increased and hip power decreased in the anterior malaligned squat compared to the control squat. Changes in joint torques and power during malaligned squats suggest that altered knee alignment increases ankle and trunk involvement to execute the movement. Increased anterior knee excursion during squatting may also lead to persistent altered loading of the ankle and knee. Sports medicine professionals using the squat for quadriceps strengthening must consider knee alignment to reduce ankle and trunk involvement during the movement.
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27
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Cronström A, Creaby MW, Nae J, Ageberg E. Gender differences in knee abduction during weight-bearing activities: A systematic review and meta-analysis. Gait Posture 2016; 49:315-328. [PMID: 27479217 DOI: 10.1016/j.gaitpost.2016.07.107] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased knee abduction during weight-bearing activities is suggested to be a contributing factor for the high knee injury risk reported in women. However, studies investigating gender difference in knee abduction are inconclusive. OBJECTIVE To systematically review gender-differences in knee abduction during weight-bearing activities in individuals with or without knee injury. METHODS A systematic review and meta-analysis were conducted according to the PRISMA guidelines. A search in the databases Medline, CINAHL and EMBASE was performed until September 2015. Inclusion criteria were studies that reported (1) gender differences, (2) healthy individuals and/or those with anterior cruciate ligament (ACL) deficiency or reconstruction or patellofemoral pain PFP, and (3) knee abduction assessed with either motion analysis or visual observation during weight-bearing activity. RESULTS Fifty-eight articles met the inclusion criteria. Women with PFP had greater peak knee abduction compared to men (Std diff in mean; -1.34, 95%CI; -1.83 to -0.84). In healthy individuals, women performed weight-bearing tasks with greater knee abduction throughout the movement (initial contact, peak abduction, excursion) (Std diff in mean; -0.68 to -0.79, 95%CI; -1.04 to -0.37). In subgroup analyses by task, differences in knee abduction between genders were present for most tasks, including running, jump landings and cutting movements. There were too few studies in individuals with ACL injury to perform meta-analysis. CONCLUSION The gender difference in knee abduction during weight-bearing activities should be considered in training programs aimed at preventing or treating knee injury.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia.
| | - Jenny Nae
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden.
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28
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Yoshida N, Kunugi S, Mashimo S, Okuma Y, Masunari A, Miyazaki S, Hisajima T, Miyakawa S. Effect of Forefoot Strike on Lower Extremity Muscle Activity and Knee Joint Angle During Cutting in Female Team Handball Players. Sports Med Open 2016; 2:32. [PMID: 27570731 PMCID: PMC4985532 DOI: 10.1186/s40798-016-0056-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 08/03/2016] [Indexed: 01/13/2023]
Abstract
Background The purpose of this study is to examine the effects of different strike forms, during cutting, on knee joint angle and lower limb muscle activity. Methods Surface electromyography was used to measure muscle activity in individuals performing cutting manoeuvres involving either rearfoot strikes (RFS) or forefoot strikes (FFS). Three-dimensional motion analysis was used to calculate changes in knee angles, during cutting, and to determine the relationship between muscle activity and knee joint angle. Force plates were synchronized with electromyography measurements to compare muscle activity immediately before and after foot strike. Results The valgus angle tends to be smaller during FFS cutting than during RFS cutting. Just prior to ground contact, biceps femoris, semitendinosus, and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was greater during RFS cutting. Immediately after ground contact, biceps femoris and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was significantly lower during FFS cutting. Conclusions The results of the present study suggest that the hamstrings demonstrate greater activity, immediately after foot strike, during FFS cutting than during RFS cutting. Thus, FFS cutting may involve a lower risk of anterior cruciate ligament injury than does RFS cutting.
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Affiliation(s)
- Naruto Yoshida
- Faculty of Health Care, Department of Acupuncture and Moxibustion, Teikyo Heisei University, 2-51-4 Higashi-ikebukuro, Toshima-ku, Tokyo, 170-8445 Japan
| | - Shun Kunugi
- Division of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Sonoko Mashimo
- Division of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Yoshihiro Okuma
- Faculty of Health Care, Department of Acupuncture and Moxibustion, Teikyo Heisei University, 2-51-4 Higashi-ikebukuro, Toshima-ku, Tokyo, 170-8445 Japan
| | - Akihiko Masunari
- Division of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Shogo Miyazaki
- Faculty of Health Care, Department of Acupuncture and Moxibustion, Teikyo Heisei University, 2-51-4 Higashi-ikebukuro, Toshima-ku, Tokyo, 170-8445 Japan
| | - Tatsuya Hisajima
- Faculty of Health Care, Department of Acupuncture and Moxibustion, Teikyo Heisei University, 2-51-4 Higashi-ikebukuro, Toshima-ku, Tokyo, 170-8445 Japan
| | - Shumpei Miyakawa
- Division of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
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Herrington L, Munro A, Comfort P. A preliminary study into the effect of jumping-landing training and strength training on frontal plane projection angle. ACTA ACUST UNITED AC 2015; 20:680-5. [PMID: 25920339 DOI: 10.1016/j.math.2015.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 03/26/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
The presence of increased knee valgus angles during functional tasks has been associated with a range of knee pathologies. A number of different exercise interventions have been undertaken to improve knee alignment during functional tasks. The most successful of these interventions are multi-modal incorporating both strength and jump-landing training. Little research has been undertaken to compare these elements individually to assess if success is due to an individual element or the training as a whole. The study assessed the between group effects of strength training or jump-landing training alone on knee valgus alignment during a number of functional tasks, using a cohort specific treatment superiority design. Thirty asymptomatic female participants undertook a 6 week (minimum 15 sessions) strength or jump-landing programme, the effects of which were examined by assessing for any change in frontal plane projection angle (FPPA) during single leg squat and landing and bilateral drop jump landing. Both training methods had positive effects of FPPA during some but not all of the tasks. Strength training brought about significant changes in FPPA during single leg squat and landing, whilst jump-landing training significantly influenced single leg landing and drop jump landing performance. The changes reported, therefore appear to be related to the nature of the training and the tasks undertaken during that training. The findings indicating that a combined training protocol incorporating both strengthening and jump-landing training may bring about the greatest improvement across a spectrum of tasks for the patient, supporting the previous work on multimodal training.
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Affiliation(s)
| | - Allan Munro
- School of Health Sciences, University of Bradford, UK
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