Patellofemoral Joint Stress during Running with Added Load in Females

AbstractPatellofemoral joint (PFJ) pain syndrome is a commonly reported form of pain in female runners and military personnel. Increased PFJ stress may be a contributing factor. Few studies have examined PFJ stress running with added load. Our purpose was to analyze PFJ stress, PFJ reaction force, quadriceps force, knee flexion angle, and other kinematic and temporospatial variables running with and without a 9 kg load. Nineteen females ran across a force platform with no added load and 9.0 kg weight vest. Kinematic data were collected using 3D motion capture and kinetic data with a force platform. Muscle forces were estimated using a musculoskeletal model, and peak PFJ loading variables were calculated during stance. Multivariate analyses were run on PFJ loading variables and on cadence, step length and foot strike index. Differences were shown in PFJ stress, PFJ reaction force, peak knee flexion angle and quadriceps force. Joint specific kinetic variables increased between 5–16% with added load. PFJ loading variables increased with 9 kg of added load without changes in cadence, step length, or foot strike index compared to no load. Added load appears to increase the PFJ loading variables associated with PFJ pain in running.

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Kinematic Comparison between Medially Congruent and Posterior-Stabilized Third-Generation TKA Designs

Journal of Functional Morphology and Kinesiology ◽

10.3390/jfmk6010027 ◽

2021 ◽

Vol 6 (1) ◽

pp. 27

Author(s):

Stefano Ghirardelli ◽

Jessica L. Asay ◽

Erika A. Leonardi ◽

Tommaso Amoroso ◽

Thomas P. Andriacchi ◽

...

Keyword(s):

Knee Flexion ◽

Knee Kinematics ◽

Primary Total Knee Arthroplasty ◽

Flexion Angle ◽

Heel Strike ◽

Third Generation ◽

Knee Flexion Angle ◽

Posterior Stabilized ◽

Rotational Angle ◽

Peak Knee

Background: This study compares knee kinematics in two groups of patients who have undergone primary total knee arthroplasty (TKA) using two different modern designs: medially congruent (MC) and posterior-stabilized (PS). The aim of the study is to demonstrate only minimal differences between the groups. Methods: Ten TKA patients (4 PS, 6 MC) with successful clinical outcomes were evaluated through 3D knee kinematics analysis performed using a multicamera optoelectronic system and a force platform. Extracted kinematic data included knee flexion angle at heel-strike (KFH), peak midstance knee flexion angle (MSKFA), maximum and minimum knee adduction angle (KAA), and knee rotational angle at heel-strike. Data were compared with a group of healthy controls. Results: There were no differences in preferred walking speed between MC and PS groups, but we found consistent differences in knee function. At heel-strike, the knee tended to be more flexed in the PS group compared to the MC group; the MSKFA tended to be higher in the PS group compared to the MC group. There was a significant fluctuation in KAA during the swing phase in the PS group compared to the MC group, PS patients showed a higher peak knee flexion moment compared to MC patients, and the PS group had significantly less peak internal rotation moments than the MC group. Conclusions: Modern, third-generation TKA designs failed to reproduce normal knee kinematics. MC knees tended to reproduce a more natural kinematic pattern at heel-strike and during axial rotation, while PS knees showed better kinematics during mid-flexion.

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Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training

The American Journal of Sports Medicine ◽

10.1177/0363546520980079 ◽

2020 ◽

pp. 036354652098007

Author(s):

Elanna K. Arhos ◽

Jacob J. Capin ◽

Thomas S. Buchanan ◽

Lynn Snyder-Mackler

Keyword(s):

Knee Flexion ◽

Cruciate Ligament ◽

Return To Sport ◽

Quadriceps Muscle ◽

Quadriceps Strength ◽

Flexion Angle ◽

Knee Flexion Angle ◽

Sport Training ◽

Gait Biomechanics ◽

Peak Knee

Background: After anterior cruciate ligament (ACL) reconstruction (ACLR), biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with preoperative gait asymmetries and postoperative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to preoperative and early rehabilitation time points before return-to-sport training. Purpose/Hypothesis: The purpose was to determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after ACLR. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics, including tibiofemoral joint loading during gait. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Of 79 athletes enrolled in the ACL-SPORTS Trial, 76 were participants in this study after completing postoperative rehabilitation and 10 return-to-sport training sessions (mean ± SD, 7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value / uninvolved limb value × 100). The biomechanical variables of interest included peak knee flexion angle, peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and midstance, quadriceps muscle force at peak knee flexion angle, and peak medial compartment contact force. Spearman rank correlation (ρ) coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable; alpha was set to .05. Results: Of the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n = 23) or >110% (n = 4) (range, 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle; 68% and 83% in knee excursion during weight acceptance and midstance, respectively; 74% in internal peak knee extension moment; 57% in medial compartment contact force; and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable after return-to-sport training ( P > .129). Conclusion: Among those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.

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The Kinematics and Kinetics Analysis of the Lower Extremity in the Landing Phase of a Stop-jump Task

The Open Biomedical Engineering Journal ◽

10.2174/1874120701509010103 ◽

2015 ◽

Vol 9 (1) ◽

pp. 103-107 ◽

Cited By ~ 3

Author(s):

L Yin ◽

D Sun ◽

Q.C Mei ◽

Y.D Gu ◽

J.S Baker ◽

...

Keyword(s):

Lower Extremity ◽

Ground Reaction Force ◽

Knee Flexion ◽

Reaction Force ◽

Flexion Angle ◽

Contact Phase ◽

Peak Knee ◽

Significant Difference ◽

The Impact ◽

Kinematics And Kinetics

Large number of studies showed that landing with great impact forces may be a risk factor for knee injuries. The purpose of this study was to illustrate the different landing loads to lower extremity of both genders and examine the relationships among selected lower extremity kinematics and kinetics during the landing of a stop-jump task. A total of 35 male and 35 female healthy subjects were recruited in this study. Each subject executed five experiment actions. Lower extremity kinematics and kinetics were synchronously acquired. The comparison of lower extremity kinematics for different genders showed significant difference. The knee and hip maximum flexion angle, peak ground reaction force and peak knee extension moment have significantly decreased during the landing of the stop-jump task among the female subjects. The hip flexion angle at the initial foot contact phase showed significant correlation with peak ground reaction force during landing of the stop-jump task (r=-0.927, p<0.001). The knee flexion angle at the initial foot contact phase had significant correlation with peak ground reaction force and vertical ground reaction forces during landing of the stop-jump task (r=-0.908, p<0.001; r=0.812, P=0.002). A large hip and knee flexion angles at the initial foot contact with the ground did not necessarily reduce the impact force during landing, but active hip and knee flexion motions did. The hip and knee flexion motion of landing was an important technical factor that affects anterior cruciate ligament (ACL) loading during the landing of the stop-jump task.

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Progressive Changes in Walking Kinematics and Kinetics After Anterior Cruciate Ligament Injury and Reconstruction: A Review and Meta-Analysis

Journal of Athletic Training ◽

10.4085/1062-6050-52.6.06 ◽

2017 ◽

Vol 52 (9) ◽

pp. 847-860 ◽

Cited By ~ 31

Author(s):

Lindsay V. Slater ◽

Joseph M. Hart ◽

Adam R. Kelly ◽

Christopher M. Kuenze

Keyword(s):

Lower Extremity ◽

Knee Flexion ◽

Cruciate Ligament ◽

Knee Extensor ◽

Flexion Angle ◽

Knee Adduction Moment ◽

Control Group ◽

Knee Flexion Angle ◽

Peak Knee ◽

Healthy Control

Context: Anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) result in persistent alterations in lower extremity movement patterns. The progression of lower extremity biomechanics from the time of injury has not been described. Objective: To compare the 3-dimensional (3D) lower extremity kinematics and kinetics of walking among individuals with ACL deficiency (ACLD), individuals with ACLR, and healthy control participants from 3 to 64 months after ACLR. Data Sources: We searched PubMed and Web of Science from 1970 through 2013. Study Selection and Data Extraction: We selected only articles that provided peak kinematic and kinetic values during walking in individuals with ACLD or ACLR and comparison with a healthy control group or the contralateral uninjured limb. Data Synthesis: A total of 27 of 511 identified studies were included. Weighted means, pooled standard deviations, and 95% confidence intervals were calculated for the healthy control, ACLD, and ACLR groups at each reported time since surgery. The magnitude of between-groups (ACLR versus ACLD, control, or contralateral limb) differences at each time point was evaluated using Cohen d effect sizes and associated 95% confidence intervals. Peak knee-flexion angle (Cohen d = −0.41) and external knee-extensor moment (Cohen d = −0.68) were smaller in the ACLD than in the healthy control group. Peak knee-flexion angle (Cohen d range = −0.78 to −1.23) and external knee-extensor moment (Cohen d range = −1.39 to −2.16) were smaller in the ACLR group from 10 to 40 months after ACLR. Reductions in external knee-adduction moment (Cohen d range = −0.50 to −1.23) were present from 9 to 42 months after ACLR. Conclusions: Reductions in peak knee-flexion angle, external knee-flexion moment, and external knee-adduction moment were present in the ACLD and ACLR groups. This movement profile during the loading phase of gait has been linked to knee-cartilage degeneration and may contribute to the development of osteoarthritis after ACLR.

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Change of Direction Biomechanics in a 180-Degree Pivot Turn and the Risk for Noncontact Knee Injuries in Youth Basketball and Floorball Players

The American Journal of Sports Medicine ◽

10.1177/03635465211026944 ◽

2021 ◽

pp. 036354652110269

Author(s):

Mari Leppänen ◽

Jari Parkkari ◽

Tommi Vasankari ◽

Sami Äyrämö ◽

Juha-Pekka Kulmala ◽

...

Keyword(s):

Knee Flexion ◽

Injury Risk ◽

Knee Injury ◽

Reaction Force ◽

Knee Injuries ◽

Flexion Angle ◽

Knee Valgus ◽

Change Of Direction ◽

Increased Risk ◽

Peak Knee

Background: Studies investigating biomechanical risk factors for knee injuries in sport-specific tasks are needed. Purpose: To investigate the association between change of direction (COD) biomechanics in a 180-degree pivot turn and knee injury risk among youth team sport players. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 258 female and male basketball and floorball players (age range, 12-21 years) participated in the baseline COD test and follow-up. Complete data were obtained from 489 player-legs. Injuries, practice, and game exposure were registered for 12 months. The COD test consisted of a quick ball pass before and after a high-speed 180-degree pivot turn on the force plates. The following variables were analyzed: peak vertical ground-reaction force (N/kg); peak trunk lateral flexion angle (degree); peak knee flexion angle (degree); peak knee valgus angle (degree); peak knee flexion moment (N·m/kg); peak knee abduction moment (N·m/kg); and peak knee internal and external rotation moments (N·m/kg). Legs were analyzed separately and the mean of 3 trials was used in the analysis. Main outcome measure was a new acute noncontact knee injury. Results: A total of 18 new noncontact knee injuries were registered (0.3 injuries/1000 hours of exposure). Female players sustained 14 knee injuries and male players 4. A higher rate of knee injuries was observed in female players compared with male players (incidence rate ratio, 6.2; 95% CI, 2.1-21.7). Of all knee injuries, 8 were anterior cruciate ligament (ACL) injuries, all in female players. Female players displayed significantly larger peak knee valgus angles compared with male players (mean for female and male players, respectively: 13.9°± 9.4° and 2.0°± 8.5°). No significant associations between biomechanical variables and knee injury risk were found. Conclusion: Female players were at increased risk of knee and ACL injury compared with male players. Female players performed the 180-degree pivot turn with significantly larger knee valgus compared with male players. However, none of the investigated variables was associated with knee injury risk in youth basketball and floorball players.

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Relationship between hip and knee strength and peak knee valgus and its associated knee flexion angle during single leg squat

Physiotherapy ◽

10.1016/j.physio.2015.03.298 ◽

2015 ◽

Vol 101 ◽

pp. e149-e150

Author(s):

A. Bin Hussein

Keyword(s):

Knee Flexion ◽

Flexion Angle ◽

Knee Valgus ◽

Knee Flexion Angle ◽

Knee Strength ◽

Peak Knee ◽

Single Leg Squat

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Effects of a Knee Extension Constraint Brace on Selected Lower Extremity Motion Patterns during a Stop-Jump Task

Journal of Applied Biomechanics ◽

10.1123/jab.24.2.158 ◽

2008 ◽

Vol 24 (2) ◽

pp. 158-165 ◽

Cited By ~ 14

Author(s):

Cheng-Feng Lin ◽

Hui Liu ◽

William E. Garrett ◽

Bing Yu

Keyword(s):

Vertical Velocity ◽

Ground Reaction Force ◽

Knee Flexion ◽

Reaction Force ◽

Three Dimensional ◽

Knee Extension ◽

Horizontal Velocity ◽

Flexion Angle ◽

Knee Flexion Angle ◽

Extremity Motion

Small knee flexion angle during landing has been proposed as a potential risk factor for sustaining noncontact ACL injury. A brace that promotes increased knee flexion and decreased posterior ground reaction force during landing may prove to be advantageous for developing prevention strategies. Forty male and forty female recreational athletes were recruited. Three-dimensional videographic and ground reaction force data in a stop-jump task were collected in three conditions. Knee flexion angle at peak posterior ground reaction force, peak posterior ground reaction force, the horizontal velocity of approach run, the vertical velocity at takeoff, and the knee flexion angle at takeoff were compared among conditions: knee extension constraint brace, nonconstraint brace, and no brace. The knee extension constraint brace significantly increased knee flexion angle at peak posterior ground reaction force. Both knee extension constraint brace and nonconstraint brace significantly decreased peak posterior ground reaction force during landing. The brace and knee extension constraint did not significantly affect the horizontal velocity of approach run, the vertical velocity at takeoff, and the knee flexion angle at takeoff. A knee extension constraint brace exhibits the ability to modify the knee flexion angle at peak posterior ground reaction force and peak posterior ground reaction force during landing.

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Effects of an Intervention Program on Lower Extremity Biomechanics in Stop-Jump and Side-Cutting Tasks

The American Journal of Sports Medicine ◽

10.1177/0363546518793393 ◽

2018 ◽

Vol 46 (12) ◽

pp. 3014-3022 ◽

Cited By ~ 4

Author(s):

Chen Yang ◽

Wanxiang Yao ◽

William E. Garrett ◽

Deborah L. Givens ◽

Jonathon Hacke ◽

...

Keyword(s):

Ground Reaction Force ◽

Knee Flexion ◽

Intervention Program ◽

Reaction Force ◽

Intervention Group ◽

Collegiate Athletes ◽

Flexion Angle ◽

Control Group ◽

Knee Flexion Angle ◽

Intervention Effects

Background: Anterior cruciate ligament (ACL) injury is one of the most common injuries in sport. To reduce the risk of noncontact ACL injury, it is critical to understand the effects of an intervention program on neuromuscular control–related biomechanical risk factors. Hypothesis: A newly developed 4-week intervention program would significantly increase the knee flexion angle at peak impact posterior ground-reaction force and would significantly decrease the peak impact posterior and vertical ground-reaction forces in the stop-jump and side-cutting tasks, while the intervention effects would be retained after the training was completed. Study Design: Controlled laboratory study. Methods: A total of 22 male and 18 female collegiate basketball and volleyball players with biomechanical characteristics associated with increased risk of ACL injury were recruited and randomly assigned to either the intervention group or the control group. The intervention group executed a program to improve landing techniques through strength and plyometric training 3 times a week for 4 weeks while participating in their regular training. The control group participated in only their regular training for 4 weeks. Three-dimensional kinematic and kinetic data in the stop-jump and side-cutting tasks were collected at week 0 (the beginning of the study) and at the ends of weeks 4, 8, 16, and 20. Knee flexion angle and ground-reaction forces were calculated. Analyses of variance with a mixed design were performed to determine the intervention effects and the retention of intervention effects for each sex. Results: Male participants in the intervention group significantly increased the knee flexion angle at peak impact posterior ground-reaction force in the stop-jump task at weeks 8, 12, and 20 when compared with that at week 0 and with the male control group ( P ≤ .002). No significant intervention effects on knee flexion angle and ground-reaction force were found in the side-cutting task for male participants. No significant interaction effects on takeoff velocities were detected in any task for male participants. No significant intervention effects on knee flexion angle and ground-reaction force were found in any task for female participants. Vertical takeoff velocity in the stop-jump task was significantly lower in the intervention group at week 20 compared with the control group ( P = .011). Conclusion: A 4-week intervention program significantly increased the knee flexion angle at peak impact posterior ground-reaction force of male collegiate athletes in the stop-jump task without significant effect on the performance of the task. This intervention effect was retained for at least 16 weeks after the training was completed. The intervention program, however, did not affect knee flexion angle and ground-reaction force in any task for female collegiate athletes. A reduction in vertical takeoff velocity of the stop-jump task was observed for female collegiate athletes 16 weeks after the intervention. Clinical Relevance: The intervention program with strength conditioning and plyometric exercises could modify landing biomechanics of male collegiate athletes in a stop-jump task. The intervention program may be a useful tool for preventing noncontact ACL injury for male collegiate athletes.

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Quadriceps Neuromuscular Function and Jump-Landing Sagittal-Plane Knee Biomechanics After Anterior Cruciate Ligament Reconstruction

Journal of Athletic Training ◽

10.4085/1062-6050-306-16 ◽

2018 ◽

Vol 53 (2) ◽

pp. 135-143 ◽

Cited By ~ 18

Author(s):

Sarah H. Ward ◽

J. Troy Blackburn ◽

Darin A. Padua ◽

Laura E. Stanley ◽

Matthew S. Harkey ◽

...

Keyword(s):

Knee Flexion ◽

Sagittal Plane ◽

Neuromuscular Function ◽

Knee Extension ◽

Spinal Reflex ◽

Flexion Angle ◽

Voluntary Activation ◽

Knee Flexion Angle ◽

Jump Landing ◽

Peak Knee

Context: Aberrant biomechanics may affect force attenuation at the knee during dynamic activities, potentially increasing the risk of sustaining a knee injury or hastening the development of osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Impaired quadriceps neuromuscular function has been hypothesized to influence the development of aberrant biomechanics. Objective: To determine the association between quadriceps neuromuscular function (strength, voluntary activation, and spinal-reflex and corticomotor excitability) and sagittal-plane knee biomechanics during jump landings in individuals with ACLR. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Twenty-eight individuals with unilateral ACLR (7 men, 21 women; age = 22.4 ± 3.7 years, height = 1.69 ± 0.10 m, mass = 69.4 ± 10.1 kg, time postsurgery = 52 ± 42 months). Main Outcome Measure(s): We quantified quadriceps spinal-reflex excitability via the Hoffmann reflex normalized to maximal muscle response (H : M ratio), corticomotor excitability via active motor threshold, strength as knee-extension maximal voluntary isometric contraction (MVIC), and voluntary activation using the central activation ratio (CAR). In a separate session, sagittal-plane kinetics (peak vertical ground reaction force [vGRF] and peak internal knee-extension moment) and kinematics (knee-flexion angle at initial contact, peak knee-flexion angle, and knee-flexion excursion) were collected during the loading phase of a jump-landing task. Separate bivariate associations were performed between the neuromuscular and biomechanical variables. Results: In the ACLR limb, greater MVIC was associated with greater peak knee-flexion angle (r = 0.38, P = .045) and less peak vGRF (r = −0.41, P = .03). Greater CAR was associated with greater peak internal knee-extension moment (ρ = −0.38, P = .045), and greater H : M ratios were associated with greater peak vGRF (r = 0.45, P = .02). Conclusions: Greater quadriceps MVIC and CAR may provide better energy attenuation during a jump-landing task. Individuals with greater peak vGRF in the ACLR limb possibly require greater spinal-reflex excitability to attenuate greater loading during dynamic movements.

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