The Feasibility of Using Augmented Auditory Feedback From a Pressure Detecting Insole to Reduce the Knee Adduction Moment: A Proof of Concept Study

2016 ◽  
Vol 138 (2) ◽  
Author(s):  
Christopher Ferrigno ◽  
Ina S. Stoller ◽  
Najia Shakoor ◽  
Laura E. Thorp ◽  
Markus A. Wimmer
Keyword(s):  
Auditory Feedback ◽  
Knee Flexion ◽  
Healthy Subjects ◽  
Knee Adduction Moment ◽  
Proof Of Concept ◽  
Normal Walking ◽  
Concept Study ◽  
Peak Knee ◽  
Flexion Moment ◽  
Gait Modification

The objective of this work was to conduct a proof of concept study utilizing auditory feedback from a pressure-detecting shoe insole to shift plantar pressure medially in order to reduce the knee adduction moment (KAM). When compared with normal walking, 32 healthy subjects significantly reduced their peak KAM using feedback (p < 0.001). When compared with medial thrust gait, an established gait modification, walking with pressure-based feedback was equally effective at reducing the peak KAM, yet it successfully mitigated other potentially detrimental gait measures such as the peak knee flexion moment (KFM), knee internal rotation moment (KIrM), and a reduction in speed.

scholarly journals Knee joint kinetics in response to multiple three-dimensional printed, customised foot orthoses for the treatment of medial compartment knee osteoarthritis

2017 ◽  
Vol 231 (6) ◽  
pp. 487-498 ◽  
Author(s):  
Richard Allan ◽  
James Woodburn ◽  
Scott Telfer ◽  
Mandy Abbott ◽  
Martijn PM Steultjens
Keyword(s):  
Knee Flexion ◽  
Significant Interaction ◽  
Three Dimensional ◽  
Knee Adduction Moment ◽  
Foot Orthoses ◽  
Peak Knee ◽  
Biomechanical Response ◽  
Flexion Moment ◽  
Foot Orthosis ◽  
Second Peak

The knee adduction moment is consistently used as a surrogate measure of medial compartment loading. Foot orthoses are designed to reduce knee adduction moment via lateral wedging. The ‘dose’ of wedging required to optimally unload the affected compartment is unknown and variable between individuals. This study explores a personalised approach via three-dimensional printed foot orthotics to assess the biomechanical response when two design variables are altered: orthotic length and lateral wedging. Foot orthoses were created for 10 individuals with symptomatic medial knee osteoarthritis and 10 controls. Computer-aided design software was used to design four full and four three-quarter-length foot orthoses per participant each with lateral posting of 0° ‘neutral’, 5° rearfoot, 10° rearfoot and 5° forefoot/10° rearfoot. Three-dimensional printers were used to manufacture all foot orthoses. Three-dimensional gait analyses were performed and selected knee kinetics were analysed: first peak knee adduction moment, second peak knee adduction moment, first knee flexion moment and knee adduction moment impulse. Full-length foot orthoses provided greater reductions in first peak knee adduction moment (p = 0.038), second peak knee adduction moment (p = 0.018) and knee adduction moment impulse (p = 0.022) compared to three-quarter-length foot orthoses. Dose effect of lateral wedging was found for first peak knee adduction moment (p < 0.001), second peak knee adduction moment (p < 0.001) and knee adduction moment impulse (p < 0.001) indicating greater unloading for higher wedging angles. Significant interaction effects were found for foot orthosis length and participant group in second peak knee adduction moment (p = 0.028) and knee adduction moment impulse (p = 0.036). Significant interaction effects were found between orthotic length and wedging condition for second peak knee adduction moment (p = 0.002). No significant changes in first knee flexion moment were found. Individual heterogeneous responses to foot orthosis conditions were observed for first peak knee adduction moment, second peak knee adduction moment and knee adduction moment impulse. Biomechanical response is highly variable with personalised foot orthoses. Findings indicate that the tailoring of a personalised intervention could provide an additional benefit over standard interventions and that a three-dimensional printing approach to foot orthosis manufacturing is a viable alternative to the standard methods.

Effect of Fatigue on Hip and Knee Joint Biomechanics in Anterior Cruciate Ligament Deficient Patients

2021 ◽  
pp. 1-8
Author(s):  
Komeil Dashti Rostami ◽  
Abbey Thomas
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Peak Knee ◽  
Flexion Moment ◽  
Protective Strategy ◽  
Joint Biomechanics ◽  
Anterior Cruciate ◽  
Anterior Cruciate Ligament Deficient

The influence of fatigue on landing biomechanics in anterior cruciate ligament deficient (ACLD) patients is poorly understood. The purpose of this study was to examine the effect of fatigue on hip and knee joint biomechanics in deficient patients. Twelve ACLD males and 12 healthy control subjects participated in the study. The ACLD patients landed with increased peak knee flexion angle (F = 15.71, p < .01) and decreased peak knee flexion moment (F = 9.13, p < .01) after fatigue. Furthermore, ACLD patients experienced lower vertical ground reaction forces compared with controls regardless of fatigue state (F = 9.75, p < .01). It seems that ACLD patients use protective strategy in response to fatigue in order to prevent further injury in knee point.

scholarly journals Comparison of Stance Phase Knee Joint Angles and Moments Using Two Different Surface Marker Representations of the Proximal Shank in Walkers and Runners

2014 ◽  
Vol 30 (1) ◽  
pp. 173-178 ◽  
Author(s):  
Daniel J. Petit ◽  
John D. Willson ◽  
Joaquin A. Barrios
Keyword(s):  
Knee Joint ◽  
Knee Flexion ◽  
Surface Marker ◽  
Data Sets ◽  
Joint Mechanics ◽  
3 Dimensional ◽  
Dynamic Task ◽  
Peak Knee ◽  
Flexion Moment ◽  
Knee Joint Mechanics

Efforts to compare different surface marker configurations in 3-dimensional motion analysis are warranted as more complex and custom marker sets become more common. At the knee, different markers can been used to represent the proximal shank. Often, two anatomical markers are placed over the femoral condyles, with their midpoint defining both the distal thigh and proximal shank segment ends. However, two additional markers placed over the tibial plateaus have been used to define the proximal shank end. For this experiment, simultaneous data for both proximal shank configurations were independently collected at two separate laboratories by different investigators, with one laboratory capturing a walking population and the other a running population. Common discrete knee joint variables were then compared between marker sets in each population. Using the augmented marker set, peak knee flexion after weight acceptance was less (1.2−1.7°, P < .02) and peak knee adduction was greater (0.7−1.4°, P < .001) in both data sets. Similarly, the calculated peak knee flexion moment was less by 15–20% and internal rotation moment was greater by 11–18% (P < .001). These results suggest that the calculation of knee joint mechanics are influenced by the proximal shank’s segment endpoint definition, independent of dynamic task, investigator, laboratory environment, and population in this study.

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

2017 ◽  
Vol 52 (9) ◽  
pp. 847-860 ◽  
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.

scholarly journals Mechanisms underpinning the peak knee flexion moment increase over 2-years following arthroscopic partial meniscectomy

2015 ◽  
Vol 30 (10) ◽  
pp. 1060-1065 ◽  
Author(s):  
Michelle Hall ◽  
Tim V. Wrigley ◽  
Ben R. Metcalf ◽  
Rana S. Hinman ◽  
Flavia M. Cicuttini ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Partial Meniscectomy ◽  
Arthroscopic Partial Meniscectomy ◽  
Peak Knee ◽  
Flexion Moment

scholarly journals Biomechanical asymmetries persist after ACL reconstruction: results of a 2-year study

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Fatemeh Sharafoddin-Shirazi ◽  
Amir Letafatkar ◽  
Jennifer Hogg ◽  
Vahid Saatchian
Keyword(s):  
Ground Reaction Force ◽  
Reaction Force ◽  
Force Plate ◽  
Asymmetry Index ◽  
Knee Adduction Moment ◽  
Vertical Ground Reaction Force ◽  
Level Of Evidence ◽  
Post Surgery ◽  
Peak Knee ◽  
Flexion Moment

Abstract Purpose This study was aimed to examine longitudinal (6, 12, 18, 24 months) asymmetries in double-leg landing kinetics and kinematics of subjects with and without unilateral ACLR. Methods Three-dimensional kinematic and kinetic parameters of 40 participants (n = 20 post-ACLR, n = 20 healthy) were collected with a motion analysis system and force plate during a drop-landing task, and asymmetry indices were compared between groups. Results The asymmetry index (AI) in the ACLR group compared to the healthy group decreased from six to 24 months for vertical ground reaction force (vGRF) from 100% to 6.5% and for anterior posterior ground reaction force (a-pGRF) from 155.5% to 7%. Also, the AI decreased for peak hip flexion moment from 74.5% to 17.1%, peak knee flexion moment from 79.0% to 5.8% and peak ankle dorsiflexion moment from 59.3% to 5.9%. As a further matter, the AI decreased for peak hip abduction moment from 67.8% to 5.1%, peak knee adduction moment from 55.7% to 14.8% and peak knee valgus angle from 48.7% to 23.5%. Conclusions Results obtained from this longitudinal study showed that ACLR patients still suffer from limb asymmetries during landing tasks, which appear to normalize by 24-monthspost-surgery. This finding can help us to better understand biomechanics of the limbs after ACLR, and design more efficient post-surgery rehabilitation programs. Level of evidence Level III.

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