Condylar Contact During Normal Walking and Lateral Trunk Sway Gait: an EMG-Driven Modeling Approach to Estimate Articular Loading

2010 ◽  
Author(s):  
Kurt Manal ◽  
Bernardo Innocenti ◽  
Luc Labey ◽  
Thomas S. Buchanan
Keyword(s):  
Contact Force ◽  
Lateral Compartment ◽  
Knee Adduction Moment ◽  
Activation Patterns ◽  
Modeling Approach ◽  
Antagonist Muscles ◽  
Subject Specific ◽  
Trunk Sway ◽  
Hump Pattern ◽  
The Relationship

The knee adduction moment has a characteristic double hump pattern with the first peak generally larger than the second. Recently, Mundermann showed that walking with a lateral trunk sway can reduce the 1st peak moment [1]. One might expect from this finding that there would be a decrease in medial compartment loading. This however may be too simplistic a view. Fregly et al. showed that a decrease in knee adduction moment does not guarantee a decrease in medial contact [2]. Moreover, the relationship between net joint moments and loading is not straightforward, especially when agonist/antagonist muscles are co-activated as occurs in patients with pathology. Computational methods can benefit by accounting for subject specific neuromuscular activation patterns while taking into account subject specific dynamics when predicting articular loading. In this paper we outline our EMG-driven modeling approach to predict articular loading during trunk sway for a patient with a force measuring instrumented knee implant. We hypothesized that walking with a lateral trunk sway would: (a) decrease medial contact force, and (b) increase contact force in the lateral compartment.

Amplitude and Phasing of Trunk Motion is Critical for the Efficacy of Gait Training Aimed at Reducing Ambulatory Loads at the Knee

2012 ◽  
Vol 134 (1) ◽  
Author(s):  
Annegret Mündermann ◽  
Lars Mündermann ◽  
Thomas P. Andriacchi
Keyword(s):  
Gait Training ◽  
Knee Adduction Moment ◽  
Heel Strike ◽  
Trunk Motion ◽  
Training Interventions ◽  
Optimal Intervention ◽  
Peak Knee ◽  
Trunk Sway ◽  
Analysis System ◽  
The Relationship

The purpose of this study was to determine the contribution of changes in amplitude and phasing of medio-lateral trunk sway to a change in the knee adduction moment when walking with increased medio-lateral trunk sway. Kinematic and kinetic data of walking trials with normal and with increased trunk sway were collected for 19 healthy volunteers using a standard motion analysis system. The relationship between the change in first peak knee adduction moment (ΔKAM) and change in trunk sway amplitude (ΔSA; difference between maximum contralateral trunk lean and maximum ipsilateral trunk lean) and phasing (SP; time of heel-strike relative to time of maximum contralateral and time of maximum ipsilateral trunk lean) was determined using nonlinear regression analysis. On average, subjects increased their SA by 9.7 ± 3.6 deg (P < 0.001) with an average SP of 98.8 ± 88.8 ms resulting in an average reduction in the first peak knee adduction moment of −55.2 ± 30.3% (P < 0.001). 64.3% of variability in change in peak knee adduction moment with the increased trunk sway condition was explained by both differences in SA and SP, and the relationship among these parameters was described by the regression equation ΔKAM = 27.220−4.128 · ΔSA-64.785 · cos(SP). Hence, not only the amplitude but also the phasing of trunk motion is critical. Not only lower limb movement but also lumbar and thoracic lateral flexion should be considered in the decision making process for an optimal intervention aimed at reducing the load on the medial compartment of the knee during walking. However, these promising findings originated from studies on healthy subjects and their relevance for gait training interventions in patients with presumably painful knee osteoarthritis remains to be determined.

Changes in Medial Knee Contact Force Through Gait Modification

2012 ◽  
Author(s):  
Allison L. Hall ◽  
Thor F. Besier ◽  
Amy Silder ◽  
Scott L. Delp ◽  
Darryl D. D’Lima ◽  
...  
Keyword(s):  
Contact Force ◽  
Treatment Strategies ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Medial Knee ◽  
Non Invasive ◽  
Trunk Sway ◽  
Invasive Method ◽  
Gait Modification ◽  
External Knee Adduction Moment

The development of medial knee osteoarthritis (OA) has been attributed to overloading of the medial compartment articular cartilage [1]. Therefore, treatment strategies are often focused on reducing medial compartment loads. Gait modification represents a non-invasive method for achieving this goal. Previous studies have shown that a variety of gait modifications (e.g., toeing out, increased medial-lateral trunk sway, walking with medialized knees (i.e., medial thrust gait)) are effective in reducing the external knee adduction moment [e.g., 2–4]. Although the external knee adduction moment is often used as a surrogate measure of medial compartment force, a recent study showed that reductions in the external knee adduction moment do not guarantee reductions in medial compartment force [5]. Therefore, direct measurements of changes in medial contact force are important for determining the effectiveness of gait modifications.

Lateral Extra-articular Tenodesis Alters Lateral Compartment Contact Mechanics under Simulated Pivoting Maneuvers: An In Vitro Study

2021 ◽  
pp. 036354652110282
Author(s):  
Niv Marom ◽  
Hamidreza Jahandar ◽  
Thomas J. Fraychineaud ◽  
Zaid A. Zayyad ◽  
Hervé Ouanezar ◽  
...  
Keyword(s):  
Contact Mechanics ◽  
Contact Force ◽  
Contact Stress ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
In Vitro Study ◽  
Lateral Compartment ◽  
Lateral Tibial Plateau ◽  
Intact Knee

Background: There is concern that utilization of lateral extra-articular tenodesis (LET) in conjunction with anterior cruciate ligament (ACL) reconstruction (ACLR) may disturb lateral compartment contact mechanics and contribute to joint degeneration. Hypothesis: ACLR augmented with LET will alter lateral compartment contact mechanics in response to simulated pivoting maneuvers. Study Design: Controlled laboratory study. Methods: Loads simulating a pivot shift were applied to 7 cadaveric knees (4 male; mean age, 39 ± 12 years; range, 28-54 years) using a robotic manipulator. Each knee was tested with the ACL intact, sectioned, reconstructed (via patellar tendon autograft), and, finally, after augmenting ACLR with LET (using a modified Lemaire technique) in the presence of a sectioned anterolateral ligament and Kaplan fibers. Lateral compartment contact mechanics were measured using a contact stress transducer. Outcome measures were anteroposterior location of the center of contact stress (CCS), contact force from anterior to posterior, and peak and mean contact stress. Results: On average, augmenting ACLR with LET shifted the lateral compartment CCS anteriorly compared with the intact knee and compared with ACLR in isolation by a maximum of 5.4 ± 2.3 mm ( P < .001) and 6.0 ± 2.6 mm ( P < .001), respectively. ACLR augmented with LET also increased contact force anteriorly on the lateral tibial plateau compared with the intact knee and compared with isolated ACLR by a maximum of 12 ± 6 N ( P = .001) and 17 ± 10 N ( P = .002), respectively. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress by 0.7 ± 0.5 MPa ( P = .005) and by 0.17 ± 0.12 ( P = .006), respectively, at 15° of flexion. Conclusion: Under simulated pivoting loads, adding LET to ACLR anteriorized the CCS on the lateral tibial plateau, thereby increasing contact force anteriorly. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress at 15° of flexion. Clinical Relevance: The clinical and biological effect of increased anterior loading of the lateral compartment after LET merits further investigation. The ability of LET to anteriorize contact stress on the lateral compartment may be useful in knees with passive anterior subluxation of the lateral tibia.

Could Different Directions of Infant Stepping Be Controlled by the Same Locomotor Central Pattern Generator?

2000 ◽  
Vol 83 (5) ◽  
pp. 2814-2824 ◽  
Author(s):  
Tania Lamb ◽  
Jaynie F. Yang
Keyword(s):  
Central Pattern Generator ◽  
Muscle Activation ◽  
Pattern Generator ◽  
Swing Phase ◽  
Smooth Transition ◽  
Cycle Duration ◽  
Human Infants ◽  
Activation Patterns ◽  
Muscle Activation Patterns ◽  
The Relationship

This study examined the idea of whether the same central pattern generator (CPG) for locomotion can control different directions of walking in humans. Fifty-two infants, aged 2–11 mo, were tested. Infants were supported to walk on a treadmill at a variety of speeds. If forward stepping was elicited, stepping in the other directions (primarily sideways and backward) was attempted. The orientation of the infant on the treadmill belt determined the direction of stepping. In some infants, we also attempted to obtain a smooth transition from one direction to another by gradually changing the orientation of the infant during a stepping sequence. Limb segment motion and surface electromyography from the muscles of the lower limb were recorded. Most infants who showed sustained forward walking also could walk in all other directions. Thirty-three of 34 infants tested could step sideways. The success of eliciting backward stepping was 69%. Most of the infants who did not meet our backward stepping criteria did, however, make stepping movements. The different directions of stepping had similar responses to changes in treadmill speed. The relationship between stance and swing phase durations and cycle duration were the same regardless of the direction of stepping across a range of speeds. Some differences were noted in the muscle activation patterns during different directions of walking. For example, the hamstrings were much more active during the swing phase of backward walking compared with forward walking. The quadriceps was more active in the trailing leg during sideways walking. In some infants, we were able to elicit stepping along a continuum of directions. We found no discrete differences in either the electromyographic patterns or the temporal parameters of stepping as the direction of stepping was gradually changed. The results support the idea that the same locomotor CPG controls different directions of stepping in human infants. The fact that most infants were able to step in all directions, the similarity in the response to speed changes, and the absence of any discrete changes as the direction of stepping was changed gradually are all consistent with this hypothesis.

The relationship between the knee adduction torque and medial contact force during gait

2006 ◽  
Vol 39 ◽  
pp. S70 ◽  
Author(s):  
D. Zhao ◽  
S.A. Banks ◽  
K. Mitchell ◽  
D. D'Lima ◽  
C. Colwell ◽  
...  
Keyword(s):  
Contact Force ◽  
The Relationship

scholarly journals Immediate Effects of Medially Posted Insoles on Lower Limb Joint Contact Forces in Adult Acquired Flatfoot: A Pilot Study

2020 ◽  
Vol 17 (7) ◽  
pp. 2226 ◽  
Author(s):  
Yinghu Peng ◽  
Duo Wai-Chi Wong ◽  
Yan Wang ◽  
Tony Lin-Wei Chen ◽  
Qitao Tan ◽  
...  
Keyword(s):  
Contact Force ◽  
Lower Limb ◽  
Random Order ◽  
Contact Forces ◽  
Knee Adduction Moment ◽  
Joint Mechanics ◽  
Joint Force ◽  
Ankle Eversion ◽  
Peak Knee ◽  
Joint Contact

Flatfoot is linked to secondary lower limb joint problems, such as patellofemoral pain. This study aimed to investigate the influence of medial posting insoles on the joint mechanics of the lower extremity in adults with flatfoot. Gait analysis was performed on fifteen young adults with flatfoot under two conditions: walking with shoes and foot orthoses (WSFO), and walking with shoes (WS) in random order. The data collected by a vicon system were used to drive the musculoskeletal model to estimate the hip, patellofemoral, ankle, medial and lateral tibiofemoral joint contact forces. The joint contact forces in WSFO and WS conditions were compared. Compared to the WS group, the second peak patellofemoral contact force (p < 0.05) and the peak ankle contact force (p < 0.05) were significantly lower in the WSFO group by 10.2% and 6.8%, respectively. The foot orthosis significantly reduced the peak ankle eversion angle (p < 0.05) and ankle eversion moment (p < 0.05); however, the peak knee adduction moment increased (p < 0.05). The reduction in the patellofemoral joint force and ankle contact force could potentially inhibit flatfoot-induced lower limb joint problems, despite a greater knee adduction moment.

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