Effect of Limiting Ankle-Dorsiflexion Range of Motion on Lower Extremity Kinematics and Muscle-Activation Patterns During a Squat

Context:Limitations in gastrocnemius/soleus flexibility that restrict ankle dorsiflexion during dynamic tasks have been reported in individuals with patellofemoral pain (PFP) and are theorized to play a role in its development.Objective:To determine the effect of restricted ankle-dorsiflexion range of motion (ROM) on lower extremity kinematics and muscle activity (EMG) during a squat. The authors hypothesized that restricted ankle-dorsiflexion ROM would alter knee kinematics and lower extremity EMG during a squat.Design:Cross-sectional.Participants:30 healthy, recreationally active individuals without a history of lower extremity injury.Interventions:Each participant performed 7 trials of a double-leg squat under 2 conditions: a nowedge condition (NW) with the foot flat on the floor and a wedge condition (W) with a 12° forefoot angle to simulate reduced plantar-flexor flexibility.Main Outcome Measures:3-dimensional hip and knee kinematics, medial knee displacement (MKD), and ankle-dorsiflexion angle. EMG of vastus medialis oblique (VMO), vastus lateralis (VL), lateral gastrocnemius (LG), and soleus (SOL). One-way repeated-measures ANOVAs were performed to determine differences between the W and NW conditions.Results:Compared with the NW condition, the wedge produced decreased peak knee flexion (P < .001, effect size [ES] = 0.81) and knee-flexion excursion (P < .001, ES = 0.82) while producing increased peak ankle dorsiflexion (P = .006, ES = 0.31), ankle-dorsiflexion excursion (P < .001, ES = 0.31), peak knee-valgus angle (P = .02, ES = 0.21), and MKD (P < .001, ES = 2.92). During the W condition, VL (P = 0.002, ES = 0.33) and VMO (P = .049, ES = 0.20) activity decreased while soleus activity increased (P = .03, ES = 0.64) compared with the NW condition. No changes were seen in hip kinematics (P > .05).Conclusions:Altering ankle-dorsiflexion starting position during a double-leg squat resulted in increased knee valgus and MKD, as well as decreased quadriceps activation and increased soleus activation. These changes are similar to those seen in people with PFP.

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Instruction and Jump-Landing Kinematics in College-Aged Female Athletes Over Time

Journal of Athletic Training ◽

10.4085/1062-6050-48.2.09 ◽

2013 ◽

Vol 48 (2) ◽

pp. 161-171 ◽

Cited By ~ 20

Author(s):

Jena Etnoyer ◽

Nelson Cortes ◽

Stacie I. Ringleb ◽

Bonnie L. Van Lunen ◽

James A. Onate

Keyword(s):

Lower Extremity ◽

Retention Test ◽

Knee Flexion ◽

Female Athletes ◽

Initial Contact ◽

Knee Valgus ◽

Drop Jump ◽

Jump Landing ◽

Peak Knee ◽

Hip Flexion

Context: Instruction can be used to alter the biomechanical movement patterns associated with anterior cruciate ligament (ACL) injuries. Objective: To determine the effects of instruction through combination (self and expert) feedback or self-feedback on lower extremity kinematics during the box–drop-jump task, running–stop-jump task, and sidestep-cutting maneuver over time in college-aged female athletes. Design: Randomized controlled clinical trial. Setting: Laboratory. Patients or Other Participants: Forty-three physically active women (age = 21.47 ± 1.55 years, height = 1.65 ± 0.08 m, mass = 63.78 ± 12.00 kg) with no history of ACL or lower extremity injuries or surgery in the 2 months before the study were assigned randomly to 3 groups: self-feedback (SE), combination feedback (CB), or control (CT). Intervention(s): Participants performed a box–drop-jump task for the pretest and then received feedback about their landing mechanics. After the intervention, they performed an immediate posttest of the box–drop-jump task and a running–stop-jump transfer test. Participants returned 1 month later for a retention test of each task and a sidestep-cutting maneuver. Kinematic data were collected with an 8-camera system sampled at 500 Hz. Main Outcome Measure(s): The independent variables were feedback group (3), test time (3), and task (3). The dependent variables were knee- and hip-flexion, knee-valgus, and hip- abduction kinematics at initial contact and at peak knee flexion. Results: For the box–drop-jump task, knee- and hip-flexion angles at initial contact were greater at the posttest than at the retention test (P < .001). At peak knee flexion, hip flexion was greater at the posttest than at the pretest (P = .003) and was greater at the retention test than at the pretest (P = .04); knee valgus was greater at the retention test than at the pretest (P = .03) and posttest (P = .02). Peak knee flexion was greater for the CB than the SE group (P = .03) during the box–drop-jump task at posttest. For the running–stop-jump task at the posttest, the CB group had greater peak knee flexion than the SE and CT (P ≤ .05). Conclusions: Our results suggest that feedback involving a combination of self-feedback and expert video feedback with oral instruction effectively improved lower extremity kinematics during jump-landing tasks.

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Subtalar Joint Position During Gastrocnemius Stretching and Ankle Dorsiflexion Range of Motion

Journal of Athletic Training ◽

10.4085/1062-6050-43.2.172 ◽

2008 ◽

Vol 43 (2) ◽

pp. 172-178 ◽

Cited By ~ 25

Author(s):

Marie Johanson ◽

Jennifer Baer ◽

Holley Hovermale ◽

Phouvy Phouthavong

Keyword(s):

Lower Extremity ◽

Healthy Volunteers ◽

Range Of Motion ◽

Repeated Measures ◽

Subtalar Joint ◽

Mixed Model ◽

Weight Bearing ◽

Ankle Dorsiflexion ◽

Joint Position ◽

Before And After

Abstract Context: Gastrocnemius stretching exercises often are prescribed as part of the treatment program for patients with overuse injuries associated with limited ankle dorsiflexion. However, little is known about how the position of the subtalar joint during gastrocnemius stretching affects ankle dorsiflexion range of motion (ROM). Objective: To determine the effect of subtalar joint position during gastrocnemius stretching on ankle dorsiflexion ROM. Design: This study was a 3-way mixed-model design. The 3 factors were subtalar joint position (supinated, pronated), lower extremity (experimental, control), and time (pretest, posttest). Lower extremity and time were the repeated measures. Setting: University research laboratory. Patients or Other Participants: Thirty-three healthy volunteers (29 women, 4 men). Intervention(s): Participants performed a gastrocnemius stretching exercise 2 times daily for 3 weeks with the subtalar joint of the randomly assigned experimental side (dominant or nondominant) in the randomly assigned position (supination or pronation). The contralateral lower extremity served as the control. Main Outcome Measure(s): Before and after the 3-week gastrocnemius stretching program, we used goniometers to measure ankle dorsiflexion ROM in weight-bearing and non–weight-bearing positions with the subtalar joint positioned in anatomic 0°. Results: Ankle dorsiflexion ROM measured in weight-bearing and non–weight-bearing positions increased after the gastrocnemius stretching program (P = .034 and .003, respectively), but the increase in ROM did not differ based on subtalar joint position (P = .775 and .831, respectively). Conclusions: Subtalar joint position did not appear to influence gains in ankle dorsiflexion ROM after a gastrocnemius stretching program in healthy volunteers.

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Muscle Activation Levels of the Gluteus Maximus and Medius During Standing Hip-Joint-Strengthening Exercises Using Elastic-Tubing Resistance

Journal of Sport Rehabilitation ◽

10.1123/jsr.2012-0082 ◽

2014 ◽

Vol 23 (1) ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

James W. Youdas ◽

Kady E. Adams ◽

John E. Bertucci ◽

Koel J. Brooks ◽

Meghan M. Nelson ◽

...

Keyword(s):

Lower Extremity ◽

Outcome Measures ◽

Hip Joint ◽

Repeated Measures ◽

Muscle Activation ◽

Gluteus Maximus ◽

Gluteus Medius ◽

Muscle Recruitment ◽

Gluteus Medius Muscle ◽

The Cross

Context:No published studies have compared muscle activation levels simultaneously for the gluteus maximus and medius muscles of stance and moving limbs during standing hip-joint strengthening while using elastic-tubing resistance.Objective:To quantify activation levels bilaterally of the gluteus maximus and medius during resisted lower-extremity standing exercises using elastic tubing for the cross-over, reverse cross-over, front-pull, and back-pull exercise conditions.Design:Repeated measures.Setting:Laboratory.Participants:26 active and healthy people, 13 men (25 ± 3 y) and 13 women (24 ± 1 y).Intervention:Subjects completed 3 consecutive repetitions of lower-extremity exercises in random order.Main Outcome Measures:Surface electromyographic (EMG) signals were normalized to peak activity in the maximum voluntary isometric contraction (MVIC) trial and expressed as a percentage. Magnitudes of EMG recruitment were analyzed with a 2 × 4 repeated-measures ANOVA for each muscle (α = .05).Results:For the gluteus maximus an interaction between exercise and limb factor was significant (F3,75 = 21.5; P < .001). The moving-limb gluteus maximus was activated more than the stance limb's during the back-pull exercise (P < .001), and moving-limb gluteus maximus muscle recruitment was greater for the back-pull exercise than for the cross-over, reverse cross-over, and front-pull exercises (P < .001). For the gluteus medius an interaction between exercise and limb factor was significant (F3,75 = 3.7; P < .03). Gluteus medius muscle recruitment (% MVIC) was greater in the stance limb than moving limb when performing the front-pull exercise (P < .001). Moving-limb gluteus medius muscle recruitment was greater for the reverse cross-over exercise than for the cross-over, front-pull, and back-pull exercises (P < .001).Conclusions:From a clinical standpoint there is no therapeutic benefit to selectively activate the gluteus maximus and gluteus medius muscles on the stance limb by resisting sagittal- and frontal-plane hip movements on the moving limb using resistance supplied by elastic tubing.

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Immediate Effect of Ankle Mobilization on Range of Motion, Dynamic Knee Valgus, and Knee Pain in Women With Patellofemoral Pain and Ankle Dorsiflexion Restriction: A Randomized Controlled Trial With 48-Hour Follow-Up

Journal of Sport Rehabilitation ◽

10.1123/jsr.2020-0183 ◽

2020 ◽

pp. 1-10

Author(s):

Bruno Augusto Lima Coelho ◽

Helena Larissa das Neves Rodrigues ◽

Gabriel Peixoto Leão Almeida ◽

Sílvia Maria Amado João

Keyword(s):

Randomized Controlled Trial ◽

Range Of Motion ◽

Outcome Measures ◽

Knee Pain ◽

Controlled Trial ◽

Patellofemoral Pain ◽

Ankle Dorsiflexion ◽

Patient Perceptions ◽

Knee Valgus ◽

Randomized Controlled

Context: Restriction in ankle dorsiflexion range of motion (ROM) has been previously associated with excessive dynamic knee valgus. This, in turn, has been correlated with knee pain in women with patellofemoral pain. Objectives: To investigate the immediate effect of 3 ankle mobilization techniques on dorsiflexion ROM, dynamic knee valgus, knee pain, and patient perceptions of improvement in women with patellofemoral pain and ankle dorsiflexion restriction. Design: Randomized controlled trial with 3 arms. Setting: Biomechanics laboratory. Participants: A total of 117 women with patellofemoral pain who display ankle dorsiflexion restriction were divided into 3 groups: ankle mobilization with anterior tibia glide (n = 39), ankle mobilization with posterior tibia glide (n = 39), and ankle mobilization with anterior and posterior tibia glide (n = 39). Intervention(s): The participants received a single session of ankle mobilization with movement technique. Main Outcome Measures: Dorsiflexion ROM (weight-bearing lunge test), dynamic knee valgus (frontal plane projection angle), knee pain (numeric pain rating scale), and patient perceptions of improvement (global perceived effect scale). The outcome measures were collected at the baseline, immediate postintervention (immediate reassessment), and 48 hours postintervention (48 h reassessment). Results: There were no significant differences between the 3 treatment groups regarding dorsiflexion ROM and patient perceptions of improvement. Compared with mobilization with anterior and posterior tibia glide, mobilization with anterior tibia glide promoted greater increase in dynamic knee valgus (P = .02) and greater knee pain reduction (P = .02) at immediate reassessment. Also compared with mobilization with anterior and posterior tibia glide, mobilization with posterior tibia glide promoted greater knee pain reduction (P < .01) at immediate reassessment. Conclusion: In our sample, the direction of the tibia glide in ankle mobilization accounted for significant changes only in dynamic knee valgus and knee pain in the immediate reassessment.

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Barbell back squat: how do resistance bands affect muscle activation and knee kinematics?

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2019-000610 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000610

Author(s):

Madeleine B Reece ◽

Graham P Arnold ◽

Sadiq Nasir ◽

Weijie W Wang ◽

Rami Abboud

Keyword(s):

Muscle Activation ◽

Knee Kinematics ◽

Gluteus Maximus ◽

Tibial Rotation ◽

Knee Valgus ◽

Biceps Femoris Muscle ◽

Back Squat ◽

Valgus Angle ◽

Peak Knee ◽

Resistance Bands

ObjectivesThis study aimed to determine whether looped resistance bands affect knee kinematics and lower body muscle activation during the barbell back squat.MethodsTwenty-six healthy participants (13 female, 13 male) calculated their one repetition maximum (RM) prior to data collection. Each participant performed three squats at both 80% and 40% 1RM wearing a light resistance band, an extra-heavy resistance band and no resistance band.Vicon 3D motion analysis cameras were used to collect the kinematic data, and Delsys Trigno Lab wireless electromyography (EMG) system was used to measure vastus medialis, vastus lateralis, gluteus maximus, gluteus medius and biceps femoris muscle activity. Peak knee flexion angle, peak knee valgus angle and maximum tibial rotation values were examined. Peak EMG values were also analysed after being normalised and expressed as a percentage of maximum voluntary contraction (MVC).ResultsGluteus maximus (GM) activity is significantly increased when a resistance band is used during squatting. However, squatting with a resistance band is detrimental to knee kinematics as it leads to an increase in knee valgus angle and maximum tibial rotation angle. A direct correlation is recorded between an increase in resistance and an increase in these two angles.ConclusionsSquatting with resistance bands is likely to increase the risk of knee injury. Coaches and clinicians who already implement this technique are advised to remove resistance band squats from training and rehabilitation programmes. Further research evaluating the long-term effects of using resistance bands during the barbell back squat should be considered.

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Ankle-Dorsiflexion Range of Motion and Landing Biomechanics

Journal of Athletic Training ◽

10.4085/1062-6050-46.1.5 ◽

2011 ◽

Vol 46 (1) ◽

pp. 5-10 ◽

Cited By ~ 127

Author(s):

Chun-Man Fong ◽

J. Troy Blackburn ◽

Marc F. Norcross ◽

Melanie McGrath ◽

Darin A. Padua

Keyword(s):

Range Of Motion ◽

Knee Flexion ◽

Injury Risk ◽

Acl Injury ◽

Ankle Dorsiflexion ◽

Ground Reaction Forces ◽

Knee Valgus ◽

Landing Biomechanics ◽

Reaction Forces ◽

Acl Injury Risk

Abstract Context: A smaller amount of ankle-dorsiflexion displacement during landing is associated with less knee-flexion displacement and greater ground reaction forces, and greater ground reaction forces are associated with greater knee-valgus displacement. Additionally, restricted dorsiflexion range of motion (ROM) is associated with greater knee-valgus displacement during landing and squatting tasks. Because large ground reaction forces and valgus displacement and limited knee-flexion displacement during landing are anterior cruciate ligament (ACL) injury risk factors, dorsiflexion ROM restrictions may be associated with a greater risk of ACL injury. However, it is unclear whether clinical measures of dorsiflexion ROM are associated with landing biomechanics. Objective: To evaluate relationships between dorsiflexion ROM and landing biomechanics. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Thirty-five healthy, physically active volunteers. Intervention(s): Passive dorsiflexion ROM was assessed under extended-knee and flexed-knee conditions. Landing biomechanics were assessed via an optical motion-capture system interfaced with a force plate. Main Outcome Measure(s): Dorsiflexion ROM was measured in degrees using goniometry. Knee-flexion and knee-valgus displacements and vertical and posterior ground reaction forces were calculated during the landing task. Simple correlations were used to evaluate relationships between dorsiflexion ROM and each biomechanical variable. Results: Significant correlations were noted between extended-knee dorsiflexion ROM and knee-flexion displacement (r = 0.464, P = .029) and vertical (r = −0.411, P = .014) and posterior (r = −0.412, P = .014) ground reaction forces. All correlations for flexed-knee dorsiflexion ROM and knee-valgus displacement were nonsignificant. Conclusions: Greater dorsiflexion ROM was associated with greater knee-flexion displacement and smaller ground reaction forces during landing, thus inducing a landing posture consistent with reduced ACL injury risk and limiting the forces the lower extremity must absorb. These findings suggest that clinical techniques to increase plantar-flexor extensibility and dorsiflexion ROM may be important additions to ACL injury-prevention programs.

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Relationship of Knee Motions With Static Leg Alignments and Hip Motions in Frontal and Transverse Planes During Double-Leg Landing in Healthy Athletes

Journal of Sport Rehabilitation ◽

10.1123/jsr.2016-0053 ◽

2017 ◽

Vol 26 (5) ◽

pp. 396-405 ◽

Cited By ~ 2

Author(s):

Shogo Uota ◽

Anh-Dung Nguyen ◽

Naoko Aminaka ◽

Yohei Shimokochi

Keyword(s):

Lower Extremity ◽

Outcome Measures ◽

External Rotation ◽

Weight Bearing ◽

Patellofemoral Pain ◽

Transverse Plane ◽

Knee Valgus ◽

Chronic Knee Pain ◽

Lower Extremity Alignment ◽

Peak Knee

Context:Excessive knee valgus and tibial external rotation relative to the femur during weight bearing motions, such as jump-landing, reportedly increases the risk of developing chronic knee pain, such as patellofemoral pain. Excessive deviations from normal ranges of several static lower extremity alignment measures and dynamic hip motions may also increase the risks for patellofemoral pain.Objective:To determine the relationship between lower extremity alignments and hip motions to frontal and transverse plane knee motions during double-leg landings.Design:Correlational study.Setting:Laboratory.Patients or Other Participants:69 healthy, competitive athletes (27 men, 42 women; height, 166.5 ± 9.5 cm; weight, 61.3 ± 9.9 kg; age, 20.7 ± 1.0 y) participated in this study.Interventions:Prone and supine hip version, quadriceps angle, and tibiofemoral angle were measured. Frontal and transverse knee and hip angles at peak knee extensor moment during landing were calculated.Main Outcome Measures:2 separate stepwise multiple regression analyses were conducted to predict frontal and transverse plane knee motions using 4 static lower extremity alignment measures and hip motions.Results:Greater hip adduction and prone hip anteversion, and lesser hip internal rotation and supine hip anteversion, were related to greater knee valgus motions (R2 = .475, P < .01). Greater hip adduction was related to greater knee external rotation (R2 = .205, P < .01).Conclusions:Some targeted static lower extremity alignments and hip motions are associated with frontal and transverse knee motions. However, stronger relationships of hip motions with knee motions than static lower extremity alignments provided evidence that improving hip movements may help improve patellofemoral pain in those with lower extremity malalignments.

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Two- and 3-Dimensional Knee Valgus Are Reduced After an Exercise Intervention in Young Adults With Demonstrable Valgus During Squatting

Journal of Athletic Training ◽

10.4085/1062-6050-48.3.16 ◽

2013 ◽

Vol 48 (4) ◽

pp. 442-449 ◽

Cited By ~ 22

Author(s):

David R. Bell ◽

D. Craig Oates ◽

Micheal A. Clark ◽

Darin A. Padua

Keyword(s):

Range Of Motion ◽

Repeated Measures ◽

Exercise Intervention ◽

Intervention Group ◽

Ankle Dorsiflexion ◽

Controlled Clinical Trial ◽

Knee Valgus ◽

Hip Strength ◽

Change Scores ◽

3 Dimensional

Context: Two-dimensional (or medial knee displacement [MKD]) and 3-dimensional (3D) knee valgus are theorized to contribute to anterior cruciate ligament injuries. However, whether these displacements can be improved in the double-legged squat (DLS) after an exercise intervention is unclear. Objective: To determine if MKD and 3D knee valgus are improved in a DLS after an exercise intervention. Design: Randomized controlled clinical trial. Setting: Research laboratory. Patients or Other Participants: A total of 32 participants were enrolled in this study and were randomly assigned to the control (n = 16) or intervention (n = 16) group. During a DLS, all participants demonstrated knee valgus that was corrected with a heel lift. Intervention(s): The intervention group completed 10 sessions of directed exercise that focused on hip and ankle strength and flexibility over a 2- to 3-week period. Main Outcome Measure(s): We assessed MKD and 3D knee valgus during the DLS using an electromagnetic tracking system. Hip strength and ankle-dorsiflexion range of motion were measured. Change scores were calculated for MKD and 3D valgus at 0%, 10%, 20%, 30%, 40%, and 50% phases, and group (2 levels)-by phase (6 levels) repeated-measures analyses of variance were conducted. Independent t tests were used to compare change scores in other variables (α < .05). Results: The MKD decreased from 20% to 50% of the DLS (P = .02) and 3D knee valgus improved from 30% to 50% of the squat phase (P = .001). Ankle-dorsiflexion range of motion (knee extended) increased in the intervention group (P = .009). No other significant findings were observed (P > .05). Conclusions: The intervention reduced MKD and 3D knee valgus during a DLS. The intervention also increased ankle range of motion. Our inclusion criteria might have limited our ability to observe changes in hip strength.

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Ankle Dorsiflexion Affects Hip and Knee Biomechanics During Landing

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211019683 ◽

2021 ◽

pp. 194173812110196

Author(s):

Jeffrey B. Taylor ◽

Elena S. Wright ◽

Justin P. Waxman ◽

Randy J. Schmitz ◽

James D. Groves ◽

...

Keyword(s):

Lower Extremity ◽

Knee Flexion ◽

Injury Risk ◽

Female Athletes ◽

Knee Extensor ◽

Ankle Dorsiflexion ◽

Level Of Evidence ◽

Peak Knee ◽

Knee Abduction ◽

Lower Extremity Biomechanics

Background: Restricted ankle dorsiflexion range of motion (DFROM) has been linked to lower extremity biomechanics that place an athlete at higher risk for injury. Whether reduced DFROM during dynamic movements is due to restrictions in joint motion or underutilization of available ankle DFROM motion is unclear. Hypothesis: We hypothesized that both lesser total ankle DFROM and underutilization of available motion would lead to high-risk biomechanics (ie, greater knee abduction, reduced knee flexion). Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Nineteen active female athletes (age, 20.0 ± 1.3 years; height, 1.61 ± 0.06 m; mass, 67.0 ± 10.7 kg) participated. Maximal ankle DFROM (clinical measure of ankle DFROM [DF-CLIN]) was measured in a weightbearing position with the knee flexed. Lower extremity biomechanics were measured during a drop vertical jump with 3-dimensional motion and force plate analysis. The percent of available DFROM used during landing (DF-%USED) was calculated as the peak DFROM observed during landing divided by DF-CLIN. Univariate linear regressions were performed to identify whether DF-CLIN or DF-%USED predicted knee and hip biomechanics commonly associated with injury risk. Results: For every 1.0° less of DF-CLIN, there was a 1.0° decrease in hip flexion excursion ( r2 = 0.21, P = 0.05), 1.2° decrease in peak knee flexion angles ( r2 = 0.37, P = 0.01), 0.9° decrease in knee flexion excursion ( r2 = 0.40, P = 0.004), 0.002 N·m·N−1·cm−1 decrease in hip extensor work ( r2 = 0.28, P = 0.02), and 0.001 N·m·N−1·cm−1 decrease in knee extensor work ( r2 = 0.21, P = 0.05). For every 10% less of DF-%USED, there was a 3.2° increase in peak knee abduction angles ( r2 = 0.26, P = 0.03) and 0.01 N·m·N−1·cm−1 lesser knee extensor work ( r2 = 0.25, P = 0.03). Conclusion: Lower levels of both ankle DFROM and DF-%USED are associated with biomechanics that are considered to be associated with a higher risk of sustaining injury. Clinical Relevance: While total ankle DFROM can predict some aberrant movement patterns, underutilization of available ankle DFROM can also lead to higher risk movement strategies. In addition to joint specific mobility training, clinicians should incorporate biomechanical interventions and technique feedback to promote the utilization of available motion.

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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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