Frontal Plane Knee Mechanics and Early Cartilage Degeneration in People With Anterior Cruciate Ligament Reconstruction: A Longitudinal Study

Background: Abnormal frontal plane gait mechanics are known risk factors for knee osteoarthritis, but their role in early cartilage degeneration after anterior cruciate ligament reconstruction (ACLR) is not well understood. Hypothesis/Purpose: The objective was to evaluate the association of frontal plane gait mechanics with medial knee cartilage magnetic resonance (MR) relaxation times over 1 year in patients with ACLR and controls. It was hypothesized that (1) there will be an increase in frontal plane medial knee loading and medial knee MR relaxation times over time in the patients with ACLR, and (2) increases in frontal plane medial knee loading will be associated with an increase in medial knee MR relaxation times. Study Design: Case-control study; Level of evidence, 3. Methods: Patients with ACLR (n = 37) underwent walking gait analyses and bilateral quantitative MR imaging (MRI) before surgery and at 6 and 12 months after ACLR. Healthy control participants (n = 13) were evaluated at baseline and 12 months. Gait variables included peak knee adduction moment (KAM), KAM impulse, and peak knee adduction angle. MRI variables included medial femur and medial tibia whole compartment and subregional T1ρ and T2 relaxation times. Statistical analyses included a comparison of changes over time for gait and MRI variables, correlations between changes in gait and MRI variables over time, and differences in change in MRI variables in patients who showed an increase versus decrease in KAM impulse. Results: There were significant increases in medial T1ρ (Δ 4%-11%) and T2 (Δ 2%-10%) relaxation times from baseline to 6 months for both knees in the ACLR group and in KAM (Δ 13%) for the injured knee. From baseline to 6 months, patients who had an increase in KAM impulse in the injured knee had a greater increase in medial T1ρ and T2 relaxation times as compared with those who did not have an increase in KAM impulse. Longitudinal changes for the control group were not significant. Conclusion: There is an increase in medial knee relaxation times over the first 6 months after ACLR. People with an increase in medial knee loading show an increase in medial knee relaxation times when compared with those who do not have an increase in medial knee loading over the first 6 months.

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Dynamic Versus Radiographic Alignment in Relation to Medial Knee Loading in Symptomatic Osteoarthritis

Journal of Applied Biomechanics ◽

10.1123/jab.28.5.551 ◽

2012 ◽

Vol 28 (5) ◽

pp. 551-559 ◽

Cited By ~ 13

Author(s):

Joaquin A. Barrios ◽

Todd D. Royer ◽

Irene S. Davis

Keyword(s):

Frontal Plane ◽

Epidemiological Studies ◽

Knee Adduction Moment ◽

Knee Alignment ◽

Radiographic Findings ◽

Medial Knee ◽

Knee Oa ◽

Peak Knee ◽

Knee Loading ◽

Radiographic Alignment

Dynamic knee alignment is speculated to have a stronger relationship to medial knee loading than radiographic alignment. Therefore, we aimed to determine what frontal plane knee kinematic variable correlated most strongly to the knee adduction moment. That variable was then compared with radiographic alignment as a predictor of the knee adduction moment. Therefore, 55 subjects with medial knee OA underwent three-dimensional gait analysis. A subset of 21 subjects also underwent full-limb radiographic assessment for knee alignment. Correlations and regression analyses were performed to assess the relationships between the kinematic, kinetic and radiographic findings. Peak knee adduction angle most strongly correlated to the knee adduction moment of the kinematic variables. In comparison with radiographic alignment, peak knee adduction angle was the stronger predictor. Given that most epidemiological studies on knee OA use radiographic alignment in an attempt to understand progression, these results are meaningful.

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Side-to-Side Differences in Varus Thrust and Knee Abduction Moment in High-Functioning Individuals With Chronic Anterior Cruciate Ligament Deficiency

The American Journal of Sports Medicine ◽

10.1177/0363546518812883 ◽

2018 ◽

Vol 47 (3) ◽

pp. 590-597 ◽

Cited By ~ 1

Author(s):

Shiek Abdullah Ismail ◽

Milena Simic ◽

Lucy J. Salmon ◽

Justin P. Roe ◽

Leo A. Pinczewski ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Angular Velocity ◽

Cruciate Ligament ◽

Frontal Plane ◽

Knee Alignment ◽

Medial Knee ◽

High Functioning ◽

Peak Knee ◽

Anterior Cruciate ◽

Knee Load

Background: There is evidence that frontal plane knee joint motion plays a crucial role in the pathogenesis of knee osteoarthritis, yet investigation of individuals with chronic anterior cruciate ligament–deficient (ACLD) knees remains sparse. Purpose: To investigate (1) if individuals with chronic ACLD knees demonstrate higher biomechanical measures of medial knee load as compared with their anterior cruciate ligament–intact (ACLI) knees, (2) if differences in static knee alignment of the ACLD knee will demonstrate a difference in the magnitude of biomechanical measures of medial knee load when compared with the ACLI knee, and (3) the side-to-side concordance of varus thrust among individuals with chronic ACLD knees. Study Design: Descriptive laboratory study. Methods: Participants were sourced from a metropolitan orthopaedic surgeon group. Those who met the inclusion criteria and agreed to participate underwent a 3-dimensional gait analysis assessment to measure knee adduction moment (KAM), knee flexion moment (KFM), KAM peaks, KAM impulse, and varus thrust. Frontal plane knee static alignment was measured with a digital inclinometer fixed to medical calipers. The participants were divided according to their static knee alignment (neutral, varus, and valgus) for subgroup analysis. Peak knee angular velocity and frontal plane knee angle were used to establish if a participant was walking with a knee thrust. An individual was deemed to have knee thrust during gait if the largest frontal plane knee movement coincided with the peak knee angular velocity that occurred within the first 30% of stance phase. Results: Forty-five participants were recruited. The mean (SD) time from injury was 34.5 (55.6) months. ACLD knees did not demonstrate higher mean KAM and KFM ( P > .5) or early-stance peak KAM ( P = .3-.8) and KAM impulse ( P = .3-.9) as compared with ACLI knees as a whole group or when the varus, neutral, and valgus alignment subgroups were investigated separately. Twenty-three percent (n = 9) of the participants had a varus thrust at the ACLD or ACLI knee, 44% (n = 4) had a varus thrust at the ACLD knee, and 22% (n = 2) had varus thrust at both knees. Conclusion: There were no side-to-side differences in mean KAM and KFM and early-stance peak KAM and KAM impulse among high-functioning individuals with chronic unilateral ACLD knees. There was a low prevalence of varus thrust among high-functioning individuals with chronic unilateral ACLD knees.

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NEURAL ACTIVITY AND LANDING BIOMECHANICS: EXPLORING THE RELATIONSHIPS BETWEEN THE BRAIN, BODY, AND ACL INJURY-RISK

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00151 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0015

Author(s):

Cody R. Criss ◽

Dustin R. Grooms ◽

Jed A. Diekfuss ◽

Manish Anand ◽

Alexis B. Slutsky-Ganesh ◽

...

Keyword(s):

Neural Activity ◽

Injury Risk ◽

Neural Control ◽

Motor Coordination ◽

Cruciate Ligament ◽

Vertical Jump ◽

Frontal Plane ◽

Peak Knee ◽

Knee Abduction ◽

Drop Vertical Jump

Background: Anterior cruciate ligament (ACL) injuries predominantly occur via non-contact mechanisms, secondary to motor coordination errors resulting in aberrant frontal plane knee loads that exceed the thresholds of ligament integrity. However, central nervous system processing underlying high injury-risk motor coordination errors remain unknown, limiting the optimization of current injury reduction strategies. Purpose: To evaluate the relationships between brain activity during motor tasks with injury-risk loading during a drop vertical jump. Methods: Thirty female high school soccer players (16.10 ± 0.87 years, 165.10 ± 4.64 cm, 63.43 ± 8.80 kg) were evaluated with 3D biomechanics during a standardized drop vertical jump from a 30 cm box and peak knee abduction moment was extracted as the injury-risk variable of interest. A neuroimaging session to capture neural activity (via blood-oxygen-level-dependent signal) was then completed which consisted of 4 blocks of 30 seconds of repeated bilateral leg press action paced to a metronome beat of 1.2 Hz with 30 seconds rest between blocks. Knee abduction moment was evaluated relative to neural activity to identify potential neural contributors to injury-risk. Results: There was a direct relationship between increased landing knee abduction moment and increased neural activation within regions corresponding to the lingual gyrus, intracalcarine cortex, posterior cingulate cortex, and precuneus (r2= 0.68, p corrected < .05, z max > 3.1; Table 1 & Figure 1). Conclusion: Elevated activity in regions that integrate sensory, spatial, and attentional information may contribute to elevated frontal plane knee loads during landing. Interestingly, a similar activation pattern related to high-risk landing mechanics has been found in those following injury, indicating that predisposing factors to injury may be accentuated by injury or that modern rehabilitation does not recover prospective neural control deficits. These data uncover a potentially novel brain marker that could guide the discovery of neural-therapeutic targets that reduce injury risk beyond current prevention methods. [Table: see text][Figure: see text]

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Efficacy of Prophylactic Knee Bracing in Sports

The Journal of Knee Surgery ◽

10.1055/s-0041-1740930 ◽

2021 ◽

Author(s):

Kyle Blecha ◽

Clayton W. Nuelle ◽

Patrick A. Smith ◽

James P. Stannard ◽

Richard Ma

Keyword(s):

Sports Medicine ◽

Injury Risk ◽

Cruciate Ligament ◽

Athletic Trainers ◽

Knee Injuries ◽

Frontal Plane ◽

American Football ◽

Work Related ◽

Knee Loading ◽

Anterior Cruciate

AbstractAnterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are common knee injuries, which can result from contact and noncontact during sports, recreation, or work-related activities. Prophylactic knee braces (PKBs) have been designed to protect the knee and decrease risk of recurrence of these injuries. Despite their success, PKBs have not been proven to be consistently effective and cost of the device must be evaluated to optimize its use in sports, particularly American football. Biomechanical studies have suggested that increased hip and knee flexion angles may reduce frontal plane loading with bracing which can protect the knee joint. This is essential with knee loading and rotational moments because they are associated with jumping, landing, and pivoting movements. The clinical efficacy of wearing PKBs can have an impact on athletic performance with respect to speed, power, motion, and agility, and these limitations are evident in athletes who are unaccustomed to wearing a PKB. Despite these concerns, use of PKBs increases in patients who have sustained an MCL injury or recovering from an ACL reconstruction surgery. As the evidence continues to evolve in sports medicine, there is limited definitive data to determine their beneficial or detrimental effects on overall injury risk of athletes, therefore leading those recommendations and decisions for their usage in the hands of the athletic trainers and team physicians' experience to determine the specific brace design, brand, fit, and situations for use.

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Effect of Laterally Wedged Foot Orthoses on Rearfoot and Hip Mechanics in Patients with Medial Knee Osteoarthritis

Prosthetics and Orthotics International ◽

10.1080/03093640802613237 ◽

2009 ◽

Vol 33 (2) ◽

pp. 107-116 ◽

Cited By ~ 42

Author(s):

Robert J. Butler ◽

Joaquin A. Barrios ◽

Todd Royer ◽

Irene S. Davis

Keyword(s):

Knee Osteoarthritis ◽

Three Dimensional ◽

Frontal Plane ◽

Knee Adduction Moment ◽

Orthotic Devices ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Peak Knee ◽

Wedge Condition ◽

Foot Orthotic

The purpose of this study was to examine the effects of laterally wedged foot orthotic devices, used to treat knee osteoarthritis, on frontal plane mechanics at the rearfoot and hip during walking. Thirty individuals with diagnosed medial knee osteoarthritis were recruited for this study. Three dimensional kinematics and kinetics were recorded as the subjects walked in the laboratory at an intentional walking speed. Peak eversion, eversion excursion and peak eversion moment were increased while the peak knee adduction moment was reduced in the laterally wedged orthotic condition compared to the no wedge condition. In contrast, no changes were observed in the variables of interest at the hip. There was no significant relationship between the change in the peak frontal plane moment at the rearfoot and change in the peak frontal plane moment at the knee or hip as a result of the lateral wedge. Laterally wedged foot orthotic devices, used to treat knee osteoarthritis, do not influence hip mechanics. However, they do result in increased rearfoot eversion and inversion moment. Therefore, a full medical screen of the foot should occur before laterally wedged foot orthotic devices are prescribed as a treatment for knee osteoarthritis.

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Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00618-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kathleen Andrä ◽

Robert Prill ◽

Enes Kayaalp ◽

Lars Irlenbusch ◽

Eckehard Liesaus ◽

...

Keyword(s):

Revision Surgery ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Frontal Plane ◽

Cartilage Degeneration ◽

Lateral View ◽

Tunnel Placement ◽

Level Of Evidence ◽

Increased Risk ◽

Roof Angle

Abstract Purpose Degeneration of the cartilage after anterior cruciate ligament reconstruction (ACL-R) is known, and further deterioration can be expected in patients with tunnel malplacement or partial meniscal resection. It was hypothesized that there is a significant increase in cartilage degeneration after failed ACL-R. Material and methods Isolated ACL revision surgery was performed in 154 patients at an interval of 46 ± 33 months (5–175 months) between primary and revision surgery. Cartilage status at the medial, lateral femorotibial, and patellofemoral compartments were assessed arthroscopically during primary and revision ACL-R in accordance with the Outerbridge classification. Tunnel placement, roof angle, and tibial slope was measured using anteroposterior and lateral radiographic views. Results Cartilage degeneration increased significantly in the medial femorotibial compartment, followed by the lateral and patellofemoral compartments. There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) (rs = 0.28, p = 0.0012) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane. Worsening of the cartilage status in the medial femorotibial compartment, either femoral or tibial, was correlated with the tibial aperture site in the lateral view (Rs = 0.28, p < 0.001). Cartilage degeneration in the lateral compartment of the knee, on both femoral or tibial side, was inversely correlated with the femoral roof angle (Rs = −0.1985, p = 0.02). Meniscal tears, either at the medial or lateral site or at both, were found in 93 patients (60%) during primary ACL-R and increased to 132 patients (86%) during revision ACL-R. Discussion Accelerated cartilage degeneration and high prevalence of meniscal lesions are seen in failed ACL-R. Tunnel placement showed significant impact on cartilage degeneration and may partially explain the increased risk of an inferior outcome when revision surgery is required after failed primary ACL-R. Level of evidence: Level IV—retrospective cohort study.

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Preferred Hip Strategy During Landing Reduces Knee Abduction Moment in Collegiate Female Soccer Players

Journal of Sport Rehabilitation ◽

10.1123/jsr.2016-0026 ◽

2018 ◽

Vol 27 (3) ◽

pp. 213-217 ◽

Cited By ~ 1

Author(s):

Anh-Dung Nguyen ◽

Jeffrey B. Taylor ◽

Taylor G. Wimbish ◽

Jennifer L. Keith ◽

Kevin R. Ford

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Frontal Plane ◽

Soccer Players ◽

Ligament Injuries ◽

Anterior Cruciate Ligament Injuries ◽

Hip Strategy ◽

Knee Loading ◽

Knee Abduction ◽

Anterior Cruciate

Context: Hip-focused interventions are aimed to decrease frontal plane knee loading related to anterior cruciate ligament injuries. Whether a preferred hip landing strategy decreases frontal plane knee loading is unknown. Objective: To determine if a preferred hip landing strategy during a drop vertical jump (DVJ) is utilized during a single-leg landing (SLL) task and whether differences in frontal plane knee loading are consistent between a DVJ and an SLL task. Design: Descriptive laboratory study. Setting: Research laboratory. Participants: Twenty-three collegiate, female soccer players. Main Outcome Measures: Participants were dichotomized into a hip (HIP; n = 9) or knee/ankle (KA; n = 14) strategy group based on the percentage distribution of each lower extremity joint relative to the summated moment (% distribution) during the DVJ. Separate 1-way analysis of variances examined the differences in joint-specific % distribution and external knee abduction moment between the HIP and KA groups. Results: The HIP group had significantly greater % distribution of hip moment and less % distribution of knee moment compared with the KA group during the DVJ and SLL. External knee abduction moment was also significantly less in the HIP group compared with the KA group during the DVJ. Conclusions: Female soccer athletes who land with a preferred hip strategy during a DVJ also land with a preferred hip strategy during an SLL. The preferred hip strategy also resulted in less external knee abduction moments during the DVJ. Clinical Relevance: Targeting the neuromuscular control of the hip extensor may be useful in reducing risk of noncontact anterior cruciate ligament injuries.

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Patient-Reported Activity Levels Correlate With Early Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546520980431 ◽

2021 ◽

Vol 49 (2) ◽

pp. 442-449

Author(s):

James M. Friedman ◽

Favian Su ◽

Alan L. Zhang ◽

Christina R. Allen ◽

Brian T. Feeley ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Relaxation Times ◽

Cartilage Degeneration ◽

Medial Compartment ◽

Activity Levels ◽

Resonance Imaging ◽

Patient Reported ◽

Anterior Cruciate

Background: The association between activity level after anterior cruciate ligament (ACL) reconstruction (ACLR) and development of posttraumatic osteoarthritis (PTOA) remains unclear. This study investigated the relationship of patient-reported outcomes and progressive cartilage degenerative changes at 3 years after ACLR. Hypothesis: Higher activity levels, as measured by Marx scores, are significantly correlated with early cartilage degeneration after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 35 patients (16 women; mean age, 31.0 ± 7.6 years) with isolated ACLR and without pre-existing arthritis were prospectively enrolled. Patients reported Marx activity scores and Knee injury and Osteoarthritis Outcome Score (KOOS) scores and underwent T1ρ magnetic resonance imaging (MRI) preoperatively, 6 months, 1 year, 2 years, and 3 years after ACLR with soft tissue graft (22 autograft). The change in cartilage relaxation times between preoperative and 3-year imaging was used to identify cartilage degeneration, defined as an increase in T1ρ values by 14.3%. Correlation between Marx activity levels, KOOS scores, and T1ρ degeneration was performed with the Spearman rank test. The Fisher exact test was used to test for association between Marx activity score cutoffs and degeneration. The Student t test was used to compare Whole-Organ Magnetic Resonance Imaging Score (WORMS) and T1ρ relaxation times. Significance was defined as P < .05. Results: Sixteen patients (45.7%) showed evidence of cartilage degeneration at 3 years, most frequently in the medial compartment (n = 12; 34%). Higher Marx activity scores at 3 years correlated with cartilage degeneration in the medial femur (rho = 0.34; P = .045), and medial tibia (rho = 0.43; P = .01). A Marx score of 11 or greater at 3 years was significantly associated with medial compartment degeneration ( P = .03), with a positive predictive value of 52.6%. No Marx score cutoff at years 1 or 2 predicted future cartilage degeneration. The KOOS Quality of Life score was inversely correlated with cartilage degeneration (rho = 0.38; P = .02). WORMS did not correlate with degeneration of the medial compartment. Conclusion: Increased activity at 3 years after ACLR was significantly associated with increased risk of medial compartment PTOA. While further research is needed to fully define these relationships, patients may be counseled that return to Marx activity levels of greater than 11 may be associated with a higher risk of medial compartment cartilage degeneration.

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The Effect of High- and Low-Damping Prosthetic Foot Structures on Knee Loading in the Uninvolved Limb Across Different Walking Speeds

Journal of Applied Biomechanics ◽

10.1123/jab.2015-0143 ◽

2016 ◽

Vol 32 (3) ◽

pp. 233-240 ◽

Cited By ~ 6

Author(s):

Li Jin ◽

Peter G. Adamczyk ◽

Michelle Roland ◽

Michael E. Hahn

Keyword(s):

Knee Osteoarthritis ◽

Frontal Plane ◽

Limb Amputation ◽

Loading Rates ◽

Prosthetic Foot ◽

Fast Speed ◽

Peak Knee ◽

Knee Loading ◽

Young Subjects ◽

Walking Speeds

Lower limb amputation has been associated with secondary impairments such as knee osteoarthritis in the uninvolved limb. Greater knee loading in the frontal plane has been related to severity and rate of progression in knee osteoarthritis. Reduced push-off work from the involved limb can increase uninvolved limb knee loading. However, little is known about specific effects that prosthetic foot damping may have on uninvolved limb loading. We hypothesized that uninvolved limb peak knee internal abduction moment (IAM) and loading rates would be greater when using a high-damping foot compared with a low-damping foot, across walking speeds. Eight healthy, young subjects walked in a prosthesis simulator boot using the experimental feet. Greater uninvolved limb first peak IAM (+16% in fast speed, P = .002; +11% in slow speed, P = .001) and loading rates (+11% in fast speed, P = .003) were observed when using the high-damping foot compared with low-damping foot. Within each foot, uninvolved limb first peak IAM and loading rates had a trend to increase with increased walking speed. These findings suggest that damping properties of prosthetic feet are related to uninvolved limb peak knee IAM and loading rates.

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