scholarly journals Is cocontraction a potential cause of tibial internal rotation restriction in patients with knee endoprostheses?

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0024
Author(s):  
Christine Suzanne Haberer ◽  
Stefan Weiss ◽  
Igor Komnik ◽  
Sina David
Keyword(s):  
Knee Joint ◽  
Internal Rotation ◽  
Stance Phase ◽  
Knee Prosthesis ◽  
Womac Score ◽  
Subjective Assessment ◽  
Tibial Rotation ◽  
Rotational Movement ◽  
Before And After ◽  
Climbing Stairs

Aims and Objectives: The ischiocrural muscles play an important role in the rotation of the tibia. The main objective of the study was to examine the extent to which an increased cocontraction of the SEMITEN and BIZFEM in patients with bicondylar (TKA) and unicondylar prostheses (UKA) under the influence of everyday forms of stress restricts the tibial rotation. Materials and Methods: 3-D-motion analysis in patients after TKA or UKA was performed to record joint kinematics before and after knee prosthesis. Inclusion criteria: Age 50-70 years, no other prostheses, BMI <31, no relevant diseases, surgery - period 04/2015 to 04/2016. Out of a total of 550 patients finally 22 patients (w:11/m:11) could be included: TKA (n = 11), UKA (n = 9). To imitate various movement patterns of ADL, a parcour was built with a ramp and a staircase with 3 steps. Kinematic data were recorded with 10 infrared 100 Hz cameras. Muscular activities were measured bilaterally with a wireless EMG system (1000 Hz, myon320, muon, CH). Walking speed was collected through a time-gate system (WEKO, Weitmann & Konrad GmbH & Co. KG, DE). Static analysis was performed by statistical nonparametric assignment (SnPM). The WOMAC score was used for subjective assessment of dysfunctions. Results: In normal walking, there was no difference in tibial rotation compared to the non-operated knee in either the TKA or the UKA group. In SnPM analysis, statistically significantly reduced tibial rotation was shown on the downturn of a ramp in the TKA group at the operated knee. The UKA group showed no significant differences on the ramp to the non-operated knee. Concerning co-contraction of the SEMITEN and BIZFEM in the EMG analysis in the operated knee joint, no deviation from the non-operated knee could be shown. When climbing stairs, the SnPM internal rotation analysis revealed significant differences between the TKA and the UKA group (stance phase). Similar to the group comparement a restricted axial rotational movement compared to an operated to non - operated knee joint in the TKA - group could be show.n Especially during the stairway, the knee internal rotation of the prosthesis was impaired compared to the non-operated knee. On the other hand, when climbing stairs, the internal rotation was mostly significantly reduced during the stance phase. The SnPM analysis showed statistically significant asymmetries in the UKA group during stairway walking. The disturbed internal rotational movement showed the UKA group in the operated knee joint compared to the un-operated knee joint to the same extent as the TKA group only during the run down from the ramp. Conclusion: The assumption that cocontractions between the SEMITEN and the BIZFEM contributes to the impairment of internal rotation can not be confirmed from the data available to us. Other influences must be the cause.

scholarly journals Multifunctional above-knee prosthesis for stairs' walking

1987 ◽  
Vol 11 (3) ◽  
pp. 139-145 ◽  
Author(s):  
K. Koganezawa ◽  
H. Fujimoto ◽  
I. Kato
Keyword(s):  
Knee Joint ◽  
Ankle Joint ◽  
Stance Phase ◽  
Knee Prosthesis ◽  
Power Sources ◽  
Stair Ascent ◽  
Level Walking ◽  
External Power ◽  
Leg Prosthesis ◽  
Full Body

The multifunctional above-knee prosthesis WLP-7R (Waseda Leg Prosthesis - type 7 Refined) described in this study allows amputees to descend and ascend stairs with no external power sources. With the hydraulic circuit mounted in the shank, the ankle joint and the knee joint mutually conterbalance during stance phase in stair walking as well as level walking so that the following performances are obtained. The yielding (flexing) of the knee joint is prevented and smooth advance from stance-phase to swing-phase is realized in level walking. The gradual yielding of the knee joint and the ankle joint while sustaining full body weight is realized in stair descent. Reciprocal stepping with sound and disabled legs during stair ascent is also realised although the powerful extension of the knee joint during stance phase is not possible. The performance of the WLP-7R was examined by a walking experiment in which amputees could descend and ascend the stairs as well as walk on a flat surface after approximately one hour's training.

Association of Navicular Drop and Selected Lower-Limb Biomechanical Measures During the Stance Phase of Running

2014 ◽  
Vol 30 (2) ◽  
pp. 250-254 ◽  
Author(s):  
Mansour Eslami ◽  
Mohsen Damavandi ◽  
Reed Ferber
Keyword(s):  
Internal Rotation ◽  
Stance Phase ◽  
Force Plate ◽  
Knee Adduction Moment ◽  
Tibial Rotation ◽  
Tibial Internal Rotation ◽  
Ankle Inversion ◽  
Navicular Drop ◽  
Peak Knee ◽  
Rearfoot Eversion

There is evidence to suggest that navicular drop measures are associated with specific lower-extremity gait biomechanical parameters. The aim of this study was to examine the relationship between navicular drop and a) rearfoot eversion excursion, b) tibial internal rotation excursion, c) peak ankle inversion moment, and d) peak knee adduction moment during the stance phase of running. Sixteen able-bodied men having an average age of 28.1 (SD = 5.30) years, weight of 81.5 (SD = 10.40) kg, height of 179.1 (SD = 5.42) cm volunteered and ran barefoot at 170 steps/minute over a force plate. Navicular drop measures were negatively correlated with tibial internal rotation excursion (r= −0.53,P= .01) but not with rearfoot eversion excursion (r= −0.19;P= .23). Significant positive correlations were found between navicular drop and peak knee adduction moment (r= .62,P< .01) and peak ankle inversion moment (r= .60,P< .01). These findings suggest that a low navicular drop measure could be associated with increasing tibial rotation excursion while high navicular drop measure could be associated with increased peak ankle and knee joint moments. These findings indicate that measures of navicular drop explained between 28% and 38% of the variability for measures of tibial internal rotation excursion, peak knee adduction moment and peak ankle inversion moments.

The influence of osteopathic correction on the viscoelastic characteristics of the lower leg muscles

2019 ◽  
pp. 93-98
Author(s):  
E. M. Timanin ◽  
N. S. Sydneva ◽  
A. A. Zakharova
Keyword(s):  
Viscoelastic Properties ◽  
Gastrocnemius Muscle ◽  
Soft Tissues ◽  
Subjective Assessment ◽  
Lymphatic Drainage ◽  
Intercellular Substance ◽  
Leg Muscles ◽  
Before And After ◽  
Viscoelastic Characteristics ◽  
Instrumental Methods

Introduction. To date there is a lack of studies dedicated to the objectification of the palpation data obtained by a specialist during the osteopathic examination. The issue of the evidence of the results of osteopathic correction still remains important. Search for instrumental methods allowing to register and to measure various palpation phenomena and manifestations of somatic dysfunctions is very relevant for the development of osteopathy as a science. It is also very important to find objective characteristics of these methods.Goal of research — to study viscoelastic characteristics of the soft tissues of the lower legs by palpation and instrumental methods before and after osteopathic correction.Materials and methods. 22 volunteers (12 women and 10 men) aged 18–23 years without complaints of the musculoskeletal system were examined. Osteopathic diagnostics and measurement of the viscoelastic properties of muscles were carried out by the method of vibration viscoelastometry before and after osteopathic correction.Results. Correlation analysis by Spearman showed that the subjective assessment of an osteopath positively correlated with both elasticity (r=0,43, p<0,05) and viscosity of soft issues (r=0,29, p<0,05). For the gastrocnemius muscle, this pattern was even more pronounced — for elasticity r=0,51, p<0,05, for viscosity =0,34, p<0,05. After osteopathic correction no changes in the elasticity of the soft tissues were observed. The viscosity of the tissues reduced, but in the projection of the gastrocnemius muscle, these changes were not statistically significant (p=0,12), whereas in the projection of the soleus muscle statistically significant changes (p=0,034) were observed.Conclusion. Changes in the viscoelastic properties of tissues demonstrated that the effects of osteopathic correction with the use of myofascial mobilization techniques, articulation mobilization techniques, and lymphatic drainage techniques were not obvious. The elasticity of soft tissues of the lower legs did not change, while the viscosity decreased, especially in the projection of the soleus muscles. This effect of the osteopathic correction can be associated with the effect of thixotropy — the transformation of gel-like intercellular substance into sol. Thus, the research showed that vibration viscoelastometry can be used for the objectifi cation of the condition of soft tissues and of the effects of osteopathic correction.

Novel active magnetorheological knee prosthesis presents low energy consumption during ground walking

2021 ◽  
pp. 1045389X2098392
Author(s):  
Rafhael Milanezi de Andrade ◽  
Jordana Simões Ribeiro Martins ◽  
Marcos Pinotti ◽  
Antônio Bento Filho ◽  
Claysson Bruno Santos Vimieiro
Keyword(s):  
Energy Consumption ◽  
Stance Phase ◽  
Gait Cycle ◽  
Dynamic Models ◽  
Knee Prosthesis ◽  
Regenerative Braking ◽  
Harmonic Drive ◽  
Low Energy Consumption ◽  
Energetic Expenditure ◽  
Over Ground Walking

This study analyses the energy consumption of an active magnetorheological knee (AMRK) actuator that was designed for transfemoral prostheses. The system was developed as an operational motor unit (MU), which consists of an EC motor, a harmonic drive and a magnetorheological (MR) clutch, that operates in parallel with an MR brake. The dynamic models of the MR brake and MU were used to simulate the system’s energetic expenditure during over-ground walking under three different working conditions: using the complete AMRK; using just its motor-reducer, to operate as a common active knee prosthesis (CAKP), and using just the MR brake, to operate as a common semi-active knee prosthesis (CSAKP). The results are used to compare the MR devices power consumptions with that of the motor-reducer. As previously hypothesized, to use the MR brake in the swing phase is more energetically efficient than using the motor-reducer to drive the joint. Even if using the motor-reducer in regenerative braking mode during the stance phase, the differences in power consumption among the systems are remarkable. The AMRK expended 16.3 J during a gait cycle, which was 1.6 times less than the energy expenditure of the CAKP (26.6 J), whereas the CSAKP required just 6.0 J.

Adjusting Insert Thickness and Tibial Slope Do Not Correct Internal Tibial Rotation Loss Caused by PCL Resection: In Vitro Study of a Medial Constraint TKA Implanted with Unrestricted Calipered Kinematic Alignment

2021 ◽  
Author(s):  
Alexander J. Nedopil ◽  
Peter J. Thadani ◽  
Thomas H. McCoy ◽  
Stephen M. Howell ◽  
Maury L. Hull
Keyword(s):  
Internal Rotation ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Kinematic Alignment ◽  
Tibial Rotation ◽  
Medial Condyle ◽  
Maximum Extension ◽  
Posterior Tibial ◽  
Internal Tibial Rotation ◽  
Lift Off

AbstractMost medial stabilized (MS) total knee arthroplasty (TKA) implants recommend excision of the posterior cruciate ligament (PCL), which eliminates the ligament's tension effect on the tibia that drives tibial rotation and compromises passive internal tibial rotation in flexion. Whether increasing the insert thickness and reducing the posterior tibial slope corrects the loss of rotation without extension loss and undesirable anterior lift-off of the insert is unknown. In 10 fresh-frozen cadaveric knees, an MS design with a medial ball-in-socket (i.e., spherical joint) and lateral flat insert was implanted with unrestricted calipered kinematic alignment (KA) and PCL retention. Trial inserts with goniometric markings measured the internal–external orientation relative to the femoral component's medial condyle at maximum extension and 90 degrees of flexion. After PCL excision, these measurements were repeated with the same insert, a 1 mm thicker insert, and a 2- and 4-mm shim under the posterior tibial baseplate to reduce the tibial slope. Internal tibial rotation from maximum extension and 90 degrees of flexion was 15 degrees with PCL retention and 7 degrees with PCL excision (p < 0.000). With a 1 mm thicker insert, internal rotation was 8 degrees (p < 0.000), and four TKAs lost extension. With a 2 mm shim, internal rotation was 9 degrees (p = 0.001) and two TKAs lost extension. With a 4 mm shim, internal rotation was 10 degrees (p = 0.002) and five TKAs lost extension and three had anterior lift-off. The methods of inserting a 1 mm thicker insert and reducing the posterior slope did not correct the loss of internal tibial rotation after PCL excision and caused extension loss and anterior lift-off in several knees. PCL retention should be considered when using unrestricted calipered KA and implanting a medial ball-in-socket and lateral flat insert TKA design, so the progression of internal tibial rotation and coupled reduction in Q-angle throughout flexion matches the native knee, optimizing the retinacular ligaments' tension and patellofemoral tracking.

Measurements of Trunk Sway for Stance and Gait Tasks 2 Years after Vestibular Neurectomy

2018 ◽  
Vol 23 (5) ◽  
pp. 298-308 ◽  
Author(s):  
Dominique Vibert ◽  
John H.J. Allum ◽  
Martin Kompis ◽  
Simona Wiedmer ◽  
Christof Stieger ◽  
...  
Keyword(s):  
Balance Control ◽  
Recovery Period ◽  
Subjective Assessment ◽  
Vestibular Neurectomy ◽  
Eyes Closed ◽  
Before And After ◽  
Task Durations ◽  
Trunk Sway ◽  
Central Compensation ◽  
Balance Problems

The aim of this study was to investigate changes in balance control for stance and gait tasks in patients 2 years before and after vestibular neurectomy (VN) performed to alleviate intractable Meniere’s disease. Amplitudes of trunk sway in roll and pitch directions were measured for stance and gait tasks in 19 patients using gyroscopes mounted at the lower-back. Measurements before VN and 2 years later were compared to those of healthy age-matched controls (HC). We also examined if changes in trunk sway amplitudes were correlated with patients’ subjective assessment of disability using the AAO-HNS scale. For patients with low AAO-HNS scores 0–2 (n = 14), trunk roll and pitch sway velocities, standing eyes closed on foam, increased 2 years post VN compared to HC values (p < 0.01). Trunk sway amplitudes remained at levels of HC for simple gait tasks, but task durations were longer and therefore gait slower. For complex gait tasks (stairs), balance control remained impaired at 2 years. In patients with AAO-HNS high scores level 6 (n = 5), balance control remained abnormal, compared to HC, 2 years postoperatively for all stance, several simple and all complex gait tasks. Trunk sway in the pitch and roll directions for stance tasks was correlated with clinical (AAO-HNS) scores (p ≤ 0.05). These results indicate that VN leads to chronic balance problems for stance and complex gait tasks. The problems are greater for patients with high compared to low AAO-HNS scores, thereby explaining the different symptoms reported by these patients. The lack of balance recovery in VN patients to levels of HCs after 2 years contrasts with the 3 months average recovery period for acute vestibular neuritis patients and is indicative of the effects of neurectomy on central compensation processes.

The Effects of Tibiofemoral Angle and Body Weight on the Stress Field in the Knee Joint

2007 ◽  
Author(s):  
Nicholas H. Yang ◽  
H. Nayeb-Hashemi ◽  
Paul K. Canavan
Keyword(s):  
Articular Cartilage ◽  
Knee Joint ◽  
Motion Analysis ◽  
Stance Phase ◽  
Gait Cycle ◽  
Mechanical Axis ◽  
Frontal Plane ◽  
Tibiofemoral Angle ◽  
Single Leg Stance ◽  
Von Mises

Osteoarthritis (OA) is a degenerative disease of articular cartilage that may lead to pain, limited mobility and joint deformation. It has been reported that abnormal stresses and irregular stress distribution may lead to the initiation and progression of OA. Body weight and the frontal plane tibiofemoral angle are two biomechanical factors which could lead to abnormal stresses and irregular stress distribution at the knee. The tibiofemoral angle is defined as the angle made by the intersection of the mechanical axis of the tibia with the mechanical axis of the femur in the frontal plane. In this study, reflective markers were placed on the subjects’ lower extremity bony landmarks and tracked using motion analysis. Motion analysis data and force platform data were collected together during single-leg stance, double-leg stance and walking gait from three healthy subjects with no history of osteoarthritis (OA), one with normal tibiofemoral angle (7.67°), one with varus (bow-legged) angle (0.20°) and one with valgus (knocked-knee) angle (10.34°). The resultant moment and forces in the knee were derived from the data of the motion analysis and force platform experiments using inverse dynamics. The results showed that Subject 1 (0.20° valgus) had a varus moment of 0.38 N-m/kg, during single-leg stance, a varus moment of 0.036 N-m/kg during static double-leg stance and a maximum varus moment of 0.49 N-m/kg during the stance phase of the gait cycle. Subject 2 (7.67° valgus tibiofemoral angle) had a varus moment of 0.31 N-m/kg, during single-leg stance, a valgus moment of 0.046 N-m/kg during static double-leg stance and a maximum varus moment of 0.37 N-m/kg during the stance phase of the gait cycle. Subject 3 (10.34° valgus tibiofemoral angle) had a varus moment of 0.30 N-m/kg, during single-leg stance, a valgus moment of 0.040 N-m/kg during static double-leg stance and a maximum varus moment of 0.34 N-m/kg during the stance phase of the gait cycle. In general, the results show that the varus moment at the knee joint increased with varus knee alignment in static single-leg stance and gait. The results of the motion analysis were used to obtain the knee joint contact stress by finite element analysis (FEA). Three-dimensional (3-D) knee models were constructed with sagittal view MRI of the knee. The knee model included the bony geometry of the knee, the femoral and tibial articular cartilage, the lateral and medial menisci and the cruciate and the collateral ligaments. In initial FEA simulations, bones were modeled as rigid, articular cartilage was modeled as isotropic elastic, menisci were modeled as transversely isotopic elastic, and the ligaments were modeled as 1-D nonlinear springs. The material properties of the different knee components were taken from previously published literature of validated FEA models. The results showed that applying the axial load and varus moment determined from the motion analysis to the FEA model Subject 1 had a Von Mises stress of 1.71 MPa at the tibial cartilage while Subjects 2 and 3 both had Von Mises stresses of approximately 1.191 MPa. The results show that individuals with varus alignment at the knee will be exposed to greater stress at the medial compartment of the articular cartilage of the tibia due to the increased varus moment that occurs during single leg support.

scholarly journals Pengaruh Range of Motion (ROM) Aktif Terhadap Fleksibilitas Sendi Lutut Pada Lanjut Usia

2020 ◽  
Vol 1 (1) ◽  
pp. 13-16
Author(s):  
Tavip Indrayana ◽  
Warijan Warijan ◽  
Joni Siswanto
Keyword(s):  
Connective Tissue ◽  
Knee Joint ◽  
Muscle Fibers ◽  
Sampling Technique ◽  
The Elderly ◽  
Before And After ◽  
Post Test ◽  
Quasi Experimental ◽  
The Right ◽  
Average Angle

ABSTRACTBackground : Joint flexibility decreases in old age due to a degenerative process resulting in changes in joints, connective tissue and cartilage in the elderly. Decreasing flexibility is also due to reduced elasticity of muscle fibers, where connective tissue in muscle fibers increases (Mariyam, 2008).Objective : The aim of this study was to analyze the effect of active exercise (ROM) on the lower extremities on increasing the flexibility of the knee joint in the elderlyMethods : This study using a quasi-experimental approach with One group pre-test and post-test design. The sampling technique uses the Slovin method of 42 people, obtained a sample of 25 elderly. Exercise is done twice a day for 8 days. Measurements were made on day 1, day 4 and day 8 of the study using a Goniometer measuring instrument..Result : The results of measurement I average of the right knee joint 117.52o, measurement II = 122.24, measurement III = 126, 36o. From the analysis with Paired simple t-Test between the measurements I and II, it was found that the different test measurements I and II t count value was equal to -1.908 with 0.068. Because sig 0.05, it can be concluded that Ho is accepted, meaning that the average angle of ROM before and after training is the same (not different). In the different test measurements II and III the value of t count is equal to -2.152 with sig 0.042.Conclusion : Because sig 0.05, it can be concluded that Ho is rejected, meaning that there is a difference in ROM angle after training between days 4 to 8 with the first day to day 4. Thus it can be stated that active ROM exercises affect the angle of ROM of the knee joint elderly after exercise ROM between day 4 to day 8. Keywords: active ROM exercise, flexibility of knee joint, elderly.

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