scholarly journals Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Margit Biehl ◽  
Philipp Damm ◽  
Adam Trepczynski ◽  
Stefan Preiss ◽  
Gian Max Salzmann
Keyword(s):  
Gait Analysis ◽  
Measurement Data ◽  
Frontal Plane ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
In Vivo Measurement ◽  
Force Ratio ◽  
Leg Alignment ◽  
Alignment Angle

Abstract Purpose Despite practised for decades, the planning of osteotomy around the knee, commonly using the Mikulicz-Line, is only empirically based, clinical outcome inconsistent and the target angle still controversial. A better target than the angle of frontal-plane static leg alignment might be the external frontal-plane lever arm (EFL) of the knee adduction moment. Hypothetically assessable from frontal-plane-radiograph skeleton dimensions, it might depend on the leg-alignment angle, the hip-centre-to-hip-centre distance, the femur- and tibia-length. Methods The target EFL to achieve a medial compartment force ratio of 50% during level-walking was identified by relating in-vivo-measurement data of knee-internal loads from nine subjects with instrumented prostheses to the same subjects’ EFLs computed from frontal-plane skeleton dimensions. Adduction moments derived from these calculated EFLs were compared to the subjects’ adduction moments measured during gait analysis. Results Highly significant relationships (0.88 ≤ R2 ≤ 0.90) were found for both the peak adduction moment measured during gait analysis and the medial compartment force ratio measured in vivo to EFL calculated from frontal-plane skeleton dimensions. Both correlations exceed the respective correlations with the leg alignment angle, EFL even predicts the adduction moment’s first peak. The guideline EFL for planning osteotomy was identified to 0.349 times the epicondyle distance, hence deducing formulas for individualized target angles and Mikulicz-Line positions based on full-leg radiograph skeleton dimensions. Applied to realistic skeleton geometries, widespread results explain the inconsistency regarding correction recommendations, whereas results for average geometries exactly meet the most-consented “Fujisawa-Point”. Conclusion Osteotomy outcome might be improved by planning re-alignment based on the provided formulas exploiting full-leg-radiograph skeleton dimensions.

Changes in Tibiofemoral Kinematics and Kinetics During Stair Ascent After Partial Medial Meniscectomy

2008 ◽  
Author(s):  
Nathan A. Netravali ◽  
Thomas P. Andriacchi
Keyword(s):  
Cruciate Ligament ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Ligament Injury ◽  
Medial Meniscectomy ◽  
Surrogate Measure ◽  
Anterior Cruciate ◽  
Tibiofemoral Kinematics ◽  
Kinematics And Kinetics

Meniscectomy is a well-known risk factor for osteoarthritis (OA) in humans. It has been reported that total meniscectomy increases the risk of developing osteoarthritis radiographically by 14 times after 21 years [1] and that partial meniscectomy increases the risk of developing radiographic evidence of osteoarthritis within 16 years by a factor of four [2]. Two possible functional measures have been suggested as mechanisms for the development and progression of premature knee osteoarthritis: alterations in either kinematics or kinetics. Changes in kinematics, such as a shift in internal-external (IE) rotation after anterior cruciate ligament injury, have been suggested as a basis for an increased rate of cartilage thinning [3]. The other possible reason for the development of premature OA post-meniscectomy is a change in kinetics, the mechanical loading that occurs, particularly in the medial compartment [4]. The knee adduction moment has been associated with the rate of progression of osteoarthritis [5] and it has thus been suggested that the knee adduction moment is a good surrogate measure for in vivo load on the medial compartment osteoarthritis [6].

Muscle Forces May Explain Paradoxical Knee Loads During Different Gait Patterns

2010 ◽  
Author(s):  
Jonathan P. Walter ◽  
Darryl D. D’Lima ◽  
Benjamin J. Fregly
Keyword(s):  
Disease Progression ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Gait Patterns ◽  
Common Assumption ◽  
Clinical Disorder ◽  
Surrogate Measure ◽  
Gait Modification ◽  
External Knee Adduction Moment

Medial compartment knee osteoarthritis is a common clinical disorder [1] in which the articular cartilage in the medial compartment progressively deteriorates. To slow disease progression without surgical intervention, researchers have proposed gait modifications to offload the medial compartment. Since knee medial contact force (MCF) cannot be measured non-invasively in vivo, researchers have identified the external knee adduction moment (KAM) as a surrogate measure that is easy to calculate [2]. A common assumption has been that reducing the peak KAM will result in a corresponding reduction in peak MCF. While the magnitude of the peak KAM has been correlated with disease severity and rate of disease progression [3,4], it is not clear that reduction of this external load via gait modification will always result in a decrease in internal MCF.

Control of Knee Frontal Plane Moment via Modulation of Center of Pressure: A Prospective Gait Analysis Study

2008 ◽  
Author(s):  
Amir Haif ◽  
Alon Wolf
Keyword(s):  
Gait Analysis ◽  
Stance Phase ◽  
Center Of Pressure ◽  
Frontal Plane ◽  
Knee Adduction Moment ◽  
Healthy Men ◽  
Study Results ◽  
The Moment ◽  
The Relationship ◽  
Kinetics Of

Objectives: Footwear-generated biomechanical manipulations (e.g., wedge insoles) have been shown to reduce the magnitude of adduction moment about the knee. The theory behind wedged insoles is that a more laterally shifted location of the center of pressure causes a smaller distance of the moment arm of the knee joint adduction moment during gait. However, the relationship between the center of pressure and the knee adduction moment remains to be determined. The aim of this study was to assess the effect of the location of the center of pressure and the magnitude of the knee adduction moment during gait in healthy men. Methods: A novel foot-worn biomechanical device which allows controlled manipulation of the center of pressure location was utilized. Successive gait analysis testing was performed on 12 healthy men under four different conditions: control, neutral sagittal axis, center of pressure shifted medially and laterally from the functional sagittal axis. Results: The knee adduction moment during the stance phase significantly correlated with the shift of the center of pressure from the functional neutral sagittal axis in the frontal plane (i.e., from medial to lateral). The moment was reduced with the lateral sagittal axis configuration and augmented with the medial sagittal axis configuration. Conclusions: The study results confirm the hypothesis of a direct correlation between the coronal position of the biomechanical elements (location of the center of pressure) and the coronal kinetics of the knee.

Prediction of Internal Contact Forces at the Knee From External Measurements

2008 ◽  
Author(s):  
Jonathan P. Walter ◽  
Scott A. Banks ◽  
Darryl D. D’Lima ◽  
Benjamin J. Fregly
Keyword(s):  
Stance Phase ◽  
Cartilage Damage ◽  
Contact Forces ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Baby Boomer Generation ◽  
Risk Of Disease ◽  
Surrogate Measure ◽  
External Knee Adduction Moment

As the baby boomer generation ages, knee osteoarthritis (OA) will become increasingly prevalent in our society. Articular cartilage damage in the knee is highly dependent upon subject-specific kinematics and load distribution inside the joint. In particular, researchers have hypothesized that overloading of the medial compartment is a primary contributing factor to the development of the disease [1]. However, since medial compartment load cannot be measured non-invasively in vivo, researchers typically use the external knee adduction moment during stance phase as a surrogate measure. This quantity has been correlated with the medial tibial contact force measured from an instrumented knee implant [2] and with the risk of disease progression over time [3].

scholarly journals Remitted photon path lengths in human skin: in-vivo measurement data

2020 ◽  
Vol 11 (5) ◽  
pp. 2866 ◽  
Author(s):  
V. Lukinsone ◽  
A. Maslobojeva ◽  
U. Rubins ◽  
M. Kuzminskis ◽  
M. Osis ◽  
...  
Keyword(s):  
Human Skin ◽  
Measurement Data ◽  
In Vivo Measurement ◽  
Path Lengths ◽  
Photon Path

Predictions of Condylar Contact During Normal and Medial Thrust Gait

2012 ◽  
Author(s):  
Kurt Manal ◽  
Thomas S. Buchanan
Keyword(s):  
Knee Extensor ◽  
Frontal Plane ◽  
Musculoskeletal Model ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Force Sensing ◽  
Joint Loading ◽  
Knee Oa ◽  
Surrogate Measure ◽  
Direct Measures

The medial compartment of the knee is the joint most often affected in those with osteoarthritis (OA). The knee adduction moment is a widely used surrogate measure of joint loading as direct measures are not possible except for a few individuals fitted with a force sensing prosthesis. A reduction in the frontal plane moment is believed to be associated with reduced joint compression. As such, treatments and/or gait alterations to reduce the magnitude of the adduction moment have been sought for those with knee OA. Walking with a medial thrust gait has been shown to reduce the magnitude of the knee adduction moment. The purpose of this paper is to apply our EMG-driven musculoskeletal model of the knee to predict muscle forces and condylar loading during normal and medial thrust gait for an individual fitted with an instrumented knee. It was anticipated that walking with a medial thrust gait would produce a reduced knee adduction moment. We propose however that a reduced knee adduction moment may not necessarily be associated with a decrease in medial compartment loading, and importantly, one must consider how the knee extensor moment changes before making inferences about joint loading.

Reduction in the Medial Compartment Force Correlates With the Reduction in Knee Adduction Moment Using a Variable-Stiffness Shoe With an Instrumented Knee

2009 ◽  
Author(s):  
Jennifer C. Erhart ◽  
Chris Dyrby ◽  
Darryl D. D’Lima ◽  
Clifford W. Colwell ◽  
Thomas P. Andriacchi
Keyword(s):  
Treatment Outcome ◽  
Variable Stiffness ◽  
Lateral Compartment ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Joint Loading ◽  
Knee Oa ◽  
Total Knee ◽  
Joint Loads

Osteoarthritis (OA) of the knee affects an estimated 20–40% of individuals over the age of 65 [1], and is nearly 10 times more common in the medial compartment than the lateral compartment [2]. Many studies have reported the effectiveness of footwear modifications using laterally-wedged insoles [3,4] and more recently, variable-stiffness soles [5] in reducing the adduction moment at the knee in patients with medial compartment knee OA. The adduction moment is known to be associated with the progression [6] and treatment outcome [7] of medial compartment knee OA, and has been shown to be correlated with medial compartment joint loading [8]. However, the exact changes in medial compartment joint loading in vivo with the variable-stiffness shoe remain unknown. The development of an instrumented total knee implant which has the ability to directly measure tibial forces, and can differentiate between medial and lateral joint loads in vivo during walking [9], allows the testing of changes in the medial compartment loading with an intervention shoe.

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