scholarly journals Kinematic Comparison between Medially Congruent and Posterior-Stabilized Third-Generation TKA Designs

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.

scholarly journals Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training

2020 ◽  
pp. 036354652098007
Author(s):  
Elanna K. Arhos ◽  
Jacob J. Capin ◽  
Thomas S. Buchanan ◽  
Lynn Snyder-Mackler
Keyword(s):  
Knee Flexion ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Sport Training ◽  
Gait Biomechanics ◽  
Peak Knee

Background: After anterior cruciate ligament (ACL) reconstruction (ACLR), biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with preoperative gait asymmetries and postoperative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to preoperative and early rehabilitation time points before return-to-sport training. Purpose/Hypothesis: The purpose was to determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after ACLR. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics, including tibiofemoral joint loading during gait. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Of 79 athletes enrolled in the ACL-SPORTS Trial, 76 were participants in this study after completing postoperative rehabilitation and 10 return-to-sport training sessions (mean ± SD, 7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value / uninvolved limb value × 100). The biomechanical variables of interest included peak knee flexion angle, peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and midstance, quadriceps muscle force at peak knee flexion angle, and peak medial compartment contact force. Spearman rank correlation (ρ) coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable; alpha was set to .05. Results: Of the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n = 23) or >110% (n = 4) (range, 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle; 68% and 83% in knee excursion during weight acceptance and midstance, respectively; 74% in internal peak knee extension moment; 57% in medial compartment contact force; and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable after return-to-sport training ( P > .129). Conclusion: Among those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.

Investigating the Effect of Real-Time Center of Pressure (CoP) Feedback Training on the Swing Phase of Lower Limb Kinematics in Transfemoral Prostheses with SACH foot

2021 ◽  
Author(s):  
Ashutosh Tiwari ◽  
Abhijeet Kujur ◽  
Jyoti Kumar ◽  
Deepak Joshi
Keyword(s):  
Real Time ◽  
Lower Limb ◽  
Knee Flexion ◽  
Center Of Pressure ◽  
Feedback System ◽  
Swing Phase ◽  
Flexion Angle ◽  
Heel Strike ◽  
Knee Flexion Angle ◽  
Joint Angles

Abstract Transfemoral amputee often encounters reduced toe clearance resulting in trip-related falls. Swing phase joint angles have been shown to influence the toe clearance therefore, training intervention that targets shaping the swing phase joint angles can potentially enhance toe clearance. The focus of this study was to investigate the effect of the shift in the location of the center of pressure (CoP) during heel strike on modulation of the swing phase joint angles in able-bodied participants (n=6) and transfemoral amputees (n=3). We first developed a real-time CoP-based visual feedback system such that participants could shift the CoP during treadmill walking. Next, the kinematic data were collected during two different walking sessions- baseline (without feedback) and feedback (shifting the CoP anteriorly/posteriorly at heel strike to match the target CoP location). Primary swing phase joint angle adaptations were observed with feedback such that during the mid-swing phase, posterior CoP shift feedback significantly increases (p&lt;0.05) the average hip and knee flexion angle by 11.55 degrees and 11.86 degrees respectively in amputees, whereas a significant increase (p&lt;0.05) in ankle dorsiflexion, hip and knee flexion angle by 3.60 degrees, 3.22 degrees, and 1.27 degrees respectively compared to baseline was observed in able-bodied participants. Moreover, an opposite kinematic adaptation was seen during anterior CoP shift feedback. Overall, results confirm a direct correlation between the CoP shift and the modulation in the swing phase lower limb joint angles.

Knee Flexion Angle at Initial Contact During Jump Landing in Individuals With and Without Chronic Ankle Instability: A Critically-Appraised Topic

2019 ◽  
Vol 24 (4) ◽  
pp. 151-155
Author(s):  
Jacob T. Hartzell ◽  
Kyle B. Kosik ◽  
Matthew C. Hoch ◽  
Phillip A. Gribble
Keyword(s):  
Knee Flexion ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Knee Kinematics ◽  
Chronic Ankle Instability ◽  
Flexion Angle ◽  
Initial Contact ◽  
Knee Flexion Angle ◽  
Bottom Line ◽  
Jump Landing

Clinical Scenario: Chronic ankle instability (CAI) is characterized by the residual symptoms and feelings of instability that persist after an acute ankle sprain. Current literature has identified several neuromuscular impairments associated with CAI that may negatively impact sagittal plane knee kinematics during dynamic activities. This has led researchers to begin examining sagittal plane knee kinematics during jump landing tasks. Understanding changes in movement patterns at the knee may assist clinicians in designing rehabilitation plans that target both the ankle and more proximal joints, such as the knee. Clinical Question: What is the evidence to support the notion that patients with CAI have decreased sagittal plane knee flexion angle at initial contact during a jump-landing task compared to healthy individuals? Summary of Key Findings: The literature was systematically searched for level 4 evidence or higher. The search yielded two case-control studies which met the inclusion criteria. Based on limited evidence, there are mixed results for whether sagittal plane knee kinematic at initial contact differ between those with and without CAI. Clinical Bottom Line: There is weak evidence to support changes in sagittal plane knee kinematics at initial contact during a jump landing in individuals with CAI compared to healthy controls. Strength of Recommendation: In accordance with the Centre for Evidence-Based Medicine, a grade of C for level 4 evidence is recommended due to variable findings.

Patellofemoral Joint Stress during Running with Added Load in Females

2020 ◽  
Vol 41 (06) ◽  
pp. 412-418
Author(s):  
Molly Kujawa ◽  
Aleyna Goerlitz ◽  
Drew Rutherford ◽  
Thomas W. Kernozek
Keyword(s):  
Knee Flexion ◽  
Patellofemoral Joint ◽  
Reaction Force ◽  
Step Length ◽  
Force Platform ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Peak Knee ◽  
Foot Strike ◽  
Quadriceps Force

AbstractPatellofemoral joint (PFJ) pain syndrome is a commonly reported form of pain in female runners and military personnel. Increased PFJ stress may be a contributing factor. Few studies have examined PFJ stress running with added load. Our purpose was to analyze PFJ stress, PFJ reaction force, quadriceps force, knee flexion angle, and other kinematic and temporospatial variables running with and without a 9 kg load. Nineteen females ran across a force platform with no added load and 9.0 kg weight vest. Kinematic data were collected using 3D motion capture and kinetic data with a force platform. Muscle forces were estimated using a musculoskeletal model, and peak PFJ loading variables were calculated during stance. Multivariate analyses were run on PFJ loading variables and on cadence, step length and foot strike index. Differences were shown in PFJ stress, PFJ reaction force, peak knee flexion angle and quadriceps force. Joint specific kinetic variables increased between 5–16% with added load. PFJ loading variables increased with 9 kg of added load without changes in cadence, step length, or foot strike index compared to no load. Added load appears to increase the PFJ loading variables associated with PFJ pain in running.

scholarly journals Progressive Changes in Walking Kinematics and Kinetics After Anterior Cruciate Ligament Injury and Reconstruction: A Review and Meta-Analysis

2017 ◽  
Vol 52 (9) ◽  
pp. 847-860 ◽  
Author(s):  
Lindsay V. Slater ◽  
Joseph M. Hart ◽  
Adam R. Kelly ◽  
Christopher M. Kuenze
Keyword(s):  
Lower Extremity ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Flexion Angle ◽  
Knee Adduction Moment ◽  
Control Group ◽  
Knee Flexion Angle ◽  
Peak Knee ◽  
Healthy Control

Context:  Anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) result in persistent alterations in lower extremity movement patterns. The progression of lower extremity biomechanics from the time of injury has not been described. Objective:  To compare the 3-dimensional (3D) lower extremity kinematics and kinetics of walking among individuals with ACL deficiency (ACLD), individuals with ACLR, and healthy control participants from 3 to 64 months after ACLR. Data Sources:  We searched PubMed and Web of Science from 1970 through 2013. Study Selection and Data Extraction:  We selected only articles that provided peak kinematic and kinetic values during walking in individuals with ACLD or ACLR and comparison with a healthy control group or the contralateral uninjured limb. Data Synthesis:  A total of 27 of 511 identified studies were included. Weighted means, pooled standard deviations, and 95% confidence intervals were calculated for the healthy control, ACLD, and ACLR groups at each reported time since surgery. The magnitude of between-groups (ACLR versus ACLD, control, or contralateral limb) differences at each time point was evaluated using Cohen d effect sizes and associated 95% confidence intervals. Peak knee-flexion angle (Cohen d = −0.41) and external knee-extensor moment (Cohen d = −0.68) were smaller in the ACLD than in the healthy control group. Peak knee-flexion angle (Cohen d range = −0.78 to −1.23) and external knee-extensor moment (Cohen d range = −1.39 to −2.16) were smaller in the ACLR group from 10 to 40 months after ACLR. Reductions in external knee-adduction moment (Cohen d range = −0.50 to −1.23) were present from 9 to 42 months after ACLR. Conclusions:  Reductions in peak knee-flexion angle, external knee-flexion moment, and external knee-adduction moment were present in the ACLD and ACLR groups. This movement profile during the loading phase of gait has been linked to knee-cartilage degeneration and may contribute to the development of osteoarthritis after ACLR.

Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652098260
Author(s):  
Ashley A. Williams ◽  
Jennifer C. Erhart-Hledik ◽  
Jessica L. Asay ◽  
Gordhan B. Mahtani ◽  
Matthew R. Titchenal ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Flexion Angle ◽  
Heel Strike ◽  
Knee Flexion Angle ◽  
Patient Reported ◽  
Flexion Moment ◽  
Anterior Cruciate

Background: Patellofemoral joint degeneration and dysfunction after anterior cruciate ligament reconstruction (ACLR) are increasingly recognized as contributors to poor clinical outcomes. Purpose: To determine if greater deep cartilage matrix disruption at 2 years after ACLR, as assessed by elevated patellofemoral magnetic resonance imaging (MRI) ultrashort echo time–enhanced T2* (UTE-T2*), is correlated with (1) worse patient-reported knee function and pain and (2) gait metrics related to patellofemoral tracking and loading, such as greater external rotation of the tibia at heel strike, reduced knee flexion moment (as a surrogate of quadriceps function), and greater knee flexion angle at heel strike. Study Design: Cross-sectional study; Level of evidence, 3. Methods: MRI UTE-T2* relaxation times in patellar and trochlear deep cartilage were compared with patient-reported outcomes and ambulatory gait metrics in 60 patients with ACLR at 2 years after reconstruction. ACLR gait metrics were compared with those of 60 uninjured reference patients matched by age, body mass index, and sex. ACLR UTE-T2* values were compared with those of 20 uninjured reference patients. Results: Higher trochlear UTE-T2* values were associated with worse Knee injury and Osteoarthritis Outcome Scores (KOOS) Sport/Recreation subscale scores (rho = −0.32; P = .015), and showed a trend for association with worse KOOS Pain subscale scores (rho = −0.26; P = .045). At 2 years after ACLR, greater external rotation of the tibia at heel strike was associated with higher patellar UTE-T2* values ( R = 0.40; P = .002); greater knee flexion angle at heel strike was associated with higher trochlear UTE-T2* values (rho = 0.39; P = .002); and greater knee flexion moment showed a trend for association with higher trochlear UTE-T2* values (rho = 0.30; P = .019). Patellar cartilage UTE-T2* values, knee flexion angle at heel strike, and external rotation of the tibia at heel strike were all elevated in ACLR knees as compared with reference knees ( P = .029, .001, and .044, respectively). Conclusion: Patellofemoral deep cartilage matrix disruption, as assessed by MRI UTE-T2*, was associated with reduced sports and recreational function and with gait metrics reflective of altered patellofemoral loading. As such, the findings provide new mechanistic information important to improving clinical outcomes related to patellofemoral dysfunction after ACLR.

Patellofemoral Imbalance in a Balanced Total Knee Arthroplasty: How Does it Occur?

2018 ◽  
Vol 32 (02) ◽  
pp. 192-195
Author(s):  
Nathan Lenz ◽  
Scott Laster ◽  
Neil Sheth ◽  
Ran Schwarzkopf ◽  
Perry Evangelista
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Primary Total Knee Arthroplasty ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Implant Position ◽  
Flexion Extension ◽  
Implant Size ◽  
Total Knee

AbstractDespite the overall successful outcomes following primary total knee arthroplasty (TKA) and the concept that a well-balanced TKA yields a more successful result, concerns still remain in the reported literature regarding the patellofemoral joint. Diminished outcomes have been associated with poorly balanced or placed patella implants. The effect of different techniques to achieve flexion–extension balance and the use of posterior stabilized (PS) versus cruciate retaining (CR) implant designs on patellofemoral balancing has not been previously studied. The purpose of this study is to utilize a validated computational analysis software to simulate the effects of varying implant positions and sizes of femoral components. The patellofemoral retinaculum (PFR) load was significantly affected by some conditions, while others did not reach significance. The proximal-distal implant position with knee flexion angle (p < 0.001), the implant size (p < 0.001), and the implant bearing type (CR/PS) (p < 0.05) were significant. For the proximal-distal implant position and knee flexion angle, a more proximal implant position (elevating the joint line) increased the PFR load from 15 to 30°, and a more proximal implant position reduced retinaculum load from 60 to 135°. However, at 45°, implant position does not affect retinaculum load. Achieving the appropriate balance between the dynamic nature of both the tibiofemoral and the patellofemoral interaction in TKA has proven to be complex and challenging to manage. Balancing of a TKA is essential to the proper functioning and overall longevity of the implant. These results demonstrate that patellofemoral balance is affected by implant size and position during flexion–extension gap balancing.

Functional stretching decreases knee joint loading in male athletes with gastroc--soleus tightness

2021 ◽  
Keyword(s):  
Knee Joint ◽  
Knee Flexion ◽  
Functional Group ◽  
Daily Activities ◽  
Flexion Angle ◽  
Heel Strike ◽  
Knee Flexion Angle ◽  
Joint Loading ◽  
Male Athletes ◽  
Knee Joint Loading

Background and objective: Tightness of the gastroc--soleus muscle complex is one of the limiting factors of the ankle joint's range of motion (ROM) during daily activities. The aim of this study was to investigate the effectiveness of functional and extra-functional stretching of the gastrocnemius--soleus complex on knee joint loading in athletes with limited ankle dorsiflexion. Material and methods: In this cross-sectional study, 30 male athletes with gastrocnemius--soleus shortness were recruited and randomly divided into three equal-size groups of functional stretching, extra-functional stretching, and a control group. The extra-functional stretching group performed stretching exercises three times per day for eight weeks. The functional stretching group was instructed to change their gait pattern via increased heel strike during daily activities. Results: None of the stretching programs reduced the knee flexion angle in heel contact (p > 0.05). The knee flexion angle was significantly increased in the stance phase in the functional group (p ≤ 0.05). Walking speed was increased significantly in the extra-functional group (p ≤ 0.05). The knee adductor moment and external rotation moment decreased significantly in the functional group (p ≤ 0.05). Conclusion: An eight-week functional stretching program in this study led to a reduction of knee loading in the frontal and horizontal planes in comparison to the extra-functional stretching group, demonstrating the effectiveness of functional stretching in improving knee joint biomechanics during walking.

scholarly journals Quadriceps Neuromuscular Function and Jump-Landing Sagittal-Plane Knee Biomechanics After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 53 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Sarah H. Ward ◽  
J. Troy Blackburn ◽  
Darin A. Padua ◽  
Laura E. Stanley ◽  
Matthew S. Harkey ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Sagittal Plane ◽  
Neuromuscular Function ◽  
Knee Extension ◽  
Spinal Reflex ◽  
Flexion Angle ◽  
Voluntary Activation ◽  
Knee Flexion Angle ◽  
Jump Landing ◽  
Peak Knee

Context:  Aberrant biomechanics may affect force attenuation at the knee during dynamic activities, potentially increasing the risk of sustaining a knee injury or hastening the development of osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Impaired quadriceps neuromuscular function has been hypothesized to influence the development of aberrant biomechanics. Objective:  To determine the association between quadriceps neuromuscular function (strength, voluntary activation, and spinal-reflex and corticomotor excitability) and sagittal-plane knee biomechanics during jump landings in individuals with ACLR. Design:  Cross-sectional study. Setting:  Research laboratory. Patients or Other Participants:  Twenty-eight individuals with unilateral ACLR (7 men, 21 women; age = 22.4 ± 3.7 years, height = 1.69 ± 0.10 m, mass = 69.4 ± 10.1 kg, time postsurgery = 52 ± 42 months). Main Outcome Measure(s):  We quantified quadriceps spinal-reflex excitability via the Hoffmann reflex normalized to maximal muscle response (H : M ratio), corticomotor excitability via active motor threshold, strength as knee-extension maximal voluntary isometric contraction (MVIC), and voluntary activation using the central activation ratio (CAR). In a separate session, sagittal-plane kinetics (peak vertical ground reaction force [vGRF] and peak internal knee-extension moment) and kinematics (knee-flexion angle at initial contact, peak knee-flexion angle, and knee-flexion excursion) were collected during the loading phase of a jump-landing task. Separate bivariate associations were performed between the neuromuscular and biomechanical variables. Results:  In the ACLR limb, greater MVIC was associated with greater peak knee-flexion angle (r = 0.38, P = .045) and less peak vGRF (r = −0.41, P = .03). Greater CAR was associated with greater peak internal knee-extension moment (ρ = −0.38, P = .045), and greater H : M ratios were associated with greater peak vGRF (r = 0.45, P = .02). Conclusions:  Greater quadriceps MVIC and CAR may provide better energy attenuation during a jump-landing task. Individuals with greater peak vGRF in the ACLR limb possibly require greater spinal-reflex excitability to attenuate greater loading during dynamic movements.

Sign in / Sign up

Export Citation Format

Share Document