Medial and Lateral Tibiofemoral Compressive Forces in Patients Following Unilateral Total Knee Arthroplasty During Stationary Cycling.

Patients following unilateral total knee arthroplasty (TKA) display interlimb differences in knee joint kinetics during gait and more recently, stationary cycling. The purpose of this study was to use musculoskeletal modeling to estimate total, medial, and lateral tibiofemoral compressive forces for patients following TKA during stationary cycling. Fifteen patients of unilateral TKA, from the same surgeon, participated in cycling at 2 workrates (80 and 100 W). A knee model (OpenSim 3.2) was used to estimate total, medial, and lateral tibiofemoral compressive forces for replaced and nonreplaced limbs. A 2 × 2 (limb × workrate) and a 2 × 2 × 2 (compartment × limb × workrate) analysis of variance were run on the selected variables. Peak medial tibiofemoral compressive force was 23.5% lower for replaced compared to nonreplaced limbs (P = .004, G = 0.80). Peak medial tibiofemoral compressive force was 48.0% greater than peak lateral tibiofemoral compressive force in nonreplaced limbs (MD = 344.5 N, P < .001, G = 1.6) with no difference in replaced limbs (P = .274). Following TKA, patients have greater medial compartment loading on their nonreplaced compared to their replaced limbs and ipsilateral lateral compartment loading. This disproportionate loading may be cause for concern regarding exacerbating contralateral knee osteoarthritis.

Are Medial and Lateral Tibiofemoral Compressive Forces Different in Uphill Compared to Level Walking for Patients Following Total Knee Arthroplasty?

The purpose of this study was to determine how tibiofemoral joint compressive forces and knee joint-spanning muscle forces during uphill walking change compared to level walking in patients with total knee arthroplasty (TKA). A musculoskeletal model capable of resolving total (TCF), medial (MCF), and lateral (LCF) tibiofemoral compressive forces was used to determine compressive forces and muscle forces during level and uphill walking on a 10 deg incline for twenty-five post-TKA patients. A 2 × 2 (slope: level and 10 deg × limb: replaced and nonreplaced) repeated measures analysis of variance was used to detect differences in knee contact forces between slope and limb conditions and their interaction. Peak loading-response TCF, MCF, and LCF were greater during uphill walking than level walking for nonreplaced limbs. During uphill walking, peak loading-response TCF was smaller in replaced limbs compared to nonreplaced limbs with no change in MCF or LCF. Peak knee extension moment and knee extensor muscle force were smaller in replaced limbs compared to nonreplaced limbs during uphill walking. During level walking, replaced and nonreplaced limbs experienced rather equal joint loading; however, replaced limb experienced reduced joint loading during uphill walking. Differences in joint loading between replaced and nonreplaced limbs were not present during level walking, suggesting compensation from the replaced limb during the more difficult task. Uphill walking following TKA promotes more balanced loading of replaced limbs during stance; however, these benefits may come at the expense of increased loading on nonreplaced limbs.

Principal Component Analysis of Knee Joint Differences Between Bilateral and Unilateral Total Knee Replacement Patients During Level Walking.

Many unilateral total knee replacement (TKR) patients will need a contralateral TKR. Differences in knee joint biomechanics between bilateral patients and unilateral patients are not well established. The purpose of this study was to examine knee joint differences in level walking between bilateral and unilateral patients, and asymptomatic controls, using principal component analysis. Knee joints of 1st replaced limbs of 15 bilateral patients (69.40 ± 5.04 years), 15 replaced limbs of unilateral patients (66.47 ± 6.15 years), and 15 asymptomatic controls (63.53 ± 9.50 years) were analyzed during level walking. Principal component analysis examined knee joint sagittal- and frontal-plane kinematics and moments, and vertical ground reaction force (GRF). A one-way analysis of variance analyzed differences between principal component scores of each group. TKR patients exhibited more flexed and abducted knees throughout stance, decreased sagittal knee range of motion (ROM), increased early-stance adduction ROM, decreased loading-response knee extension and push-off knee flexion moments, decreased loading-response and push-off peak knee abduction moment (KAbM), increased KAbM at midstance, increased midstance vertical GRF, and decreased loading-response and push-off vertical GRF. Additionally, bilateral patients exhibited reduced sagittal knee ROM, increased adduction ROM, decreased sagittal knee moments throughout stance, decreased KAbM throughout stance, an earlier loading-response peak vertical GRF, and a decreased push-off vertical GRF, compared to unilateral patients. TKR patients, especially bilateral patients had stiff knee motion in the sagittal-plane, increased frontal-plane joint laxity, and a quadriceps avoidance gait.

Overground Walking Biomechanics of Dissatisfied Persons With Total Knee Replacements.

Patient dissatisfaction following total knee replacement (TKR) procedures is likely influenced by both subjective and objective aspects. Increased pain and reduced performance on clinical tests have been shown in persons who are dissatisfied with the outcome of their surgery. However, it is unknown how overground walking kinematics and kinetics might differ in the dissatisfied versus satisfied patients following TKR surgery. This study compared the lower-extremity walking kinematics and kinetics of patients dissatisfied with their TKR to that of satisfied patients and healthy controls. Thirty nine subjects completed walking trials, including nine dissatisfied and 15 satisfied TKR patients and 15 healthy controls. A 2 × 3 repeated -measures analysis of variance was used to assess differences between groups and limbs (P < .05). Dissatisfied persons showed significantly reduced loading-response and push-off peak vertical ground reaction forces, flexion range of motion, loading-response extension moments, and loading-response abduction moments compared to the controls. Peak loading-response and push-off vertical ground reaction forces and flexion range of motion were reduced in the replaced limb of dissatisfied patients compared with their nonreplaced limb. Push-off plantar flexion moments were reduced in the dissatisfied patients compared with the satisfied and healthy controls. Dissatisfied patients also reported increased knee joint pain and reduced preferred gait speed. Moreover, dissatisfied patients experienced mechanical limb asymmetries not present in those satisfied with their surgery result. Thus, patients dissatisfied with their total knee replacement outcome were found to be experiencing significant negative physiological changes.

Effects of Increased Step-Width on Knee Biomechanics During Inclined and Declined Walking.

The purpose of this study was to investigate effects of preferred step width and increased step width modification on knee biomechanics of obese and healthy-weight participants during incline and decline walking. Seven healthy-weight participants and 6 participants who are obese (body mass index ≥ 30) performed 5 walking trials on level ground and a 10° inclined and declined instrumented ramp system at both preferred and wide step-widths. A 2 × 2 (step-width × group) mixed-model analysis of variance was used to examine selected variables. There were significant increases in step-width between the preferred and wide step-width conditions for all 3 walking conditions (all P < .001). An interaction was found for peak knee extension moment (P = .048) and internal knee abduction moment (KAM) (P = .025) in uphill walking. During downhill walking, there were no interaction effects. As step-width increased, KAM was reduced (P = .007). In level walking, there were no interaction effects for peak medial ground reaction force and KAM (P = .007). There was a step-width main effect for KAM (P = .007). As step-width increased, peak medial ground reaction force and peak knee extension moment increased, while KAM decreased for both healthy weight and individuals who are obese. The results suggest that increasing step-width may be a useful strategy for reducing KAM in healthy and young populations.

Frontal Plane Tibiofemoral Alignment is Strongly Related to Compartmental Knee Joint Contact Forces and Muscle Control Strategies During Stair Ascent.

Static frontal plane tibiofemoral alignment is an important factor in dynamic knee alignment and knee adduction moments (KAMs). However, little is known about the relationship between alignment and compartment contact forces or muscle control strategies. The purpose of this study was to estimate medial (MCF) and lateral (LCF) compartment knee joint contact forces and muscle forces during stair ascent using a musculoskeletal model implementing subject-specific knee alignments. Kinematic and kinetic data from 20 healthy individuals with radiographically confirmed varus or valgus knee alignments were simulated using alignment specific models to predict MCFs and LCFs. Muscle forces were determined using static optimization. Independent samples t-tests compared contact and muscle forces between groups during weight acceptance and during pushoff. The varus group exhibited increased weight acceptance peak MCFs, while the valgus group exhibited increased pushoff peak LCFs. The varus group utilized increased vasti muscle forces during weight acceptance and adductor forces during pushoff. The valgus group utilized increased abductor forces during pushoff. The alignment-dependent contact forces provide evidence of the significance of frontal plane knee alignment in healthy individuals, which may be important in considering future knee joint health. The differing muscle control strategies between alignments detail-specific neuromuscular responses to control frontal plane knee loads.

Effects of Knee Alignments and Toe Clip on Frontal Plane Knee Biomechanics in Cycling.

Effects of knee alignment on the internal knee abduction moment (KAM) in walking have been widely studied. The KAM is closely associated with the development of medial knee osteoarthritis. Despite the importance of knee alignment, no studies have explored its effects on knee frontal plane biomechanics during stationary cycling. The purpose of this study was to examine the effects of knee alignment and use of a toe clip on the knee frontal plane biomechanics during stationary cycling. A total of 32 participants (11 varus, 11 neutral, and 10 valgus alignment) performed five trials in each of six cycling conditions: pedaling at 80 rpm and 0.5 kg (40 Watts), 1.0 kg (78 Watts), and 1.5 kg (117 Watts) with and without a toe clip. A motion analysis system and a customized instrumented pedal were used to collect 3D kinematic and kinetic data. A 3 × 2 × 3 (group × toe clip × workload) mixed design ANOVA was used for statistical analysis (p < 0.05). There were two different knee frontal plane loading patterns, internal abduction and adduction moment, which were affected by knee alignment type. The knee adduction angle was 12.2° greater in the varus group compared to the valgus group (p = 0.001), yet no difference was found for KAM among groups. Wearing a toe clip increased the knee adduction angle by 0.95º (p = 0.005). The findings of this study indicate that stationary cycling may be a safe exercise prescription for people with knee malalignments. In addition, using a toe clip may not have any negative effects on knee joints during stationary cycling.

Influence of Total Knee Arthroplasty on Gait Mechanics of the Replaced and Non-Replaced Limb During Stair Negotiation.

This study compared biomechanics during stair ascent in replaced and non-replaced limbs of total knee arthroplasty (TKA) patients with control limbs of healthy participants. Thirteen TKA patients and fifteen controls performed stair ascent. Replaced and non-replaced knees of TKA patients were less flexed at contact compared to controls. The loading response peak knee extension moment was greater in control and non-replaced knees compared with replaced. The push-off peak knee abduction moment was elevated in replaced limbs compared to controls. Loading and push-off peak hip abduction moments were greater in replaced limbs compared to controls. The push-off peak hip abduction moment was greater in non-replaced limbs compared to controls. Future rehabilitation protocols should consider the replaced knee and also the non-replaced knee and surrounding joints.

Greater Step Widths Reduce Internal Knee Abduction Moments in Medial Compartment Knee Osteoarthritis Patients During Stair Ascent.

Increased step widths have been shown to reduce peak internal knee abduction moments in healthy individuals but not in knee osteoarthritis patients during stair descent. This study aimed to assess effects of increased step widths on peak knee abduction moments and associated variables in adults with medial knee osteoarthritis and healthy older adults during stair ascent. Thirteen healthy older adults and 13 medial knee osteoarthritis patients performed stair ascent using preferred, wide, and wider step widths. Three-dimensional kinematics and ground reaction forces (GRFs) using an instrumented staircase were collected. Increased step width reduced first and second peak knee abduction moments, and knee abduction moment impulse. In addition, frontal plane GRF at time of first and second peak knee abduction moment and lateral trunk lean at time of first peak knee abduction moment were reduced with increased step width during stair ascent in both groups. Knee abduction moment variables were not different between knee osteoarthritis patients and healthy controls. Our findings suggest that increasing step width may be an effective simple gait alteration to reduce knee abduction moment variables in both knee osteoarthritis and healthy adults during stair ascent. However, long term effects of increasing step width during stair ascent in knee osteoarthritis and healthy adults remain unknown.

Effects of Two Football Stud Types on Knee and Ankle Kinetics of Single-Leg Land-Cut and 180° Cut Movements on Infilled Synthetic Turf.

Higher ACL injury rates have been recorded in cleats with higher torsional resistance in American football, which warrants better understanding of shoe/stud-dependent joint kinetics. The purpose of this study was to determine differences in knee and ankle kinetics during single-leg land cuts and 180° cuts on synthetic infilled turf while wearing 3 types of shoes. Fourteen recreational football players performed single-leg land cuts and 180° cuts in nonstudded running shoes (RS) and in football shoes with natural (NTS) and synthetic turf studs (STS). Knee and ankle kinetic variables were analyzed with a 3 × 2 (shoe × movement) repeated-measures ANOVA (P < .05). A significant shoe-by-movement interaction was found in loading response peak knee adduction moments, with NTS producing smaller moments compared with both STS and RS only in 180° cuts. Reduced peak negative plantar flexor powers were also found in NTS compared with STS. The single-leg land cut produced greater loading response and push-off peak knee extensor moments, as well as peak negative and positive extensor and plantar flexor powers, but smaller loading peak knee adduction moments and push-off peak ankle eversion moments than 180° cuts. Overall, the STS and 180° cuts resulted in greater frontal plane knee loading and should be monitored for possible increased ACL injury risks.

Effects of a multichannel dynamic functional electrical stimulation system on hemiplegic gait and muscle forces.

[Purpose] The purpose of the study was to design and implement a multichannel dynamic functional electrical stimulation system and investigate acute effects of functional electrical stimulation of the tibialis anterior and rectus femoris on ankle and knee sagittal-plane kinematics and related muscle forces of hemiplegic gait. [Subjects and Methods] A multichannel dynamic electrical stimulation system was developed with 8-channel low frequency current generators. Eight male hemiplegic patients were trained for 4 weeks with electric stimulation of the tibia anterior and rectus femoris muscles during walking, which was coupled with active contraction. Kinematic data were collected, and muscle forces of the tibialis anterior and rectus femoris of the affected limbs were analyzed using a musculoskelatal modeling approach before and after training. A paired sample t-test was used to detect the differences between before and after training. [Results] The step length of the affected limb significantly increased after the stimulation was applied. The maximum dorsiflexion angle and maximum knee flexion angle of the affected limb were both increased significantly during stimulation. The maximum muscle forces of both the tibia anterior and rectus femoris increased significantly during stimulation compared with before functional electrical stimulation was applied. [Conclusion] This study established a functional electrical stimulation strategy based on hemiplegic gait analysis and musculoskeletal modeling. The multichannel functional electrical stimulation system successfully corrected foot drop and altered circumduction hemiplegic gait pattern.

Stair ambulation biomechanics following total knee arthroplasty: a systematic review.

The purpose of this review was to summarize the biomechanical adaptations during stair ambulation that occur after total knee arthroplasty (TKA). Articles were identified by searching PubMed and Web of Science. During stair ascent, knee flexion angle at heel strike and walking velocity were reduced in TKA subjects compared to controls. Results of other variables were not consistent between studies. During stair descent only one study found any differences for knee moments in the sagittal and frontal plane between TKA subjects and controls. Other results during stair descent were not consistent between studies. Differences in methods can partially explain discrepancies between studies in this review. More studies with consistent and improved methods are needed in order to provide better understanding of stair ambulation following TKA.

Gait biomechanics of a second generation unstable shoe.

The recent popularity of unstable shoes has sparked much interest in the efficacy of the shoe design. Anecdotal evidence suggests that earlier designs appear bulky and less aesthetically appealing for everyday use. The purpose of this study was to examine effects of a second generation unstable shoe on center of pressure (COP), ground reaction force (GRF), kinematics, and kinetics of the ankle joint during level walking at normal and fast speeds. In addition, findings were compared with results from the first generation shoe. Fourteen healthy males performed five successful level walking trials in four testing conditions: walking in unstable and control shoes at normal (1.3 m/s) and fast (1.8 m/s) speeds. The unstable shoe resulted in an increase in mediolateral COP displacement, first peak vertical GRF loading rate, braking GRF, ankle eversion range of motion (ROM), and inversion moment; as well as a decrease in anteroposterior COP displacement, second peak vertical GRF, ankle plantarflexion ROM, and dorsiflexion moment. Only minor differences were found between the shoe generations. Results of the generational comparisons suggest that the lower-profile second generation shoe may be as effective at achieving the desired unstable effects while promoting a smoother transition from heel contact through toe off compared with the first generation shoe.

Effects of two football stud configurations on biomechanical characteristics of single-leg landing and cutting movements on infilled synthetic turf.

Multiple playing surfaces and footwear used in American football warrant a better understanding of relationship between different combinations of turf and footwear. The purpose of this study was to examine effects of shoe and stud types on ground reaction force (GRF) and ankle and knee kinematics of a 180° cut and a single-leg 90° land-cut on synthetic turf. Fourteen recreational football players performed five trials of the 180° cut and 90° land-cut in three shoe conditions: non-studded running shoe, and football shoe with natural and synthetic turf studs. Variables were analyzed with a 3 × 2 (shoe × movement) repeated measures analysis of variance (p < 0.05). Peak vertical GRF (p < 0.001) and loading rate (p < 0.001) were greater during 90° land-cut than 180° cut. For 180° cut, natural turf studs produced smaller peak medial GRFs compared to synthetic turf studs and non-studded shoe (p = 0.012). For land-cut, peak eversion velocity was reduced in running shoes compared to natural (p = 0.016) and synthetic (p = 0.002) turf studs. The 90° land-cut movement resulted in greater peak vertical GRF and loading rate compared to the 180° cut. Overall, increased GRFs in the 90° land-cut movement may increase the chance of injury.

Feasibility of Stationary Cycling with Pedal Force Visual Feedback Post-Total Knee Arthroplasty: Implications for Inter-Limb Deficits in Knee Joint Biomechanics.

The purpose of this study was to assess the biomechanical adaptations prompted by stationary cycling paired with visual feedback of vertical pedal reaction forces during both stationary cycling and overground walking for patients who underwent a total knee arthroplasty (TKA). Specifically, an emphasis on the inter-limb deficits in knee joint biomechanics were examined. Ten patients who underwent a TKA took part in an acute intervention with pre- and post-testing measurements of kinematics (240 Hz) and kinetics (1200 Hz) during stationary cycling and overground walking. The intervention phase consisted of six cycling sessions during which participants were provided with visual feedback of their bilateral peak vertical pedal reaction force, with instructions to maintain a symmetrical loading between limbs. A 2 × 2 (work rate/speed × time) repeated measures ANOVA (α = 0.05) was conducted on key outcome variables. Peak knee extension moment asymmetry during stationary cycling significantly improved (p = 0.038, η2p = 0.610) following the acute intervention. Walking velocities for both preferred (p = 0.001, d = 0.583) and fast (p = 0.002, d = 0.613) walking speeds displayed improvements from pre- to post-testing. Significant improvements in the total score (p = 0.009, d = 0.492) and ADL subscale score (p = 0.041, d = 0.270) for the Knee Injury and Osteoarthritis Outcome Score were present following the acute intervention. Stationary cycling with visual feedback may be beneficial post-TKA; however, further investigation is merited.

Validity, reliability, and bias between instrumented pedals and loadsol insoles during stationary cycling.

The purpose of this study was to evaluate the validity and reliability of the loadsol in measuring pedal reaction force (PRF) during stationary cycling as well as lower limb symmetry. Ten healthy participants performed bouts of cycling at 1kg, 2kg, and 3kg workloads (conditions) on a cycle ergometer. The ergometer was fitted with instrumented pedals and participants wore loadsol plantar pressure insoles. A 3 x 2 (Condition x Sensor Type) ANOVA was used to examine the differences in measured peak PRF, impulse, and symmetry indices. Root mean square error, intraclass correlation coefficients, and Passing-Bablok regressions were used to further assess reliability and validity. The loadsol demonstrated poor (< 0.5) to excellent (> 0.9) agreement as measured by intraclass correlation coefficients for impulse and peak PRF. Passing-Bablok regression revealed a systematic bias only when assessing all workloads together for impulse with no bias present when looking at individual workloads. The loadsol provides a consistent ability to measure PRF and symmetry when compared to a gold standard of instrumented pedals but exhibits an absolute underestimation of peak PRF. This study provides support that the loadsol can identify and track symmetry differences in stationary cycling which means there is possible usage for clinical scenarios and interventions in populations with bilateral asymmetries such as individuals with knee replacements, limb length discrepancies, diabetes, or neurological conditions. Further investigation of bias should be conducted in longer cycling sessions to ensure that the loadsol system is able to maintain accuracy during extended use.

Effects of different slopes on hip and ankle biomechanics of replaced and non-replaced limbs of patients with total knee arthroplasty during incline ramp walking.

Although knee biomechanics has been examined, hip and ankle biomechanics in incline ramp walking has not been explored for patients with total knee arthroplasty (TKA). The purpose of this study was to investigate the hip and ankle joint kinematic and kinetic biomechanics of different incline slopes for replaced limbs and non-replaced limbs in individuals with TKA compared to healthy controls. Twenty-five patients with TKR and ten healthy controls performed walking trials on four slope conditions of level (0°), 5°, 10° and 15° on a customized instrumented ramp system. A 3x4 (limb x slope) repeated analysis of variance was used to evaluate selected variables. The results showed a greater peak ankle dorsiflexion angle in the replaced limbs compared to healthy limbs. No significant interactions or limb main effect for other ankle and hip variables. The peak dorsiflexion angle, eversion angle and dorsiflexion moment were progressively higher in each comparison from level to 15°. The peak plantarflexion moment was also increased with each increase of slopes. Both the replaced and non-replaced limbs of patients with TKA had lower hip flexion moments than the healthy control limbs. Hip angle at contact and hip extension range of motion increased with each increase of slopes. Peak hip loading-response internal extension moment increased with each increase in slope and peak hip push-off internal flexion moment decreased with each increase of slope. Our results showed increased dorsiflexion in replaced limbs but no other compensations of hip and ankle joints of replaced limbs compared to non-replaced limbs and their healthy controls during incline walking, providing further support of using incline walking in rehabilitation for patients with TKA.

Investigation of Biomechanical Differences in Level Walking between Patients with Bilateral and Unilateral Total Knee Replacements.

Due to the high risk of a bilateral total knee arthroplasty (TKR) following unilateral TKR, this study was performed to investigate bilateral TKR patients. Specifically, we examined biomechanical differences between the first replaced and second replaced limbs of bilateral patients. Furthermore, we examined bilateral TKR effects on hip, knee, and ankle biomechanics, compared to the replaced and non-replaced limbs of unilateral patients. Eleven bilateral patients (70.09 ± 5.41 years, 1.71 ± 0.08 m, 91.78 ± 13.00 kg) and fifteen unilateral TKR patients (65.67 ± 6.18 years, 1.73 ± 0.10 m, 87.72 ± 15.70 kg) were analyzed while performing level walking. A repeated measures one-way ANOVA was performed to analyze between-limb differences within the bilateral TKR group. A 2 × 2 (limb × group) ANOVA was used to determine differences between bilateral and unilateral patients. Our results showed that the second replaced limb exhibited a lower peak initial-stance knee extension moment than the first replaced limb. No other kinematic or kinetic differences were found. Bilateral patients exhibited lower initial-stance knee extension moments, knee abduction moments, and dorsiflexion moments, compared to unilateral patients. Bilateral patients also exhibited lower push-off peak hip flexion moments and vertical GRF. The differences between the first and second replaced limbs of bilateral patients may indicate different adaptation strategies used following a second TKR. The significant group differences indicate that adaptations are different between these groups, and it is not recommended to use patients with unilateral and bilateral TKR together in gait analyses.

The effects of heading motion and sex on lower extremity biomechanics in soccer players.

BACKGROUND: Soccer is one of the most popular sports worldwide, which subsequently increases the number of injuries experienced by players. Furthermore, a large percentage of all anterior cruciate ligament injuries occur while playing soccer. In order to more clearly understand injury mechanisms, it is important to make the testing environment as real-life as possible. Inclusion of an external focus and secondary task, such as heading a soccer ball, may increase joint loading during landing. The purpose of this study was to investigate the effect of a forward heading motion on lower extremity kinetics and kinematics between sexes during a stop-jump task and a jump-heading task. METHODS: Ten male and ten female soccer players performed stop-jumps with no soccer ball present and jump-headings with a soccer ball present. Three-dimensional kinematics and kinetics were collected and analyzed during the landing. 2 × 2 mixed design analysis of variances (ANOVA) were performed to examine sex × jump task interactions and determine the main effects of sex and jump task. RESULTS: Results indicated jump-heading yields greater peak vertical ground reaction forces, an 8% increase in peak knee extension moments, a reduced initial knee flexion angle by approximately 5°, and an increased initial hip flexion angle by approximately 7°. Additionally, females exhibited 5.6° greater peak knee abduction angles compared to men, regardless of task. CONCLUSIONS: Inclusion of an overhead target may have distracted the athletes from focusing on frontal plane knee control when landing, and could potentially lead to increased ACL stress.

Bicycle Set-Up Dimensions and Cycling Kinematics: A Consensus Statement Using Delphi Methodology.

Bicycle set-up dimensions and cycling kinematic data are important components of bicycle fitting and cyclist testing protocols. However, there are no guidelines on how bicycles should be measured and how kinematic data should be collected to increase the reliability of outcomes. This article proposes a consensus regarding bicycle set-up dimensions and recommendations for collecting cycling-related kinematic data. Four core members recruited panellists, prepared the document to review in each round for panellists, analysed the scores and comments of the expert panellists, reported the decisions and communicated with panellists. Fourteen experts with experience in research involving cycling kinematics and/or bicycle fitting agreed to participate as panellists. An initial list of 17 statements was proposed, rated using a five-point Likert scale and commented on by panellists in three rounds of anonymous surveys following a Delphi procedure. The consensus was agreed upon when more than 80% of the panellists scored the statement with values of 4 and 5 (moderately and strongly agree) with an interquartile range of less than or equal to 1. A consensus was achieved for eight statements addressing bicycle set-up dimensions (e.g. saddle height, saddle setback, etc.) and nine statements for cycling kinematic assessment (e.g. kinematic method, two-dimensional methodology, etc.). This consensus statement provides a list of recommendations about how bicycle set-up dimensions should be measured and the best practices for collecting cycling kinematic data. These recommendations should improve the transparency, reproducibility, standardisation and interpretation of bicycle measurements and cycling kinematic data for researchers, bicycle fitters and cycling related practitioners.