Is ACL deficiency always a contraindication for medial UKA? Kinematic and kinetic analysis of implanted and contralateral knees.

BACKGROUND: Prevalence of knee osteoarthritis increases because life expectancy continues to rise with an active patient population. Hence, the concept of unicompartmental knee arthroplasty (UKA) has regained popularity as a treatment option for unicompartmental knee osteoarthritis. Anterior cruciate ligament (ACL) deficiency is widely considered as a contraindication for UKA, however, there are conflicting reports. If otherwise indicated, some surgeons consider UKA for ACL-deficient patients using a modified surgical technique, with a reduction of posterior tibial slope. RESEARCH QUESTION: The purpose of this study was to evaluate outcomes in UKA patients with ACL deficiency in comparison to a conventional UKA group (intact ACL) by the measurement of knee kinematics and kinetics. METHODS: Ten patients with conventional UKA and an intact ACL and eight patients with an ACL-deficient UKA and a reduced posterior tibial slope relative to the native knee were recruited. Three-dimensional joint kinematics of the knee were measured, using skin markers and an infrared optical motion capture system. Ground reaction forces (GRF) were measured with force plates in all three directions. Level walking, ramp descent and stair descent were analyzed, comparing implanted and contralateral native knees and the two UKA groups. RESULTS: No significant differences in kinetics and kinematics were observed between conventional UKA and ACL-deficient UKA groups for any of the activities. However, some asymmetries in GRF between the implanted and contralateral side were present for the ACL-deficient group, during level walking (unloading rate) and stair descent (stance time). SIGNIFICANCE: Promising outcomes of the ACL-deficient UKA group suggest that ACL deficiency may not always be a contraindication. Therefore, ACL-deficient UKA could be an alternative treatment option to total knee arthroplasty for an appropriate surgeon selected patient population.

Influence of the moving fluoroscope on gait patterns.

Video-fluoroscopic analysis can provide important insights for the evaluation of outcome and functionality after total knee arthroplasty, allowing the in vivo assessment of tibiofemoral kinematics without soft tissue artefacts. To enable measurement of the knee throughout activities of daily living such as gait, robotic systems like the moving fluoroscope have been developed that follow the knee movement and maintain the joint in front of the image intensifier. Since it is unclear whether walking while being accompanied by moving fluoroscope affects normal gait, the objective of this study was to investigate its influence on gait characteristics in healthy subjects. In addition, the impact of the motors' noise was analysed. By means of skin markers analysis (VICON MX system, Oxford Metrics Group, UK) and simultaneous measurement of ground reaction forces (Kistler force plates, Kistler, Switzerland), gait characteristics when walking with and without the moving fluoroscope as well as with and without ear protectors in combination with the moving fluoroscope, were obtained in young (n = 10, 24.5y ± 3.0y) and elderly (n = 9, 61.6y ± 5.3y) subjects during level gait and stair descent. Walking with the moving fluoroscope significantly decreased gait velocity in level gait and stair descent over the respective movement without the fluoroscope. Statistical analysis, including gait velocity as a covariate, resulted in no differences on the ground reaction force parameters. However, some kinematic parameters (ankle, knee and hip ranges of motion, minimal knee angle in late stance phase, maximal knee angles in stance and swing phase) seemed to be modified by the presence of the moving fluoroscope, but statistical comparison was limited due to velocity differences between the conditions. Wearing ear protectors to avoid the influence of motor sound during walking with the moving fluoroscope caused no significant difference. Walking with the moving fluoroscope has been shown to decrease gait velocity and small alterations in kinematic parameters were observed. Therefore, gait and movement alterations due to the moving fluoroscope cannot completely be excluded. However, based on the absence of differences in ground reaction force parameters (when adjusted for velocity within ANCOVA), as well as based on the comparable shape of the angular curves to the slow control condition, it can be concluded that changes in gait when walking with the moving fluoroscope are small, especially in comparison to natural slow walking. In order to allow assessment of joint replacement with the moving fluoroscope, including an understanding of the effects of joint pain, clinical analyses can only be compared to gait activities showing similarly reduced velocities. Importantly, the reduced gait speeds observed in this study are similar to those observed after total knee arthroplasty, suggesting that analyses in such subjects are appropriate. However, the moving fluoroscope would likely need to be optimized in order to detect natural gait characteristics at the higher gait velocities of healthy young subjects. The moving fluoroscope can be applied for comparisons between groups measured with the moving fluoroscope, but care should be taken when comparing data to subjects walking at self-selected speed without the moving fluoroscope.

In-situ force plate calibration: 12 years' experience with an approach for correcting the point of force application.

Force plates are common assessment tools used in biomechanics to measure ground reaction forces during motion capture or strength exercises. While the accuracy of the resulting kinetic data is critical for accurate gait analysis, factors such as plate mounting are thought to influence the measured point of force application (PFA) of the ground reaction forces. The aim of this study was therefore to present an accurate in-situ PFA calibration method. In addition, the approach was evaluated by examining the required PFA corrections over a period of ten years, which included plate remounting and a change of foundation. The in-situ PFA calibration was performed on six plates by assessing the locations of up to 98 points of force application per plate using an instrumented pole. Application of the in-situ PFA calibration approach reduced the root mean square errors by up to approximately 60% compared to the manufacturers calculation. Correction coefficients were strongly dependent on the individual platform as well as the location of the applied force on the plate. Remounting of the plates altered the plate coefficient corrections considerably, while changes over time were notable but not as extensive. We therefore recommend that plates should be recalibrated after remounting, but also at least every 5 years, in order to ensure the preservation of an accurate PFA.

High-heeled walking decreases lumbar lordosis.

An estimated 78% of women regularly walk in high heels. However, up to 58% complain about low back pain, which is commonly thought to be caused by increased lumbar lordosis. However, the extent to which a subject's posture is modified by high-heeled shoes during dynamic activities remains unknown. Therefore, we sought to evaluate whether low- or high-heeled shoes influence the kinematics of the pelvis and the spine during walking. Twenty-three inexperienced women, and seventeen women experienced in wearing high-heeled shoes, all aged 20-55 years, were measured barefoot and while wearing low- (4cm) and high-heeled (10cm) shoes during gait at a self-selected speed. A 22-camera motion capture system was used to assess the gait patterns for each condition. No significant inter-experience-group kinematic differences were found. In contrast to the results of some studies, our results show that the heels' height does indeed influence the motion of the pelvis and the spine during walking, whereby low-heeled shoes influenced the subjects' trunk kinematics during gait less than high-heeled shoes compared to barefooted walking. However, inexperienced high-heel wearers showed less thoracic curvature angle while wearing high-heels than while wearing low-heels. Importantly, both groups exhibited significantly lower maximum and minimal lumbar and thoracic curvature angles when wearing high-heeled shoes compared to the barefoot condition. As a result, it seems that low back pain might be associated with other factors induced by high-heels.