The role of the biarticular hamstrings and gastrocnemius muscles in closed chain lower limb extension.

The role of the biarticular muscles is a topic that has received considerable attention however their function is not well understood. In this paper, we argue that an analysis that is based upon considering the effect of the biarticular muscles on the segments that they span (rather than their effect on joint rotations) can be illuminating. We demonstrate that this understanding is predicated on a consideration of the relative sizes of the moment arms of a biarticular muscle about the two joints that it crosses. The weight of the previous literature suggests that the moment arms of both the biarticular hamstrings and gastrocnemius are smaller at the knee than at the hip or ankle, (respectively). This in turn leads to the conclusion that both biarticular hamstrings and gastrocnemius are extensors of the lower limb. We show that the existence of these biarticular structures lends a degree of flexibility to the motor control strategies available for lower limb extension. In particular, the role of the gastrocnemius and biarticular hamstrings in permitting a large involvement of the quadriceps musculature in closed chain lower limb extension may be more important than is typically portrayed. Finally, the analysis presented in this paper demonstrates the importance of considering the effects of muscles on the body as a whole, not just on the joints they span.

The effect of humeral avulsion of the glenohumeral ligaments and humeral repair site on joint laxity: a biomechanical study.

PURPOSE: The aims of this cadaveric study were to assess the effect of different sizes of humeral avulsion of the glenohumeral ligament (HAGL) lesions on joint laxity and to investigate any difference between repairs with anchors placed in a juxtachondral position and repairs with anchors placed in the humeral neck. METHODS: Glenohumeral specimens were tested on a shoulder laxity testing system with translations applied anteriorly up to 30 N, with the joint in 60° of glenohumeral abduction. Testing was conducted in neutral rotation and under 1-Nm external rotation for 5 specimen states: intact, medium HAGL lesion (4:30 to 5:30 clock-face position), large HAGL lesion (3:30 to 6:30 clock-face position), repair with juxtachondral suture anchors, and repair with humeral neck suture anchors. RESULTS: Significant increases in translation were observed between the intact and large HAGL lesion states for neutral rotation (1.46 mm [SD, 2.33 mm] at 30 N; P = .049) and external rotation (0.81 mm [SD, 0.72 mm] at 30 N; P = .005). Significant reductions in translation were also observed between the large HAGL lesion and humeral neck repair states for neutral rotation (-1.78 mm [SD, 2.23 mm] at 30 N; P = .022) and external rotation (-0.33 mm [SD, 0.37 mm] at 30 N; P = .015). CONCLUSIONS: Large HAGL lesions can increase the passive motion of the glenohumeral joint in both neutral and external rotation, although these differences are small and may be difficult to measure clinically. A repair using anchors placed in the humeral neck is more likely to restore the normal restraint to anterior translation than a juxtachondral repair. CLINICAL RELEVANCE: Medium HAGL lesions are unlikely to show significant increases in joint translation, and repair of large HAGL lesions should be achieved with anchors placed in the humeral neck if possible.

The role of negative intraarticular pressure and the long head of biceps tendon on passive stability of the glenohumeral joint.

BACKGROUND: The purpose of this study was to determine the effect of intraarticular pressure and the long head of biceps (LHB) tendon on passive translations of the glenohumeral (GH) joint. Tenotomy or tenodesis of the LHB are common procedures but the consequences on shoulder stability are unclear. METHODS: A novel shoulder laxity testing rig permitting six degrees of freedom of motion was used to test passive translations in anterior, posterior, superior, and inferior directions in 10 cadaveric shoulders. Specimens were tested in neutral rotation with 0°, 30°, 60°, or 90° of GH abduction in the scapular plane. Translation loads up to 30N were applied, and displacements measured in an intact joint, vented joint and with the biceps tendon loaded (20N). RESULTS: The GH joint was most lax at 30° GH abduction. Venting of the joint increased translations in all positions and directions (mean ± standard error of the mean), the greatest difference was 12.5 (3.9) mm in the anterior-posterior direction and 7.5 (3.9) mm in the SI direction. Loading the LHB tendon with 20N decreased translations in all directions. The largest difference was observed in the anterior direction, 13.9 (2.8) mm (P < .0005) and inferior direction, 12.0 (2.8) mm (P < .0005). CONCLUSION: Negative intraarticular pressure and the LHB contribute significantly to overall passive stability of the GH joint. Surgical division or transfer of the LHB tendon may impact on joint stability and function.

The sensitivity of a lower limb model to axial rotation offsets and muscle bounds at the knee.

Soft tissue artifacts during motion capture can lead to errors in kinematics and incorrect estimation of joint angles and segment motion. The aim of this study was to evaluate the effect of shank segment axial rotation and knee rotator muscle bounds on predicted muscle and joint forces in a musculoskeletal model of the lower limb. A maximal height jump for ten subjects was analysed using the original motion data and then modified for different levels of internal and external rotation, and with the upper force bound doubled for five muscles. Both externally rotating the shank and doubling the muscle bounds increased the ability of the model to find a solution in regions of high loading. Muscle force levels in popliteus and tensor fascia latae showed statistically significant differences, but less so in plantaris, sartorius or gracilis. The shear and patellofemoral joint forces were found to be significantly affected by axial rotation during specific phases of the motion and were dependent on the amount of rotation. Fewer differences were observed when doubling the muscle bounds, except for the patellofemoral force and plantaris and sartorius muscle force, which were significantly increased in many of the jump phases. These results give an insight into the behaviour of the model and give an indication of the importance of accurate kinematics and subject-specific geometry.

On the role of the patella, ACL and joint contact forces in the extension of the knee.

Traditional descriptions of the knee suggest that the function of the patella is to facilitate knee extension by increasing the moment arm of the quadriceps muscles. Through modelling and evidence from the literature it is shown in this paper that the presence of the patella makes the ability of the quadriceps to rotate the thigh greater than their ability to rotate the tibia. Furthermore, this difference increases as the knee is flexed, thus demonstrating a pattern that is consistent with many human movements. This paper also shows that the anterior cruciate ligament plays a previously unheralded role in extending the shank and that translation at the tibiofemoral and patellofemoral joints is important in improving the capacity for thigh rotation when the knee is flexed. This study provides new insights as to how the structure of the knee is adapted to its purpose and illustrates how the functional anatomy of the knee contributes to its extension function.

Balance and gait adaptations in patients with early knee osteoarthritis.

Gait adaptations in people with severe knee osteoarthritis (OA) have been well documented, with increased knee adduction moments (KAM) the most commonly reported parameter. Neuromuscular adaptations have also been reported, including reduced postural control. However these adaptations may be the result of morphological changes in the joint, rather than the cause. This study aimed to determine if people with early OA have altered gait parameters and neuromuscular adaptations. Gait and postural tasks were performed by 18 people with early medial knee OA and 18 age and gender-matched control subjects. Parameters measured were kinematics and kinetics during gait and postural tasks, and centre of pressure and electromyographic activity during postural tasks. OA subjects showed no differences in the gait parameters measured, however they demonstrated postural deficits during one-leg standing on both their affected and unaffected sides and altered hip adduction moments compared with controls. Increased activity of the gluteus medius of both sides (p<0.05), and quadriceps and hamstrings of the affected side (p<0.05) during one-leg standing compared with controls were also noted. This study has demonstrated that gait adaptations commonly associated with OA do not occur in the early stages, while neuromuscular adaptations are evident. These results may be relevant for early interventions to delay or prevent osteoarthritis in its early stages.

Measuring body weight distribution during sit-to-stand in patients with early knee osteoarthritis.

People with severe degenerative conditions, such as osteoarthritis (OA), have been shown to have altered movement patterns during sit-to-stand. However it remains unclear whether such alterations exist in people with early OA, in the absence of pain. This study aimed to determine if a novel seat could be used to discriminate people with early OA compared with controls. The sit-to-stand task was performed by 20 people with early medial knee OA and 20 age and gender-matched control subjects, using an instrumented seat. OA subjects showed altered weight distribution in the transition phase from sit to stand, in that they placed more load through their unaffected side. Task duration was significantly longer for OA subjects, and ground reaction force integrals were significantly greater for both legs of OA subjects. OA subjects had significantly higher knee flexion and adduction moments in their unaffected compared with affected side. This study has demonstrated that a novel instrumented seat can be used to discriminate people with early medial knee OA during the sit-to-stand activity. These results may be relevant for early interventions to delay or prevent changes in muscle function of the affected limb as well as contralateral knee or hip osteoarthritis in these patients.

The range of axial rotation of the glenohumeral joint.

There is a paucity of data in the literature on the restraining effects of the glenohumeral (GH) ligaments; cadaveric testing is one of the best methods for determining the function of these types of tissues. The aim of this work was to commission a custom-made six degrees of freedom (dof) joint loading apparatus and to establish a protocol for laxity testing of cadaveric shoulder specimens. Nine cadaveric shoulder specimens were used in this study and each specimen had all muscle resected leaving the scapula, humerus (transected at mid-shaft) and GH capsule. Specimens were mounted on the testing apparatus with the joint in the neutral position and at 30 degrees, 60 degrees and 90 degrees GH abduction in the coronal, scapula and 30 degrees forward flexion planes. For each orientation, 0-1 N m in 0.1 N m increments was applied in internal/external rotation and the angular displacement recorded. The toe-region of the moment-displacement curves ended at approximately +/-0.5 N m. The highest rotational range of motion for the joint was 140 degrees for +/-1.0 N m at 30 degrees GH abduction in the scapula plane. The range of motion shifted towards external rotation with increasing levels of abduction. The results provide the optimum loading regime to pre-condition shoulder specimens and minimise viscoelastic effects in the ligaments prior to laxity testing (>0.5 N m at 30 degrees GH abduction in any of the three planes). Knowledge of the mechanical properties of the GH capsuloligamentous complex has implications for modelling of the shoulder as well surgical planning and intervention.