Functional electrostimulation therapy for vastus medialis decreases the varus thrust during gait.

[Purpose] This study aimed to investigate whether modification of vastus medialis activity can delay the varus thrust. [Participants and Methods] Ten participants (Kellgren-Laurence grades I: n=2, II: n=6, and III: n=2) diagnosed with knee osteoarthritis were enrolled. The intervention involved free walking on a 10-m walkway at any speed after donning a functional electrical stimulation set to contract the vastus medialis before heel contact. Using a Vicon Nexus ground reaction force meter and a wireless electromyograph DELSYS, varus thrust, maximal knee extension angle, maximal knee adduction moment, and vastus medialis onset time were assessed both before and after intervention. [Results] A significant difference in varus thrust was detected from before to after the intervention (2.7 ± 1.1° vs. 2.2 ± 1.3°). Both the vastus medialis activation time (-0.06 ± 0.09 vs. -0.21 ± 0.1) and the knee-joint extension angle (8.7 ± 5.1° vs. 5.5 ± 5.9°) decreased following intervention, whereas the knee adduction moment significantly increased (0.50 ± 0.20° vs 0.56 ± 0.18°). [Conclusion] Wearing the functional electrical stimulation set caused the vastus medialis to act earlier in response to heel strike, thereby improving the knee-joint extension angle and suppressing varus thrust.

Medial meniscus extrusion during gait is associated with decrease in knee rotation in early-stage knee osteoarthritis.

BACKGROUND: In patients with medial knee osteoarthritis (OA), medial meniscus extrusion during gait is aggravated by mechanical stress, such as knee adduction moment (KAM). Conversely, the decrease in the range of knee rotation during stance phase is also one of the important issues in early knee OA, whereas the correlation between medial meniscus extrusion and knee rotation during gait are unclear. RESEARCH QUESTION: To investigate the correlation between increase in medial meniscus extrusion and range of knee rotation during gait in patients with early- and late-stage of knee OA. METHODS: Forty patients with medial knee OA were enrolled and divided into early- and late-OA group by Kellgren-Lawrence grading scale. During gait tasks, the extent of medial meniscus extrusion was measured using ultrasonography and kinetic/kinematic data were measured using three-dimensional motion analysis system. The correlation between medial meniscus extrusion and the range of knee rotation or KAM were evaluated in the overall, early-, and late- OA groups. RESULTS: A significant negative correlation was observed between an increase in medial meniscus extrusion and range of knee rotation angle in early-OA group only. However, an increase in medial meniscus extrusion significantly correlated with the second KAM peak in the overall and early-OA groups. SIGNIFICANCE: The decrease in range of knee rotation during stance phase may be associated with the increase in medial meniscus extrusion during gait in patients with early knee OA.

Influence of time from injury to surgery on knee biomechanics during walking in patients with anterior cruciate ligament reconstruction.

The pilot study aimed to determine whether the time from injury to surgery influences on postoperative knee biomechanics during walking in patients with anterior cruciate ligament reconstruction (ACLR). Thirty-two patients with unilateral ACLR (early, 10 patients; delayed, 22 patients) and 30 control subjects participated in this study. All examinations for patients with ACLR were performed preoperatively and at 12 months postoperatively and comprised passive knee joint laxity, knee muscle strength, and knee kinematics and kinetics during walking. At both time points, there were no significant differences in passive knee joint laxity and knee muscle strength between the early ACLR and delayed ACLR groups. Preoperatively, both the early ACLR and delayed ACLR patients exhibited significantly reduced knee extension movement from midstance to terminal stance compared to the control subjects. Moreover, the delayed ACLR patients exhibited significantly decreased peak external knee flexion moment compared to the control subjects. At 12 months postoperatively, the early ACLR patients showed significant improvement in knee extension movement from midstance to terminal stance compared to pre-ACLR, while the delayed ACLR patients did not show significant improvement in this knee extension movement. It can be concluded that early ACLR may be more beneficial to improve knee biomechanics during walking.

Detecting side-to-side differences of lower limb biomechanics during single-legged forward landing after anterior cruciate ligament reconstruction.

BACKGROUND: Motion analysis can be used to evaluate functional recovery after anterior cruciate ligament (ACL) reconstruction; however, the biomechanics parameters of the lower limb that are specifically altered in ACL-reconstructed knees compared to the contralateral side are not well understood. This retrospective study aimed to compare side-to-side differences in lower limb biomechanics during the first 100 milliseconds (ms) after initial contact in a single-leg forward landing task. METHODS: Using three-dimensional motion analysis, lower joint kinematic and kinetic variables were measured 8-10 months postoperatively in 22 patients who had undergone ACL reconstruction. We determined side-to-side differences in lower limb biomechanics over the 100-ms timeframe after landing, and receiver operating characteristic (ROC) curve analyses were performed to calculate the area under the curve (AUC) for parameters showing significant side-to-side differences. RESULTS: During the 100-ms timeframe after landing, 58 kinematic and kinetic items showed significant side-to-side differences. Side-to-side differences in lower limb biomechanics over the 40-ms timeframe after landing existed. The ROC curve analysis identified 11 items with AUC values ≥ 0.70, including hip flexion, abduction moment, and knee joint power, and their AUC values were not significantly different. CONCLUSION: Hip flexion/abduction moment and knee power after GRF max could be used as outcomes for assessing functional recovery in patients who have undergone ACL reconstruction.

Biomechanics of Double Poling in Paralympic Cross-Country Skiing-A Cross-Sectional Study Comparing the Standing and Sitting Positions in Healthy Male Subjects.

Background and Objectives: Double poling is an important fundamental skill required for cross-country skiing in able-bodied athletes and in those with physical disabilities. Meanwhile, the performance improvement and injury prevention related to double poling requires a thorough assessment, whereas the scapular and shoulder kinematics in different postural conditions remain to be clarified. The main purpose of this study was to evaluate the biomechanics during cross-country ski double poling in the standing and sitting positions. Materials and Methods: Eleven participants underwent kinematic assessments of the shoulder girdle during double poling on a ski ergometer with an electromagnetic tracking device. The cycle rate, stroke length, stroke speed, thorax motion relative to pelvis, scapular motions relative to thorax, humeral motions relative to thorax, and humeral motions relative to scapula were calculated for five double-poling cycles. Results: In the sitting position, the angles of humerothoracic elevation were 18 degrees larger and glenohumeral elevation 13 degrees larger than in the standing position at the upward point and range of motion. Conclusions: The study revealed that double poling in the sitting condition increased the humerothoracic and glenohumeral elevation angle to secure the poling margin. If these are excessive, there is a risk of shoulder injuries such as subacromial impingement.

Factors associated with dynamic knee valgus angle during single-leg forward landing in patients after anterior cruciate ligament reconstruction.

BACKGROUND: A few studies have reported on how to predict increased dynamic knee valgus angle (KVA), a risk factor for second anterior cruciate ligament (ACL) injury after ACL reconstruction. This study aimed to identify the factors with the potential to predict the KVA during single-leg hop landing. METHODS: Using three-dimensional motion analysis systems, knee motion during a single-leg hop landing task was measured in 22 patients who had undergone ACL reconstruction at 8-10 months postoperatively. The KVA at initial contact (IC) and maximum KVA during the 40-ms period after IC were calculated using the point cluster technique; correlations between the KVA and other factors were assessed. We performed multiple regression analysis to determine whether KVA could be predicted by these parameters. RESULTS: The KVA was significantly negatively correlated with the static femorotibial angle (FTA; P < 0.01) and patient height (P < 0.01). It was positively correlated with the body mass index (P < 0.05). Multiple regression analysis showed that a small FTA could predict the KVA at IC (ß: 0.52, 95% confidence interval (CI): 2.24-(-0.42); P < 0.01). The maximum KVA during the 40-ms period after IC was associated with the FTA (ß: 0.46, 95% CI: 2.22-(-0.26); P = 0.02) and height (ß: 0.40, 95% CI: 0.59-(-0.02); P = 0.04). CONCLUSION: At 8-10 months after ACL reconstruction, the KVA was significantly correlated with the FTA, with reduced FTA being associated with an increased dynamic KVA during single-leg hop landing. The measurement of anatomical parameters may aid in predicting the second ACL injury risk after reconstruction.

The Relationship between Knee Biomechanics and Clinical Assessments in ACl Deficient Patients.

The purpose of this study was to clarify the relationship between knee biomechanics and clinical assessments in ACL deficient patients. Subjects included 22 patients with unilateral ACL rupture and 22 healthy controls. Knee kinematics and kinetics during walking and running were examined using a 3-dimensional motion analysis system. The passive knee joint laxity, range of motion of knee joint, and knee muscle strength were also measured. Correlations between the knee kinematic and kinetic data and clinical assessments were evaluated. In the ACL deficient patients, there were no significant relationships between tibial translation during walking and running and passive knee joint laxity. The correlations between knee kinematics and kinetics and range of motion of knee joint were also not significant. Additionally, there were no significant correlations between knee kinematics during walking and knee muscle strength. However, there were several significant correlations between knee kinematics during running and knee muscle strength. The results demonstrate the importance of knee muscle strength for knee kinematics and kinetics during running in ACL deficient patients. Patients with stronger knee muscle strength may demonstrate more nearly normal knee joint movement during dynamic activities such as running.

The relationship between knee muscle strength and knee biomechanics during running at 6 and 12 months after anterior cruciate ligament reconstruction.

BACKGROUND: Knee joint kinematics and kinetics during running recover at 12 months, not 6 months, following anterior cruciate ligament (ACL) reconstruction surgery. Knee muscle strength is a criterion used to assess an individual's readiness to return-to-sports (RTS); however, the relationship between knee muscle strength and knee biomechanics is unclear. This study investigated the relationship between knee muscle strength and dynamic knee biomechanics during running at 6 and 12 months after ACL reconstruction surgery. METHODS: Knee joint kinematics and kinetics during running were analyzed in 21 patients (10 males, 11 females) who underwent ACL reconstruction for a unilateral ACL deficiency. Kinematics and Kinetics were measured by three-dimensional motion analysis system, and Knee flexion angle was calculated using Point cluster technique and internal extension moment was calculated by the inverse dynamics method. Patients were compared to a control group matched by age, height and weight. Isokinetic knee extension and flexion strength in ACL-reconstructed patients were measured at 6 and 12 months postsurgery, by separated gender. RESULTS: Knee flexion angle was significantly lower in ACL patients at 6 months postsurgery compared to the control group (F (2, 62)=5.78, P=0.014). There were significant lower peak knee flexion angles in male groups than female (F (1, 62)=6.33, P<0.01). Knee extension moments were significantly lower in both male and female ACL patients compared to the control group at 6 and 12 months postsurgery (F (2, 62)=12.05, P<0.01(6 months), P=0.034(12 months)), and there were significant correlations with knee extension moments and maximum torque of knee extension/flexion (P<0.05). At 12 months after surgery, knee joint kinematics in ACL patients were restored. Both peak knee angle and knee extension moment were significantly associated with maximum knee extension/flexion torque values in female patients at 12 months postsurgery. CONCLUSIONS: Dynamic knee biomechanics during running were not restored 6 and 12 months after ACL reconstruction both male and female. It is necessary to strengthen knee extension and flexion muscles to restore knee kinetics during running, especially female patients.

Gender differences in the restoration of knee joint biomechanics during gait after anterior cruciate ligament reconstruction.

BACKGROUND: The aim of our study was to evaluate the effects of gender on recovery of knee joint biomechanics over the stance phase of gait after reconstruction of the anterior cruciate ligament (ACL). METHODS: Gait parameters and knee joint kinematics and kinetics were compared in 32 patients (16 male and 16 female) who underwent ACL reconstruction for a unilateral ACL deficiency, with comparison to an age-, height-, and weight-matched Control group. Knee flexion, adduction and tibial rotation angles were measured and knee extension and abduction moment was calculated by inverse dynamics methods. RESULTS: Females exhibited more tibial external rotation, in both the Control and ACL groups (P<0.05), which was not changed after ACL reconstruction. Prior to reconstruction, sagittal plane biomechanics were changed, in both males and females, compared to the Control groups (P<0.05). These abnormal sagittal plane mechanics were recovered at 12months, but not six months post-reconstruction. CONCLUSIONS: We identified gender-based differences in tibial rotation that influenced the kinematics and kinetics of the knee over the stance phase of gait, both pre-operatively and post-ACL reconstruction. Evaluation of biomechanical effects of ACL injury, before and after reconstruction, should be separately evaluated for females and males.

Characteristics of thoracic and lumbar movements during gait in lumbar spinal stenosis patients before and after decompression surgery.

BACKGROUND: Although gait analysis has been previously conducted for lumbar spinal stenosis patients, the vertebral segmental movements, such as of the thoracic and lumbar regions, and whether the spinal movement during gait changes after decompression surgery remain unclear. METHODS: Ten patients with lumbar spinal stenosis and 10 healthy controls participated. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Visual Analogue Scale. Spinal kinematic data of the participants during gait were acquired using a three-dimensional motion analysis system. The trunk (whole spine), thoracic, and lumbar flexion and pelvic tilting values were calculated. Spinal kinematic data and clinical outcomes were collected preoperatively and 1month postoperatively for the patients. FINDINGS: Compared to that observed preoperatively, the clinical outcomes significantly improved at 1month postoperatively. In the standing position, the preoperative lumbar extension of the patients was significantly smaller than that of the controls. Moreover, during gait, the lumbar flexion relative to the standing position of the patients was smaller than that of the controls preoperatively, and increased at 1month postoperatively. The sum of the thoracic and lumbar flexion values during gait negatively correlated with the score for leg pain. INTERPRETATION: The epidural pressure of lumbar spinal stenosis patients is known to be higher than that of normal subjects during gait, and to decrease during walking with lumbar flexion. Preoperatively, smaller thoracic and lumbar flexion movements during gait relative to the standing position cannot decrease epidural pressure; as a result, severe leg pain might be induced.

Knee biomechanics during walking in recurrent lateral patellar dislocation are normalized by 1 year after medial patellofemoral ligament reconstruction.

PURPOSE: Gait kinematics and kinetics of the knee before and after medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent lateral patellar dislocation (RPD) are unknown. The purpose of this study was to measure knee kinematics and kinetics during gait before and 1 year after anatomical MPFL reconstruction in patients with RPD and compare the results to healthy individuals. METHODS: Eleven RPD patients were treated using an anatomical MPFL reconstruction procedure. Gait analysis was conducted before and at 3, 6, and 12 months after surgery. For comparison, 15 healthy volunteers with no history of orthopaedic problems in their lower limbs were included as the control group. Knee kinematics and kinetics were analysed during gait. RESULTS: Before surgery, the internal knee extension moment in RPD patients was significantly lower than in controls (P = 0.025). At 3 months post-operatively, there was an additional decrease in knee extension moment compared to before surgery, and so it was still significantly lower than in the control group (P < 0.01). One year post-operatively, knee extension moment in the RPD group was significantly increased compared to 3 months post-operatively (P < 0.01). The knee flexion angle in the early stance phase in the RPD group at 3 months post-operatively was significantly lower than that of controls (P < 0.01). Knee kinematics and kinetics were similar to that of controls 1 year after surgery. CONCLUSION: Initially, RPD patients had lower knee extension moments during gait compared with controls, but by 1 year after MPFL reconstruction, knee kinematics and kinetics of gait in the RPD patients had returned to normal. These observations indicate that MPFL reconstruction may help to delay prospective knee OA as long as possible by restoring the conformation of the patellofemoral joint and gait biomechanics by surgery.

[The approach to bone and joint disease for extending the healthy life expectancy].

In Japan, the super-aged society, the difference between the healthy life expectancy and life expectancy is large, it has become a social problem. For the extension of healthy life expectancy, measures to bone and joint disease are important. Lower limb muscle strengthening is useful to decrease in pain and improvement of walking ability. Further, in order to maintain a balance function, improvement in range of motion is important. On the other hand, for patients who had joint destruction, decreased ability of exercise, muscle weakness, balance dysfunction has already occurred, it is necessary for extension of healthy life expectancy including surgical treatment. We believe that by performing the appropriate therapeutic intervention, extending healthy life expectancy would be possible.