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1.
PLoS One ; 19(8): e0309406, 2024.
Article in English | MEDLINE | ID: mdl-39208198

ABSTRACT

The production of triceps surae plantarflexion moment is complex in that the Achilles tendon moment arm affects the Achilles tendon force by determining the muscle length change and shortening velocity during ankle rotation. In addition, there is evidence for associations between the sizes of muscles and their moment arm at the joints they span. These relationships between muscle architecture and tendon moment arm ultimately affect the muscle's force generating capacity and are thus important for understanding the roles played by muscles in producing locomotion. The purpose of this study was to investigate in vivo the relationship between architecture of two plantarflexors and the Achilles tendon moment arm in a healthy adult population. Ultrasound-based measurements were made of the architecture (fascicle length, muscle volume, physiological cross-sectional area, and anatomical cross-sectional area) of the lateral and medial gastrocnemius and the Achilles tendon moment arm was assessed using a technique that combined ultrasound imaging and motion analysis. Positive correlations were observed between the length (r = 0.499, p = 0.049) and size variables (muscle volume r = 0.621, p = 0.010; ACSA r = 0.536, p = 0.032) of the lateral gastrocnemius and the Achilles tendon moment arm, but correlations were only observed for size variables (muscle volume r = 0.638, p = 0.008; PCSA r = 0.525, p = 0.037; ACSA r = 0.544, p = 0.029), and not the length, of the medial gastrocnemius. These findings suggest lateral gastrocnemius adapts to moment arms to maintain force production throughout the range of motion across individuals, while the medial gastrocnemius does not and is thus better suited for static force generation.


Subject(s)
Achilles Tendon , Muscle, Skeletal , Ultrasonography , Humans , Achilles Tendon/physiology , Achilles Tendon/diagnostic imaging , Achilles Tendon/anatomy & histology , Muscle, Skeletal/physiology , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/anatomy & histology , Adult , Male , Female , Biomechanical Phenomena , Range of Motion, Articular/physiology , Young Adult , Ankle Joint/physiology , Ankle Joint/diagnostic imaging , Ankle Joint/anatomy & histology
3.
Gait Posture ; 92: 199-205, 2022 02.
Article in English | MEDLINE | ID: mdl-34864485

ABSTRACT

BACKGROUND: Body-worn inertial measurement unit (IMU) sensors have been widely used in postural stability and balance studies because of their low cost and convenience. In most of these studies, a single IMU sensor is attached to a waist belt near the body's center of mass. Some populations such as pregnant women, however, may find a waist belt challenging in terms of fit and comfort. For this reason it may be useful to identify an alternative location for placement of an IMU and a more comfortable means for attaching the sensor to the body. Research question Does placing an IMU sensor in a pendant worn around the neck permit discrimination between conditions with varying postural stability? METHODS: Twenty-six healthy participants performed three standing tasks (double-leg, tandem, and single-leg standing) under eyes-open and eyes-closed vision conditions to preliminarily assess the ability of the pendant sensor to discriminate between balance conditions. Discrimination based upon data from a belt-mounted IMU was assessed in the same trials. Differences in standard deviation of acceleration components, sway area, and jerkiness due to trial condition and sensor were evaluated using analysis of variance followed by post hoc comparisons. These data were also incorporated into receiver-operator characteristic (ROC) curve analysis to assess the effectiveness of each sensor at discriminating between conditions. RESULTS: Stability was found to vary across conditions, but there was no interaction between stability and sensor location (all p ≥ 0.323). ROC curve analysis showed that sensors in both locations were good discriminators between conditions. Significance Placing an IMU in a pendant may be feasible for studying and monitoring postural instability. This approach may be especially valuable when considering populations for which wearing a belt is uncomfortable.


Subject(s)
Nervous System Diseases , Wearable Electronic Devices , Acceleration , Female , Humans , Postural Balance , Pregnancy , Standing Position
4.
J Appl Biomech ; 37(6): 578, 2021 12 01.
Article in English | MEDLINE | ID: mdl-34872066
5.
J Exp Biol ; 224(21)2021 11 01.
Article in English | MEDLINE | ID: mdl-34522962

ABSTRACT

Elastic energy storage and release can enhance performance that would otherwise be limited by the force-velocity constraints of muscle. Although functional influence of a biological spring depends on tuning between components of an elastic system (the muscle, spring-driven mass and lever system), we do not know whether elastic systems systematically adapt to functional demand. To test whether altering work and power generation during maturation alters the morphology of an elastic system, we prevented growing guinea fowl (Numida meleagris) from jumping. We compared the jump performance of our treatment group at maturity with that of controls and measured the morphology of the gastrocnemius elastic system. We found that restricted birds jumped with lower jump power and work, yet there were no significant between-group differences in the components of the elastic system. Further, subject-specific models revealed no difference in energy storage capacity between groups, though energy storage was most sensitive to variations in muscle properties (most significantly operating length and least dependent on tendon stiffness). We conclude that the gastrocnemius elastic system in the guinea fowl displays little to no plastic response to decreased demand during growth and hypothesize that neural plasticity may explain performance variation.


Subject(s)
Galliformes , Muscle, Skeletal , Animals , Biomechanical Phenomena , Tendons
6.
Mil Med ; 186(Suppl 1): 665-673, 2021 01 25.
Article in English | MEDLINE | ID: mdl-33499476

ABSTRACT

INTRODUCTION: Dynamic alignment of lower limb prostheses is subjective and time-consuming. Compensatory gait strategies caused by prosthesis misalignment can negatively affect lower limb amputees who cannot access a certified prosthetist for alignment adjustments. The objective of this study is to evaluate a novel six-degrees-of-freedom passive transtibial prosthetic adapter that self-aligns during various phases of gait. This self-aligning adapter may benefit service members and veterans stationed or living far from a clinical facility. METHODS: Four transtibial amputee subjects, aged 47 to 62 (mean: 55.75) years with mean weight of 163.6 lbs and mean K-level of 3.25, walked at self-selected speeds on a 10-m level walkway. Subjects walked with the self-aligning and a size- or weight-matched control adapter, assembled to a commercially available energy-storing-and-returning foot and their own socket, with 22-mm alignment perturbations in the anterior, posterior, medial, or lateral directions. Subjects were blinded to both adapter type and misalignment. Socket moments, spatiotemporal gait parameters, and subjective socket comfort were recorded. RESULTS: Preliminary results showed improvements in mean peak socket moments and step length differential with the self-aligning adapter across all alignments. Walking speed and prosthesis-side base of support showed little change in all configurations. Prosthesis-side stance duration and Functional Ambulation Profile Score increased with the self-aligning adapter in some alignments. Patient-reported socket comfort increased slightly with the self-aligning adapter across all misalignments. CONCLUSION: Subjects maintained similar walking speeds and experienced greater gait symmetry and reduced sagittal plane peak moments with the self-aligning adapter when exposed to misalignments. These trends suggest a benefit to transtibial amputees from a reduction in secondary gait effects from prosthesis misalignments. Additionally, a wider range of acceptable prosthesis alignments may be possible with the self-aligning adapter. Subsequent trials are underway to evaluate the self-aligning adapter in real-world environments like walking on uneven terrains, stairs, ramps, and abrupt turns.


Subject(s)
Biomimetics , Amputees , Artificial Limbs , Biomechanical Phenomena , Humans , Middle Aged , Tibia/surgery , Walking
7.
J Orthop Res ; 39(3): 572-579, 2021 03.
Article in English | MEDLINE | ID: mdl-33222251

ABSTRACT

Prior research on total ankle arthroplasty (TAA) has focused on improvements in pain and function following the surgical treatment of ankle arthritis, but its effect on ankle joint mechanics has received relatively little attention. The plantarflexion moment arm of the Achilles tendon is a critical determinant of ankle function with the potential to be altered by TAA. Here we investigate the effect of TAA on Achilles tendon moment arm assessed using two methods. Standing sagittal-plane radiographs were obtained for ten patients presurgery and postsurgery, from which anterior-posterior distance between the posterior calcaneus and the center of the talar dome was measured. Ultrasound imaging and three-dimensional (3D) motion capture were used to obtain moment arm pre- and post-TAA. The absolute changes in moment arm pre- to post-TAA were significantly different from zero for both methods (9.6 mm from ultrasound and 4.6% of the calcaneus length from radiographs). Only 46% of the variance in postoperative 3D Achilles tendon moment arm was explained by the preoperative value (r2 = 0.460; p = .031), while pre- and post-TAA values from radiographs were not correlated (r2 = 0.192, p = .206). While we did not find significant mean differences in Achilles tendon moment arm between pre- and post-TAA, we did find absolute changes in 3D moment arm that were significantly different from zero and these changes were partially explained by a change in location of the talar dome as indicated by measurements from radiographs (r2 = 0.497, p = .023).


Subject(s)
Achilles Tendon/physiology , Arthroplasty, Replacement, Ankle/rehabilitation , Achilles Tendon/diagnostic imaging , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Radiography , Ultrasonography
8.
Article in English | MEDLINE | ID: mdl-32984280

ABSTRACT

Tendon mechanical properties respond to altered load in adults, but how load history during growth affects adult tendon properties remains unclear. To address this question, we adopted an avian model in which we altered the mechanical load environment across the growth span. Animals were divided at 2 weeks of age into three groups: (1) an exercise control group given the opportunity to perform high-acceleration movements (EXE, n = 8); (2) a sedentary group restricted from high-intensity exercise (RES, n = 8); and (3) a sedentary group also restricted from high-intensity exercise and in which the gastrocnemius muscles were partially paralyzed using repeated bouts of botulinum toxin-A injections (RES-BTX, n = 8). Video analysis of bird movement confirmed the restrictions eliminated high-intensity exercise and did not alter time spent walking and sitting between groups. At skeletal maturity (33-35 weeks) animals were sacrificed for analysis, consisting of high-field MRI and material load testing, of both the entire free Achilles tendon and the tendon at the bone-tendon junction. Free tendon stiffness, modulus, and hysteresis were unaffected by variation in load environment. Further, the bone-tendon junction cross-sectional area, stress, and strain were also unaffected by variations in load environment. These results suggest that: (a) a baseline level of low-intensity activity (standing and walking) may be sufficient to maintain tendon growth; and (b) if this lower threshold of tendon load is met, non-mechanical mediated tendon growth may override the load-induced mechanotransduction signal attributed to tendon remodeling in adults of the same species. These results are important for understanding of musculoskeletal function and tendon health in growing individuals.

9.
J Biomech ; 109: 109907, 2020 08 26.
Article in English | MEDLINE | ID: mdl-32807332

ABSTRACT

Accurate location of the axis of ankle rotation is critical to in vivo estimates of Achilles tendon moment arm. Here we investigated how the plantarflexion moment arm of the Achilles tendon is affected by using an instantaneous helical axis that moves with ankle motion as opposed to a single fixed joint axis that approximates the average axis of rotation. Twenty young healthy adults performed a series of weightbearing cyclical plantar- and dorsi-flexion motions. Motion analysis tracked the motions of markers placed on the foot and shank and also tracked an ultrasound probe imaging the Achilles tendon. Differences in ATma between the methods were investigated using a two-way repeated-measures ANOVA with factors of joint angle (+5°, 0°, -5°, -10°, -15°) and method (instantaneous helical axes, fixed axis). Moment arms computed between the two methods were moderately to strongly correlated, especially in the mid-range of motion (for 0° to 10° plantarflexion, all r2 > 0.619 and all p < 0.004). The two methods produced Achilles tendon moment arms that were comparable and not significantly different except in the most dorsiflexed position, when they differed on average by 9.35 ± 3.23 mm (p = 0.001). Our results suggest that either approach for locating the axis of ankle rotation would be appropriate for the purpose of estimating ATma, but that a fixed axis may be preferable because it is applicable over a greater range of ankle motion.


Subject(s)
Achilles Tendon , Achilles Tendon/diagnostic imaging , Adult , Ankle , Ankle Joint , Humans , Magnetic Resonance Imaging , Range of Motion, Articular
10.
J Appl Physiol (1985) ; 128(1): 50-58, 2020 01 01.
Article in English | MEDLINE | ID: mdl-31751181

ABSTRACT

Decreases in activity levels in children worldwide are feared to have long-term health repercussions. Yet, because of the difficulty of performing controlled long-term studies in humans, we do not yet understand how decreases in childhood activity influence adult functional capacity. Here, in an avian bipedal model, we evaluated the elimination of all high-intensity activity during growth on adult performance. We evaluated three alternative hypotheses: Elimination of high-intensity activity 1) does not influence adult function, 2) results in task-specific deficits in adulthood, or 3) results in deficits that generalize across locomotor tasks. We found that animals restricted from jumping and sprinting during growth showed detriments as adults in maximal jump performance in comparison to controls, but did not require more metabolic energy during steady-state running or standing. From this, we conclude that functional deficits from elimination of high-intensity exercise are task specific and do not generalize across all locomotor functions.NEW & NOTEWORTHY Decreasing childhood activity levels are feared to have long-term health repercussions, but testing this hypothesis is hampered by restrictions of human experimentation. Here, in a bipedal animal model, we examine how the elimination of high-intensity activity during all of maturation influences adult locomotor capacity. We found restricted activity during growth reduced mechanical power capacity but not submaximal metabolic cost. This suggests that reduced childhood activity may result in task-specific, rather than generalized locomotor deficits.


Subject(s)
Galliformes/physiology , Locomotion/physiology , Muscle, Skeletal/physiology , Physical Conditioning, Animal , Animals , Biomechanical Phenomena , Galliformes/growth & development , Models, Animal
11.
J Biomech ; 90: 71-77, 2019 Jun 11.
Article in English | MEDLINE | ID: mdl-31084886

ABSTRACT

The plantarflexor moment arm of the Achilles tendon determines the mechanical advantage of the triceps surae and also indirectly affects muscle force generation by setting the amount of muscle-tendon shortening per unit of ankle joint rotation. The Achilles tendon moment arm may be determined geometrically from an axis (or center) of joint rotation and the line of action of the tendon force, but such moment arms may be sensitive to the location of the joint axis. Using motion analysis to track an ultrasound probe overlying the Achilles tendon along with markers on the shank and foot, we measured Achilles tendon moment arm during loaded and unloaded dynamic plantarflexion motions in 15 healthy subjects. Three representations of the axis or center of rotation of the ankle were considered: (1) a functional axis, defined by motions of the foot and shank; (2) a transmalleolar axis; and (3) a transmalleolar midpoint. Moment arms about the functional axis were larger than those found using the transmalleolar axis and transmalleolar midpoint (all p < 0.001). Moment arms computed with the functional axis increased with plantarflexion angle (all p < 0.001), and increased with loading in the most plantarflexed position (p < 0.001) but these patterns were not observed when either using a transmalleolar axis or transmalleolar midpoint. Functional axis moment arms were similar to those estimated previously using magnetic resonance imaging, suggesting that using a functional axis for ultrasound-based geometric estimates of Achilles tendon moment arm is an improvement over landmark-based methods.


Subject(s)
Achilles Tendon/physiology , Ankle/physiology , Movement , Rotation , Healthy Volunteers , Humans , Muscle, Skeletal/physiology , Orthopedic Procedures
12.
J Biomech ; 77: 201-205, 2018 08 22.
Article in English | MEDLINE | ID: mdl-29960733

ABSTRACT

Geometric and tendon excursion methods have both been used extensively for estimating plantarflexor muscle moment arm in vivo. Geometric measures often utilize magnetic resonance imaging, which can be costly and impractical for many investigations. Estimating moment arm from tendon excursion measured with ultrasonography may provide a cost-effective alternative to geometric measures of moment arm, but how well such measures represent geometry-based moment arms remains in question. The purpose of this study was to determine whether moment arms from tendon excursion can serve as a surrogate for moment arms measured geometrically. Magnetic resonance and ultrasound imaging were performed on 19 young male subjects to quantify plantarflexor moment arm based on geometric and tendon excursion paradigms, respectively. These measurements were weakly correlated that approached statistical significance (R2 = 0.21, p = 0.052), and moment arm from tendon excursion under-approximated geometric moment arm by nearly 40% (p < 0.001). This weak correlation between methods is at odds with a prior report (N = 9) of a strong correlation (R2 = 0.94) in a similar study. Therefore, we performed 92,378 regression analyses (19 choose 9) to determine if such a strong correlation existed in our study population. We found that certain sub-populations of the current study generated similarly strong coefficients of determination (R2 = 0.92), but 84% of all analyses revealed no correlation (p > 0.05). Our results suggest that the moment arms from musculoskeletal geometry cannot be otherwise obtained by simply scaling moment arms estimated from tendon excursion.


Subject(s)
Arm/physiology , Mechanical Phenomena , Tendons/physiology , Adult , Arm/anatomy & histology , Arm/diagnostic imaging , Biomechanical Phenomena , Humans , Magnetic Resonance Imaging , Male , Muscle, Skeletal/physiology , Tendons/anatomy & histology , Tendons/diagnostic imaging , Ultrasonography
13.
J Biomech ; 73: 227-232, 2018 05 17.
Article in English | MEDLINE | ID: mdl-29576314

ABSTRACT

The "Oxford Rig" cadaveric simulator permits researchers and clinicians to study knee mechanics during a simulated squatting motion. The motion of the lower limb in the Oxford Rig is typically controlled by a single actuator that applies tension to the quadriceps tendon. The location of the quadriceps actuator, however, has differed across published descriptions of the Oxford Rig. Actuators have been placed on the femur and pelvis, and on "grounded" locations external to the specimen, but the consequences of this placement for knee kinematics and kinetics are unknown. The purpose of this study was to examine these effects using a validated computational musculoskeletal model. When the actuator was placed on the femur or pelvis, forces realistically increased with knee flexion, with quadriceps and patellofemoral contact forces exceeding 2000 N and 3000 N, respectively, at 100° flexion. When the actuator was grounded, however, forces were substantially reduced and did not monotonically increase with flexion. Articular joint contact forces were not strongly influenced by changing the location of the actuator from the femur to the pelvis, with small RMS differences in quadriceps forces (48.2 N), patellofemoral forces (83.6 N), and tibiofemoral forces (58.9 N) between these conditions. The location of the actuator did not substantially affect knee kinematics. The results of this study suggest that the quadriceps actuator of the Oxford Rig should be attached to either the femur or the pelvis when the goal is to make realistic estimates of quadriceps forces and articular contact forces within the knee joint.


Subject(s)
Knee Joint/physiology , Models, Biological , Quadriceps Muscle/physiology , Arthroplasty, Replacement, Knee , Biomechanical Phenomena , Femur/physiology , Humans , Patella/physiology , Pelvis/physiology , Posture/physiology , Range of Motion, Articular , Tibia/physiology
14.
J Biomech ; 57: 27-31, 2017 05 24.
Article in English | MEDLINE | ID: mdl-28385335

ABSTRACT

Variability in musculoskeletal structure has the potential to influence locomotor function. It has been shown, for example, that sprinters have smaller Achilles tendon moment arms and longer toes than non-sprinters, and toe length has been found to correlate with toe flexor work in running humans. These findings suggest that interindividual variation in human foot structure allows for function that is adapted to various motor tasks. The purpose of this study was to test for correlations between foot anthropometry and single-joint maximal-height jumping performance. Ten male subjects performed static jumps using only their ankles for propulsion. Several anthropometric measures were taken. Bivariate correlation analyses were performed between all anthropometric variables and the average jump height for each subject. Results showed that the best jumpers had longer lateral heel lengths (r=0.871; p=0.001) and longer toes (r=0.712; p=0.021). None of the other anthropometric variables (stature, mass, lower extremity lengths) measured were found to correlate significantly with jump height. A factor analysis was performed to investigate whether some underlying feature related to body stature could explain jumping performance. Taller subjects did not necessarily jump higher. Specific variations in foot structure, unrelated to other general stature measures, were associated with performance in this single-joint jumping task.


Subject(s)
Foot/anatomy & histology , Foot/physiology , Movement/physiology , Adult , Body Weights and Measures , Humans , Male , Young Adult
15.
J Appl Biomech ; 33(5): 317-322, 2017 Oct 01.
Article in English | MEDLINE | ID: mdl-28338382

ABSTRACT

Several recent investigations have linked running economy to heel length, with shorter heels being associated with less metabolic energy consumption. It has been hypothesized that shorter heels require larger plantar flexor muscle forces, thus increasing tendon energy storage and reducing metabolic cost. The goal of this study was to investigate this possible mechanism for metabolic cost reduction. Fifteen male subjects ran at 16 km⋅h-1 on a treadmill and subsequently on a force-plate instrumented runway. Measurements of oxygen consumption, kinematics, and ground reaction forces were collected. Correlational analyses were performed between oxygen consumption and anthropometric and kinetic variables associated with the ankle and foot. Correlations were also computed between kinetic variables (peak joint moment and peak tendon force) and heel length. Estimated peak Achilles tendon force normalized to body weight was found to be strongly correlated with heel length normalized to body height (r = -.751, p = .003). Neither heel length nor any other measured or calculated variable were correlated with oxygen consumption, however. Subjects with shorter heels experienced larger Achilles tendon forces, but these forces were not associated with reduced metabolic cost. No other anthropometric and kinetic variables considered explained the variance in metabolic cost across individuals.


Subject(s)
Ankle Joint/anatomy & histology , Ankle Joint/physiology , Anthropometry/methods , Energy Metabolism/physiology , Foot/anatomy & histology , Foot/physiology , Running/physiology , Achilles Tendon/anatomy & histology , Achilles Tendon/physiology , Biomechanical Phenomena , Body Weight/physiology , Humans , Male , Oxygen Consumption/physiology , Predictive Value of Tests , Young Adult
16.
Sci Rep ; 6: 29870, 2016 07 15.
Article in English | MEDLINE | ID: mdl-27417976

ABSTRACT

Previous studies of human locomotion indicate that foot and ankle structures can interact in complex ways. The structure of the foot defines the input and output lever arms that influences the force-generating capacity of the ankle plantar flexors during push-off. At the same time, deformation of the foot may dissipate some of the mechanical energy generated by the plantar flexors during push-off. We investigated this foot-ankle interplay during walking by adding stiffness to the foot through shoes and insoles, and characterized the resulting changes in in vivo soleus muscle-tendon mechanics using ultrasonography. Added stiffness decreased energy dissipation at the foot (p < 0.001) and increased the gear ratio (i.e., ratio of ground reaction force and plantar flexor muscle lever arms) (p < 0.001). Added foot stiffness also altered soleus muscle behaviour, leading to greater peak force (p < 0.001) and reduced fascicle shortening speed (p < 0.001). Despite this shift in force-velocity behaviour, the whole-body metabolic cost during walking increased with added foot stiffness (p < 0.001). This increased metabolic cost is likely due to the added force demand on the plantar flexors, as walking on a more rigid foot/shoe surface compromises the plantar flexors' mechanical advantage.


Subject(s)
Biomechanical Phenomena/physiology , Foot/physiology , Muscle, Skeletal/physiology , Walking/physiology , Ankle/physiology , Gait/physiology , Humans
17.
J Orthop Res ; 34(3): 435-43, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26291455

ABSTRACT

Surgical technique is one factor that has been identified as critical to success of total knee arthroplasty. Researchers have shown that computer simulations can aid in determining how decisions in the operating room generally affect post-operative outcomes. However, to use simulations to make clinically relevant predictions about knee forces and motions for a specific total knee patient, patient-specific models are needed. This study introduces a methodology for estimating knee soft-tissue properties of an individual total knee patient. A custom surgical navigation system and stability device were used to measure the force-displacement relationship of the knee. Soft-tissue properties were estimated using a parameter optimization that matched simulated tibiofemoral kinematics with experimental tibiofemoral kinematics. Simulations using optimized ligament properties had an average root mean square error of 3.5° across all tests while simulations using generic ligament properties taken from literature had an average root mean square error of 8.4°. Specimens showed large variability among ligament properties regardless of similarities in prosthetic component alignment and measured knee laxity. These results demonstrate the importance of soft-tissue properties in determining knee stability, and suggest that to make clinically relevant predictions of post-operative knee motions and forces using computer simulations, patient-specific soft-tissue properties are needed.


Subject(s)
Arthroplasty, Replacement, Knee , Knee Joint/physiology , Knee/physiology , Models, Biological , Precision Medicine , Adult , Aged , Computer Simulation , Female , Humans , Male , Middle Aged
18.
Am J Sports Med ; 44(2): 417-24, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26684661

ABSTRACT

BACKGROUND: Increases in the rates and intensity of youth sports participation have led to an elevated incidence of anterior cruciate ligament (ACL) injuries and reconstruction in adolescents. Traditional reconstruction techniques in the skeletally immature patient may violate the growth plates and potentially lead to deformities. HYPOTHESIS/PURPOSE: The purpose of this study was to compare the volume and location of femoral growth plate violations resulting from anteromedial (AM) and transtibial (TT) techniques in ACL reconstruction. The hypothesis was that the more oblique angle used in femoral tunnels drilled with the AM portal technique would produce larger and more lateral violations compared with those resulting from TT tunnels. STUDY DESIGN: Controlled laboratory study. METHODS: Growth plate disturbances were quantified by performing simulated reconstructions in computer models created from magnetic resonance imaging scans of the knees of 17 adolescent participants. Locations of tunnels drilled with simulated AM and TT portal techniques were specified by an orthopaedic surgeon blinded to the locations of the femoral physes in the knee models. Tunnels with lengths of 20, 25, and 30 mm were placed in each model using simulated drill diameters of 7, 8, and 9 mm in addition to a 4.5-mm tunnel breaching the lateral cortex. Normalized measures of the volume and laterality of violations were computed. RESULTS: Tunnels drilled with the AM portal technique disrupted a significantly larger percentage of the physis (P = .007), but the difference was not substantial. Tunnels drilled with the AM portal technique produced violations that were more lateral in the physis than those drilled with the TT technique (P < .001). Tunnels drilled with the AM portal technique resulted in mean violations that were 5.1% ± 2.1% of the physis as compared with 4.7% ± 2.0% for TT tunnels. The mean value for a normalized measure of the laterality of the violation (L score) was 0.590 ± 0.115 for tunnels drilled with the AM portal technique and 0.290 ± 0.104 for TT tunnels. The AM approach produced 16 of 153 simulated reconstructions with growth plate violations greater than 8% compared with only 10 with the TT approach. CONCLUSION: Results suggest that the AM approach produces growth plate violations that are larger and more lateral than the violations generated using the TT technique. AM approaches were more likely to remove more than 8% of the physeal volume, a level previously identified as posing a greater risk of growth disturbances. While the difference in the mean physeal volume removed between the approaches was small, the violations for the AM approach were much more lateral, a finding of potentially greater clinical significance. CLINICAL RELEVANCE: As progressively younger patients are considered candidates for ACL reconstruction, knowledge of how variations in technique affect the developing knee is critical to preventing iatrogenic injuries.


Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction/methods , Growth Plate/surgery , Tibia/surgery , Adolescent , Computer Simulation , Epiphyses/surgery , Fasciotomy , Female , Femur/surgery , Functional Laterality/physiology , Humans , Knee Injuries/surgery , Knee Joint/surgery , Ligaments/surgery , Magnetic Resonance Imaging , Male
19.
J Parkinsons Dis ; 5(1): 141-50, 2015.
Article in English | MEDLINE | ID: mdl-25502948

ABSTRACT

BACKGROUND: Reduced arm swing amplitude, symmetry, and coordination during gait have been reported in Parkinson's disease (PD), but the relationship between dopaminergic depletion and these upper limb gait changes remains unclear. OBJECTIVE: We aimed to investigate the effects of dopaminergic drugs on arm swing velocity, symmetry, and coordination in PD. METHODS: Forearm angular velocity was recorded in 16 PD and 17 control subjects (Controls) during free walking trials. Angular velocity amplitude of each arm, arm swing asymmetry, and maximum cross-correlation were compared between control and PD groups, and between OFF- and ON-medication states among PD subjects. RESULTS: Compared to Controls, PD subjects in the OFF-medication state exhibited lower angular velocity amplitude of the slower- (p = 0.0018), but not faster- (p = 0.2801) swinging arm. In addition, PD subjects demonstrated increased arm swing asymmetry (p = 0.0046) and lower maximum cross-correlation (p = 0.0026). Following dopaminergic treatment, angular velocity amplitude increased in the slower- (p = 0.0182), but not faster- (p = 0.2312) swinging arm among PD subjects. Furthermore, arm swing asymmetry decreased (p = 0.0386), whereas maximum cross-correlation showed no change (p = 0.7436). Pre-drug angular velocity amplitude of the slower-swinging arm was correlated inversely with the change in arm swing asymmetry (R = -0.73824, p = 0.0011). CONCLUSIONS: This study provides quantitative evidence that reduced arm swing and symmetry in PD can be modulated by dopaminergic replacement. The lack of modulations of bilateral arm coordination suggests that additional neurotransmitters may also be involved in arm swing changes in PD. Further studies are warranted to investigate the longitudinal trajectory of arm swing dynamics throughout PD progression.


Subject(s)
Arm/physiopathology , Gait Disorders, Neurologic/drug therapy , Gait Disorders, Neurologic/etiology , Movement/drug effects , Parkinson Disease/complications , Aged , Dopamine Agents/pharmacology , Dopamine Agents/therapeutic use , Female , Humans , Male , Middle Aged , Movement/physiology , Parkinson Disease/drug therapy , Psychomotor Performance/drug effects , Walking
20.
J Appl Physiol (1985) ; 116(5): 538-44, 2014 Mar 01.
Article in English | MEDLINE | ID: mdl-24371016

ABSTRACT

Muscle volume is known to correlate with maximal joint torque in humans, but the role of muscle moment arm in determining maximal torque is less clear. Moderate correlations have been reported between maximal isometric knee extensor torque and knee extensor moment arm, but no such observations have been made for the ankle joint. It has been suggested that smaller muscle moment arms may enhance force generation at high rates of joint rotation, but this has not yet been observed for ankle muscles in vivo. The purpose of the present study was to correlate plantar flexor moment arm and plantar flexor muscle volume with maximal plantar flexor torque measured at different rates of plantar flexion. Magnetic resonance imaging was used to quantify the plantar flexor moment arm and muscle volume of the posterior compartment in 20 healthy young men. Maximal plantar flexor torque was measured isometrically and at three plantar flexion speeds using an isokinetic dynamometer. Plantar flexor torque was significantly correlated with muscle volume (0.222 < R(2) < 0.322) and with muscle moment arm at each speed (0.323 < R(2) < 0.494). While muscle volume was strongly correlated with body mass and stature, moment arm was not. The slope of the torque-moment arm regression line decreased as the rate of joint rotation increased, indicating that subjects with small moment arms experienced smaller reductions in torque at high speeds. The findings of this study suggest that plantar flexor moment arm is a determinant of joint strength that is at least as important as muscle size.


Subject(s)
Arm/physiology , Foot/physiology , Movement/physiology , Muscle, Skeletal/anatomy & histology , Achilles Tendon/physiology , Ankle Joint/physiology , Arm/anatomy & histology , Biomechanical Phenomena , Foot/anatomy & histology , Humans , Isometric Contraction , Joints/anatomy & histology , Joints/physiology , Linear Models , Magnetic Resonance Imaging , Male , Muscle Contraction/physiology , Muscle Strength Dynamometer , Rotation , Torque , Young Adult
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