Exploring relationships among multi-disciplinary assessments for knee joint health in service members with traumatic unilateral lower limb loss: a two-year longitudinal investigation.

Motivated by the complex and multifactorial etiologies of osteoarthritis, here we use a comprehensive approach evaluating knee joint health after unilateral lower limb loss. Thirty-eight male Service members with traumatic, unilateral lower limb loss (mean age = 38 yr) participated in a prospective, two-year longitudinal study comprehensively evaluating contralateral knee joint health (i.e., clinical imaging, gait biomechanics, physiological biomarkers, and patient-reported outcomes); seventeen subsequently returned for a two-year follow-up visit. For this subset with baseline and follow-up data, outcomes were compared between timepoints, and associations evaluated between values at baseline with two-year changes in tri-compartmental joint space. Upon follow-up, knee joint health worsened, particularly among seven Service members who presented at baseline with no joint degeneration (KL = 0) but returned with evidence of degeneration (KL ≥ 1). Joint space narrowing was associated with greater patellar tilt (r[12] = 0.71, p = 0.01), external knee adduction moment (r[13] = 0.64, p = 0.02), knee adduction moment impulse (r[13] = 0.61, p = 0.03), and CTX-1 concentration (r[11] = 0.83, p = 0.001), as well as lesser KOOSSport and VR-36General Health (r[16] = - 0.69, p = 0.01 and r[16] = - 0.69, p = 0.01, respectively). This longitudinal, multi-disciplinary investigation highlights the importance of a comprehensive approach to evaluate the fast-progressing onset of knee osteoarthritis, particularly among relatively young Service members with lower limb loss.

Reduced Achilles tendon stiffness in aging persists at matched activations and associates with higher metabolic cost of walking.

The mechanisms responsible for increased walking metabolic cost among older adults are poorly understood. We recently proposed a theoretical premise by which age-related reductions in Achilles tendon stiffness (k AT ) can disrupt the neuromechanics of calf muscle behavior and contribute to faster rates of oxygen consumption during walking. The purpose of this study was to objectively evaluate this premise. We quantified k AT at a range of matched activations prescribed using electromyographic biofeedback and walking metabolic cost in a group of 15 younger (age: 23±4 yrs) and 15 older adults (age: 72±5 yrs). Older adults averaged 44% less k AT than younger adults at matched triceps surae activations (p=0.046). This effect appeared to arise not only from altered tendon length-tension relations with age, but also from differences in the operating region of those length-tension relations between younger and older adults. Older adults also walked with a 17% higher net metabolic power than younger adults (p=0.017). In addition, we discovered empirical evidence that lesser k AT exacts a metabolic penalty and was positively correlated with higher net metabolic power during walking (r=-0.365, p=0.048). These results pave the way for interventions focused on restoring ankle muscle-tendon unit structural stiffness to improve walking energetics in aging.

American Society of Biomechanics Journal of Biomechanics Award 2021: Exploring the Functional Boundaries and Metabolic Consequences of Triceps Surae Force-Length Relations during Walking.

The relationship between individual muscle dynamics and whole-body metabolic cost is not well established. Here we use biofeedback to modulate triceps surae (TS) activity during walking to test the following hypotheses based on basic principles of muscle physiology: (1) increased TS activity would increase metabolic cost via shorter muscle fascicle lengths and thus reduced force capacity and (2) decreased TS activity would decrease metabolic cost via longer muscle fascicle lengths and thus increased force capacity. 23 young adults walked on an instrumented treadmill at 1.25 m/s using electromyographic (EMG) biofeedback to match targets corresponding to ±20 and ±40% TS activity during push-off (late stance). B-mode ultrasound imaged the medial gastrocnemius (MG). Participants increased net metabolic power up to 85% and 21% when targeting increased and decreased TS activity, respectively (p < 0.001). At the instant of peak gastrocnemius force, MG fascicle length was 7% shorter (p < 0.001) and gastrocnemius force was 6% larger (p < 0.001) when targeting + 40% TS activity. Fascicle length was 3% shorter (p = 0.004) and force was 7% lower (p = 0.010) when targeting -40% TS activity; participants were unable to achieve decreased activation targets. MG fascicle length and activity mediated 11.7% (p = 0.036) and 57.2% (p = 0.006) of the changes in net metabolic power, respectively. MG force did not mediate changes in net metabolic power (p = 0.948). These findings suggest that changes in the functional operating length of muscle, induced here by volitional changes in TS activity, mediated changes in the metabolic cost of walking, relatively independently of force. Thus, shifts to shorter fascicle lengths (e.g., aging) may mediate activity-induced increases in metabolic cost.

A Comprehensive, Multidisciplinary Assessment for Knee Osteoarthritis Following Traumatic Unilateral Lower Limb Loss in Service Members.

INTRODUCTION: Knee osteoarthritis (KOA) is a primary source of long-term disability and decreased quality of life (QoL) in service members (SM) with lower limb loss (LL); however, it remains difficult to preemptively identify and mitigate the progression of KOA and KOA-related symptoms. The objective of this study was to explore a comprehensive cross-sectional evaluation, at the baseline of a prospective study, for characterizing KOA in SM with traumatic LL. MATERIALS AND METHODS: Thirty-eight male SM with traumatic unilateral LL (23 transtibial and 15 transfemoral), 9.5 ± 5.9 years post-injury, were cross-sectionally evaluated at initial enrollment into a prospective, longitudinal study utilizing a comprehensive evaluation to characterize knee joint health, functionality, and QoL in SM with LL. Presences of medial, lateral, and/or patellofemoral articular degeneration within the contralateral knee were identified via magnetic resonance imaging(for medically eligible SM; Kellgren-Lawrence Grade [n = 32]; and Outerbridge classification [OC; n = 22]). Tri-planar trunk and pelvic motions, knee kinetics, along with temporospatial parameters, were quantified via full-body gait evaluation and inverse dynamics. Concentrations of 26 protein biomarkers of osteochondral tissue degradation and inflammatory activity were identified via serum immunoassays. Physical function, knee symptoms, and QoL were collected via several patient reported outcome measures. RESULTS: KOA was identified in 12 of 32 (37.5%; KL ≥ 1) SM with LL; however, 16 of 22 SM presented with patellofemoral degeneration (72.7%; OC ≥ 1). Service members with versus without KOA had a 26% reduction in the narrowest medial tibiofemoral joint space. Biomechanically, SM with versus without KOA walked with a 24% wider stride width and with a negative correlation between peak knee adduction moments and minimal medial tibiofemoral joint space. Physiologically, SM with versus without KOA exhibited elevated concentrations of pro-inflammatory biomarker interleukin-7 (+180%), collagen breakdown markers collagen II cleavage (+44%), and lower concentrations of hyaluronic acid (-73%) and bone resorption biomarker N-telopeptide of Type 1 Collagen (-49%). Lastly, there was a negative correlation between patient-reported contralateral knee pain severity and patient-reported functionality and QoL. CONCLUSIONS: While 37.5% of SM with LL had KOA at the tibiofemoral joint (KL ≥ 1), 72.7% of SM had the presence of patellofemoral degeneration (OC ≥ 1). These findings demonstrate that the patellofemoral joint may be more susceptible to degeneration than the medial tibiofemoral compartment following traumatic LL.

Multimodal Diagnostic Approaches to Advance Precision Medicine in Sarcopenia and Frailty.

Sarcopenia, defined as the loss of muscle mass, strength, and function with aging, is a geriatric syndrome with important implications for patients and healthcare systems. Sarcopenia increases the risk of clinical decompensation when faced with physiological stressors and increases vulnerability, termed frailty. Sarcopenia develops due to inflammatory, hormonal, and myocellular changes in response to physiological and pathological aging, which promote progressive gains in fat mass and loss of lean mass and muscle strength. Progression of these pathophysiological changes can lead to sarcopenic obesity and physical frailty. These syndromes independently increase the risk of adverse patient outcomes including hospitalizations, long-term care placement, mortality, and decreased quality of life. This risk increases substantially when these syndromes co-exist. While there is evidence suggesting that the progression of sarcopenia, sarcopenic obesity, and frailty can be slowed or reversed, the adoption of broad-based screening or interventions has been slow to implement. Factors contributing to slow implementation include the lack of cost-effective, timely bedside diagnostics and interventions that target fundamental biological processes. This paper describes how clinical, radiographic, and biological data can be used to evaluate older adults with sarcopenia and sarcopenic obesity and to further the understanding of the mechanisms leading to declines in physical function and frailty.

Reduced Achilles Tendon Stiffness Disrupts Calf Muscle Neuromechanics in Elderly Gait.

Older adults walk slower and with a higher metabolic energy expenditure than younger adults. In this review, we explore the hypothesis that age-related declines in Achilles tendon stiffness increase the metabolic cost of walking due to less economical calf muscle contractions and increased proximal joint work. This viewpoint may motivate interventions to restore ankle muscle-tendon stiffness, improve walking mechanics, and reduce metabolic cost in older adults.

Mechanics and energetics of human feet: a contemporary perspective for understanding mobility impairments in older adults.

Much of our current understanding of age-related declines in mobility has been aided by decades of investigations on the role of muscle-tendon units spanning major lower extremity joints (e.g., hip, knee and ankle) for powering locomotion. Yet, mechanical contributions from foot structures are often neglected. This is despite the emerging evidence for their critical importance in youthful locomotion. With rapid growth in the field of human foot biomechanics over the last decade, our theoretical knowledge of young asymptomatic feet has transformed, from long-held views of a stiff lever and a shock-absorber to a versatile system that can modulate mechanical power and energy output to accommodate various locomotor task demands. In this perspective review, we predict that the next set of impactful discoveries related to locomotion in older adults will emerge by integrating the novel tools and approaches that are currently transforming the field of human foot biomechanics. By illuminating the functions of feet in older adults, we envision that future investigations will refine our mechanistic understanding of mobility deficits affecting our aging population, which may ultimately inspire targeted interventions to rejuvenate the mechanics and energetics of locomotion.

The metabolic and mechanical consequences of altered propulsive force generation in walking.

Older adults walk with greater metabolic energy consumption than younger for reasons that are not well understood. We suspect that a distal-to-proximal redistribution of leg muscle demand, from muscles spanning the ankle to those spanning the hip, contributes to greater metabolic energy costs. Recently, we found that when younger adults using biofeedback target smaller than normal peak propulsive forces (FP), they do so via a similar redistribution of leg muscle demand during walking. This alludes to an experimental paradigm that emulates characteristics of elderly gait independent of other age-related changes relevant to metabolic energy cost. Thus, our purpose was to quantify the metabolic and limb- and joint-level mechanical energy costs associated with modulating propulsive forces during walking in younger adults. Walking with larger FP increased net metabolic power by 47% (main effect, p = 0.001), which was accompanied by small by relatively uniform increases in hip, knee, and ankle joint power and which correlated with total joint power (R2 = 0.151, p = 0.019). Walking with smaller FP increased net metabolic power by 58% (main effect, p < 0.001), which was accompanied by higher step frequencies and increased total joint power due to disproportionate increases in hip joint power. Increases in hip joint power when targeting smaller than normal FP accounted for more than 65% of the variance in the measured changes in net metabolic power. Our findings suggest that walking with a diminished push-off exacts a metabolic penalty because of higher step frequencies and more total limb work due to an increased demand on proximal leg muscles.

Automated analysis of medial gastrocnemius muscle-tendon junction displacements in heathy young adults during isolated contractions and walking using deep neural networks.

BACKGROUND AND OBJECTIVE: Direct measurement of muscle-tendon junction (MTJ) position is important for understanding dynamic tendon behavior and muscle-tendon interaction in healthy and pathological populations. Traditionally, obtaining MTJ position during functional activities is accomplished by manually tracking the position of the MTJ in cine B-mode ultrasound images - a laborious and time-consuming process. Recent advances in deep learning have facilitated the availability of user-friendly open-source software packages for automated tracking. However, these software packages were originally intended for animal pose estimation and have not been widely tested on ultrasound images. Therefore, the purpose of this paper was to evaluate the efficacy of deep neural networks to accurately track medial gastrocnemius MTJ positions in cine B-mode ultrasound images across tasks spanning controlled loading during isolated contractions to physiological loading during treadmill walking. METHODS: Cine B-mode ultrasound images of the medial gastrocnemius MTJ were collected from 15 subjects (6M/9F, 23 yr, 71.9 kg, 1.8 m) during treadmill walking at 1.25 m/s and during maximal voluntary isometric plantarflexor contractions (MVICs). Five deep neural networks were trained using 480 manually-labeled images collected during walking, defined as the ground truth, and were then used to predict MTJ position in images from novel subjects: 1) during walking (novel-subject) and 2) during MVICs (novel-condition). RESULTS: We found an average mean absolute error of 1.26±1.30 mm and 2.61±3.31 mm between the ground truth and predicted MTJ positions in the novel-subject and novel-condition evaluations, respectively. CONCLUSIONS: Our results provide support for the use of open-source software for creating deep neural networks to reliably track MTJ positions in B-mode ultrasound images. We believe this approach to MTJ position tracking is an accessible and time-saving solution, with broad applications for many fields, such as rehabilitation or clinical diagnostics.

Effects of age and locomotor demand on foot mechanics during walking.

Older adults exhibit reductions in push-off power that are often attributed to deficits in plantarflexor force-generating capacity. However, growing evidence suggests that the foot may also contribute to push-off power during walking. Thus, age-related changes in foot structure and function may contribute to altered foot mechanics and ultimately reduced push-off power. The purpose of this paper was to quantify age-related differences in foot mechanical work during walking across a range of speeds and at a single fixed speed with varied demands for push-off power. 9 young and 10 older adults walked at 1.0, 1.2, and 1.4 m/s, and at 1.2 m/s with an aiding or impeding horizontal pulling force equal to 5% BW. We calculated foot work in Visual3D using a unified deformable foot model, accounting for contributions of structures distal to the hindfoot's center-of-mass. Older adults walked while performing less positive foot work and more negative net foot work (p < 0.05). Further, we found that the effect of age on mechanical work performed by the foot and the ankle-foot complex increased with increased locomotor demand (p < 0.05). Our findings suggest that during walking, age-related differences in foot mechanics may contribute to reduced push-off intensity via greater energy loss from distal foot structures, particularly during walking tasks with a greater demand for foot power generation. These findings are the first step in understanding the role of the foot in push-off power deficits in older adults and may serve as a roadmap for developing future low-cost mobility interventions.

Habitual endurance running does not mitigate age-related differences in gait kinetics.

Older adults often walk with smaller ankle joint kinetics and larger hip joint kinetics compared to young adults. These age-related differences have been attributed, in part, to weaker plantarflexor muscles. While it is thought that regular physical activity helps to maintain muscle strength and mobility in older adults, physical activity levels on average decline with age. Therefore, understanding the effect of physical activity level on gait kinetics is an important objective for the management of mobility impairment in older adults. The purpose of this study was determine the effect of habitual endurance running on lower-extremity joint kinetics. 12 male older long-term runners (67 ± 5 yrs., 1.79 ± 0.07 m, 77.3 ± 13.7 kg) and 12 male older non-runners (70 ± 3 yrs., 1.78 ± 0.06 m, 79.68 ± 10.6 kg), performed overground walking trials at 1.3 m/s while kinematic and kinetic data were collected. Participants also performed maximal voluntary contractions at the hip, knee, and ankle joints on an isokinetic dynamometer. Older runners displayed similar ankle plantarflexor strength, similar hip extensor strength, and greater knee extensor strength compared to older non-runners, and walked with similar ankle joint kinetics (p > 0.05), and larger hip joint kinetics compared to older non-runners (p < 0.05). Thus, physical activity, in the form of running at least 20 miles/wk. and training for at least one race per year, did not mitigate the characteristic age-related differences in gait kinetics. Our findings may indicate that age-related differences in lower-extremity gait kinetics are a normal consequence of natural aging.

Medial knee cartilage is unlikely to withstand a lifetime of running without positive adaptation: a theoretical biomechanical model of failure phenomena.

Runners on average do not have a high risk of developing knee osteoarthritis, even though running places very high loads on the knee joint. Here we used gait analysis, musculoskeletal modeling, and a discrete-element model of knee contact mechanics to estimate strains of the medial knee cartilage in walking and running in 22 young adults (age 23 ± 3 years). A phenomenological model of cartilage damage, repair, and adaptation in response to these strains then estimated the failure probability of the medial knee cartilage over an adult lifespan (age 23-83 years) for 6 km/day of walking vs. walking and running 3 km/day each. With no running, by age 55 the cumulative probability of medial knee cartilage failure averaged 36% without repair and 13% with repair, similar to reports on incidence of knee osteoarthritis in non-obese adults with no knee injuries, but the probability for running was very high without repair or adaptation (98%) and remained high after including repair (95%). Adaptation of the cartilage compressive modulus, cartilage thickness, and the tibiofemoral bone congruence in response to running (+1.15 standard deviations of their baseline values) was necessary for the failure probability of walking and running 3 km/day each to equal the failure probability of walking 6 km/day. The model results suggest two conclusions for further testing: (i) unlike previous findings on the load per unit distance, damage per unit distance on the medial knee cartilage is greater in running vs. walking, refuting the "cumulative load" hypothesis for long-term joint health; (ii) medial knee cartilage is unlikely to withstand a lifetime of mechanical loading from running without a natural adaptation process, supporting the "cartilage conditioning" hypothesis for long-term joint health.

Older Adults Overcome Reduced Triceps Surae Structural Stiffness to Preserve Ankle Joint Quasi-Stiffness During Walking.

Ankle joint quasi-stiffness is an aggregate measure of the interaction between triceps surae muscle stiffness and Achilles tendon stiffness. This interaction may be altered due to age-related changes in the structural properties and functional behavior of the Achilles tendon and triceps surae muscles. The authors hypothesized that, due to a more compliant of Achilles' tendon, older adults would exhibit lower ankle joint quasi-stiffness than young adults during walking and during isolated contractions at matched triceps surae muscle activations. The authors also hypothesized that, independent of age, triceps surae muscle stiffness and ankle joint quasi-stiffness would increase with triceps surae muscle activation. The authors used conventional gait analysis in one experiment and, in another, electromyographic biofeedback and in vivo ultrasound imaging applied during isolated contractions. The authors found no difference in ankle joint quasi-stiffness between young and older adults during walking. Conversely, this study found that (1) young and older adults modulated ankle joint quasi-stiffness via activation-dependent changes in triceps surae muscle length-tension behavior and (2) at matched activation, older adults exhibited lower ankle joint quasi-stiffness than young adults. Despite age-related reductions during isolated contractions, ankle joint quasi-stiffness was maintained in older adults during walking, which may be governed via activation-mediated increases in muscle stiffness.

Effects of Self-Selected Step Length and Trunk Position on Joint Kinetics in Highly Physically Fit Older Adults.

The causes of age-related differences in lower-extremity joint moments and powers are unknown. The purpose of this study was to determine the effects of highly physically active older adults walking with (1) a step length similar to young adults and (2) an upright trunk posture, on hip and ankle joint kinetics. The authors hypothesized that, compared with their self-selected walking mechanics, older adults would exhibit decreased hip kinetics and increased ankle kinetics when prescribed a young adult step length, and would exhibit decreased hip extension moments when maintaining an upright trunk posture during walking. A total of 12 active older adults (67 [5] y) and 13 active young adults (21 [3] y) walked at 1.3 m/s. The older adults also walked at 1.3 m/s with step lengths prescribed from height-matched young adults and, in a separate condition, walked with an upright trunk. The older adults did not display larger ankle kinetics or smaller hip kinetics in either condition compared to walking with a self-selected step length. These findings indicate that step length and trunk position do not primarily contribute to age-related differences in kinetics in highly active older adults and should serve as a starting point for investigating alternative explanations.

Relationships between mediolateral trunk-pelvic motion, hip strength, and knee joint moments during gait among persons with lower limb amputation.

BACKGROUND: Repeated exposures to larger lateral trunk-pelvic motion and features of knee joint loading likely influence the onset of low back pain and knee osteoarthritis among persons with lower-limb amputation. Decreased hip abductor strength can also influence frontal plane trunk-pelvic motion and knee moments; however, it is unclear how these are inter-related post-amputation. METHODS: Twenty-four participants with unilateral lower-limb amputation (14 transtibial; 10 transfemoral) and eight uninjured controls walked at 1.3 m/s while full-body biomechanical data were captured. Multiple linear regression and Cohen's f2 predicted (P < 0.05) the influences of mediolateral trunk and pelvic ranges of motion and angular accelerations, and bilateral isometric hip abductor strength on peak (intact) knee adduction moment and loading rate. FINDINGS: There were no group differences in hip strength, peak knee adduction moment or pelvis acceleration (p > 0.06). The combination of hip strength, and mediolateral trunk and pelvic motion did not predict (F(5,29) = 2.53, p = 0.06, adjusted R2 = 0.27, f2 = 0.08) peak knee adduction moment. However, the combination of hip strength and trunk and pelvis acceleration predicted knee adduction moment loading rate (F(7,29) = 3.59, p = 0.008, adjusted R2 = 0.45, f2 = 0.25), with peak trunk acceleration (ß = 0.72, p = 0.008) and intact hip strength (ß = 0.78, p = 0.008) significantly contributing to the model. INTERPRETATION: These data suggest increased hip abductor strength counteracts increased lateral trunk acceleration, concomitantly influencing the rate at which the ground reaction force vector loads the intact knee joint. Persons with lower-limb amputation perhaps compensate for increased intact limb loading by increasing trunk motion, thereby increasing demand on hip abductors to attenuate this preferential loading.

Knee adduction moment peak and impulse do not change during the first six months of walking with a prosthesis.

BACKGROUND: Individuals with unilateral lower limb loss are at increased risk for developing knee osteoarthritis in their contralateral limb. The mechanisms underlying this phenomenon are unknown, but large or unusual loads on the limb are thought to contribute to osteoarthritis development. Yet, to our knowledge, there have been no longitudinal assessments of knee joint kinetics to assist with identifying the origin or progression of such loads. RESEARCH QUESTION: This study aimed to examine knee joint kinetics of individuals with lower limb loss as a function of time from independent ambulation. METHODS: Eight male Service Members with unilateral lower limb loss (3 transfemoral/5 transtibial) completed gait analyses, walking at self-selected speed and cadence, at 0, 2, and 6 months following initial independent ambulation. RESULTS: Although there was a significant time effect on stride length (p = 0.047), there were no pairwise differences (all p ≥ 0.152). Additionally, there was not a significant effect of time on the peak (p = 0.666), loading rate (p = 0.336), or impulse (p = 0.992) of knee adduction moment (KAM), peak knee flexion moment (KFM) (p = 0.128), or the peak (p = 0.485) or loading rate (p = 0.130) of vertical ground reaction force (VGRF). SIGNIFICANCE: The results of the current study demonstrate that major features of knee joint loading do not change over the first 6 months of independently walking with a prosthesis. The magnitude of these loads are similar to loads observed in individuals with lower limb loss further from injury/initial ambulation, but the present results do not imply that no changes occur after 6 months.

Medial knee joint contact force in the intact limb during walking in recently ambulatory service members with unilateral limb loss: a cross-sectional study.

BACKGROUND: Individuals with unilateral lower limb amputation have a high risk of developing knee osteoarthritis (OA) in their intact limb as they age. This risk may be related to joint loading experienced earlier in life. We hypothesized that loading during walking would be greater in the intact limb of young US military service members with limb loss than in controls with no limb loss. METHODS: Cross-sectional instrumented gait analysis at self-selected walking speeds with a limb loss group (N = 10, age 27 ± 5 years, 170 ± 36 days since last surgery) including five service members with transtibial limb loss and five with transfemoral limb loss, all walking independently with their first prosthesis for approximately two months. Controls (N = 10, age 30 ± 4 years) were service members with no overt demographical risk factors for knee OA. 3D inverse dynamics modeling was performed to calculate joint moments and medial knee joint contact forces (JCF) were calculated using a reduction-based musculoskeletal modeling method and expressed relative to body weight (BW). RESULTS: Peak JCF and maximum JCF loading rate were significantly greater in limb loss (184% BW, 2,469% BW/s) vs. controls (157% BW, 1,985% BW/s), with large effect sizes. Results were robust to probabilistic perturbations to the knee model parameters. DISCUSSION: Assuming these data are reflective of joint loading experienced in daily life, they support a "mechanical overloading" hypothesis for the risk of developing knee OA in the intact limb of limb loss subjects. Examination of the evolution of gait mechanics, joint loading, and joint health over time, as well as interventions to reduce load or strengthen the ability of the joint to withstand loads, is warranted.

Knee Joint Loading during Single-Leg Forward Hopping.

Increased or abnormal loading on the intact limb is thought to contribute to the relatively high risk of knee osteoarthritis in this limb for individuals with unilateral lower limb loss. This theory has been assessed previously by studying walking, but knee joint loading during walking is often similar between individuals with and without limb loss, prompting assessment of other movements that may place unusual loads on the knee. One such movement, hopping, is a form of locomotion that individuals with unilateral lower limb loss may situationally use instead of walking, but the mechanical effects of hopping on the intact limb are unknown. PURPOSE: Compare knee joint kinetics of healthy adults during single-leg forward hopping compared to walking, a more traditional form of locomotion. METHODS: Twenty-four healthy adults walked and hopped at self-selected speeds of 1.5 and 2.3 m·s, respectively. Joint moments were calculated using inverse dynamics. A paired Student's t-test was utilized to compare peak, impulse, and loading rate (LR) of knee adduction moment (KAM), and peak knee flexion moment (KFM) between walking and hopping. RESULTS: Peak KFM and KAM LR were greater during hopping compared to walking (peak KFM: 20.73% vs 5.51% body weight (BW) × height (Ht), P < 0.001; KAM LR: 0.47 vs. 0.33 BW·Ht·s, P = 0.01). CONCLUSIONS: Kinetic measures affecting knee joint loading are greater in hopping compared to walking. It may be advisable to limit single-leg forward hopping in the limb loss population until it is known if these loads increase knee osteoarthritis risk.

The relationships between muscle force steadiness and visual steadiness in young and old adults.

Since vision is used in studies of muscle force control, reduced muscle force control might be related to reduced visual ability. We investigated relationships between steadiness in eye movements and quadriceps muscle torque (a surrogate for force) during isometric contractions of constant and varying torques. Nineteen young adults with an average age of 20.7 years and 18 old adults with an average age of 71.6 years performed three vision tasks, three vision and torque tasks at 40% maximal voluntary contraction (MVC), and three vision and torque tasks at 54 nm. Age groups had identical torque steadiness (CV) in 40%-MVC and 54-nm conditions (p > .05). Old had similar vertical (p > .05) but decreased horizontal visual steadiness (SD) (p < .05) compared with young. Correlations between visual steadiness and muscle torque steadiness failed to show a significant relationship (p > .05). We were unable to identify a substantial relationship between muscle torque steadiness and eye movement, as a component of visual steadiness, and conclude that reduced visual steadiness does not contribute to reduced muscle torque steadiness.