Poincaré analysis detects pathological limb loading rate variability in post-anterior cruciate ligament reconstruction individuals.

BACKGROUND: Post-ACLR individuals can experience repeated exposure to variable limb loading, which contributes to development of knee osteoarthritis. Variable limb loading can present as loading rate variability (LRV) and is magnified during tasks like fast walking when the system is stressed. Nonlinear measures that evaluate temporal variability have successfully detected changes in gait variability associated with altered motor control, however, appropriately describing and uncovering the nature of gait variability has been challenging. Here, Poincaré analysis, a nonlinear method unique in its ability to capture different aspects of variability, served to uncover and quantify changes in limb LRV. It was hypothesized that post-ACLR individuals' overloaded limbs would quantitatively and graphically demonstrate greater short-term stride-to-stride and long-term limb LRV during fast walking compared to the underloaded and healthy control limbs. METHODS: Fourteen post-ACLR individuals and fourteen healthy controls completed a walking protocol on an instrumented treadmill where they walked at 1.0 m/s and 1.5 m/s for 5-minutes each. A Welch's test was performed to compare differences in short-term and long-term LRV metrics for the post-ACLR individuals' overloaded and underloaded limbs and the healthy controls' right limbs. RESULTS: Analyses revealed that the post-ACLR individuals' overloaded limb exhibited significantly greater short-term and long-term values compared to the underloaded and healthy control limbs at 1.5 m/s (p<0.05). Additionally, the loading rate data was widely scattered across the plots for the overloaded limb, indicating greater LRV. SIGNIFICANCE: Poincaré analysis successfully identified that post-ACLR overloaded limbs exhibited impaired motor control during fast walking based on quantitative and graphical changes in variability. This highlights the clinical applications of Poincaré analysis, with the plots potentially serving as an easy-to-interpret diagnostic tool for pathological limb LRV.

Classification Model for Differentiating Post-ACLR Individuals Using Loading Rate Variation.

In post-ACLR individuals, gait variability often represents the presence of altered motor control. Quantifying variable limb loading is challenging, yet nonlinear analyses have been successful in detecting changes in gait variability due to altered motor control. Here, nonlinear metrics were derived and used to train multiple machine learning models to classify between healthy controls and post-ACLR individuals. The metrics were extracted from individuals' vertical ground reaction force data during a fast-walking trial as variable limb loading is exacerbated when the system is stressed and being challenged. It was hypothesized that effective differentiation between healthy control and post-ACLR individuals would be achieved using machine learning models derived from limb loading rate variability measures. Seventeen healthy control and fourteen post-ACLR participants with measured between-limb loading rate asymmetries completed the walking protocol. Ground reaction force data was collected on an instrumented treadmill where they performed walking trials at 1.5 m/s. Nonlinear limb loading rate measures extracted from the healthy controls and post-ACLR participants' data served as inputs to the models in order to train them to distinguish between the two states. A Decision Tree Classifier that utilized a bagging strategy was the best model for distinguishing between healthy control and post-ACLR participants. The model was successful in classifying participants, reporting an accuracy score of 73%, precision score of 100%, and an AUC score of 0.77, despite the smaller dataset. The ability to detect and classify post-ACLR loading rate variation has significant clinical implications, as these methods could be implemented in clinical settings to diagnose pathological limb loading dynamics and/or altered motor control.Clinical Relevance- This classification model can be easily integrated into the clinic to help diagnose pathological limb loading based solely on vertical ground reaction forces and can aid clinicians in providing data-driven metrics to help inform rehabilitation decisions.

Effect of Purposely Induced Asymmetric Walking Perturbations on Limb Loading After Anterior Cruciate Ligament Reconstruction.

Background: Patients often sustain prolonged neuromuscular dysfunction after anterior cruciate ligament reconstruction (ACLR). This dysfunction can present as interlimb loading rate asymmetries linked to reinjury and knee osteoarthritis progression. Purpose/Hypothesis: To evaluate how asymmetric walking protocols can reduce interlimb loading rate asymmetry in patients after ACLR. It was hypothesized that asymmetric walking perturbations would (1) produce a short-term adaptation of interlimb gait symmetry and (2) induce the temporary storage of these new gait patterns after the perturbations were removed. Study Design: Descriptive laboratory study. Methods: Fifteen patients who had undergone ACLR were asked to perform an asymmetric walking protocol during the study period (2022-2023). First, to classify each limb as overloaded or underloaded based on the vertical ground-reaction force loading rate for each limb, participants were asked to perform baseline symmetric walking trials. Participants then performed an asymmetric walking trial for 10 minutes, where one limb was moving 0.5 m/s faster than the other limb (1 vs 1.5 m/s), followed by a 2-minute 1 m/s symmetric deadaptation walking trial. This process was repeated with the limb speeds switched for a second asymmetric trial. Results: Participants adopted a new, symmetric interlimb loading rate gait pattern over time in response to the asymmetric trial, where the overloaded limb was set at 1 m/s. A linear mixed-effects model detected a significant change in gait dynamics (P < .001). The participants exhibited negative aftereffects after this asymmetric perturbation, indicating the temporary storage of the new gait pattern. No positive short-term gait adaptation or storage was observed when the overloaded limb was set to a faster speed. Conclusion: Asymmetric walking successfully produced the short-term adaptation of interlimb loading rate symmetry in patients after ACLR and induced the temporary storage of these gait patterns in the initial period when the perturbation was removed. Clinical Relevance: These findings are promising, as they suggest that asymmetric walking could serve as an effective gait retraining protocol that has the potential to improve long-term outcomes in patients after ACLR.

Time series modeling characterizes stride time variability to identify individuals with neurodegenerative disorders.

The progressive death and dysfunction of neurons causes altered stride-to-stride variability in individuals with Amyotrophic Lateral Sclerosis (ALS) and Huntington's Disease (HD). Yet these altered gait dynamics can manifest differently in these populations based on how and where these neurodegenerative disorders attack the central nervous system. Time series analyses can quantify differences in stride time variability which can help contribute to the detection and identification of these disorders. Here, autoregressive modeling time series analysis was utilized to quantify differences in stride time variability amongst the Controls, the individuals with ALS, and the individuals with HD. For this study, fifteen Controls, 12 individuals with ALS and 15 individuals with HD walked up and down a hallway continuously for 5-min. Participants wore force sensitive resistors in their shoes to collect stride time data. A second order autoregressive (AR) model was fit to the time series created from the stride time data. The mean stride time and two AR model coefficients served as metrics to identify differences in stride time variability amongst the three groups. The individuals with HD walked with significantly greater stride time variability indicating a more chaotic gait while the individuals with ALS adopted more ordered, less variable stride time dynamics (p < 0.001). A plot of the stride time metrics illustrated how each group exhibited significantly different stride time dynamics. The stride time metrics successfully quantified differences in stride time variability amongst individuals with neurodegenerative disorders. This work provided valuable insight about how these neuromuscular disorders disrupt motor coordination leading to the adoption of new gait dynamics.

A new metric for characterizing limb loading dynamics in post anterior cruciate ligament reconstruction individuals.

BACKGROUND: Unresolved neuromuscular deficits often persist in post-anterior cruciate ligament reconstruction (ACLR) individuals manifesting as altered impact and active peak force production during running that can contribute to detrimental limb loading. Elevated impact and active peaks are common in pathological populations indicating a stiffer limb loading strategy. Although impact and active peaks are sensitive to changes in limb loading, to our knowledge, there are no established, standardized measures or cutoff criteria to differentiate between healthy and pathological limb loading. However, prior studies have demonstrated that the ratio between traditional biomechanical measures can be used to successfully establish quantifiable and graphical ranges to delineate between healthy and pathological movement. RESEARCH QUESTION: Therefore, this study sought to exploit the impact-to-active peak ratio to generate a new, standardized metric to quantify and characterize limb loading dynamics in healthy controls and post-ACLR individuals during running. METHODS: Twenty-eight post-ACLR individuals and 18 healthy controls performed a running protocol. Impact peak and active peak data were extracted from their strides as they ran at a self-selected speed. A linear regression model was fit to the healthy control data and the models 95 % prediction intervals were used to define a boundary region of healthy limb loading dynamics. RESULTS: The post-ACLR individuals produced a higher impact-to-active peak ratio than the healthy controls indicating that they adopted a stiffer limb loading strategy. The boundary regions derived from the impact and active peak model successfully classified the healthy controls and post-ACLR individual's limb loading dynamics with an accuracy, sensitivity, and specificity of 89 %, 100 %, and 75 %, respectively. SIGNIFICANCE: The ability to effectively evaluate limb loading dynamics using impact and active peaks can provide clinicians with a new, non-invasive metric to quantify and characterize healthy and pathological movement in a clinical setting.

Differing hypertrophy patterns from open and closed kinetic chain training affect quadriceps femoris center of mass and moment of inertia.

Purpose: To determine whether kinetic chain pattern during knee extensor strength training influences quadriceps femoris center of mass and moment of inertia about the hip in a predictable manner as such changes can affect running economy. Methods: Twelve participants completed 8 weeks of both unilateral open (OKC) and closed (CKC) kinetic chain resistance training on opposing legs. Changes in quadriceps femoris muscle volume (VOLQF), center of mass location (CoMQF), and moment of inertia (I QF) about the hip were determined from magnetic resonance images scans. Regional hemodynamics of the vastus lateralis taken at 30% and 70% of muscle length during OKC and CKC bouts early in the training program were measured using near-infrared spectroscopy (NIRS) and used post hoc to predict changes in CoMQF. Results: While increases in VOLQF were similar between OKC (Δ79.5 ± 87.9 cm3) and CKC (Δ60.2 ± 110.5 cm3, p = 0.29), the patterns of hypertrophy differed; a distal shift in CoMQF (Δ2.4 ± 0.4 cm, p < 0.001) and increase in I QF (Δ0.017 ± 0.014 kg m2, p < 0.001) occurred in OKC but not in CKC (CoMQF: Δ-2.2 ± 2.0 cm, I QF: Δ-0.022 ± 0.020 kg m2, p > 0.05). Regional hemodynamics assessed by NIRS during a single training session displayed similar exercise and regional differences and predicted 39.6% of observed changes in CoMQF. Conclusions: Exercise selection influences muscle shape sufficiently to affect CoMQF and I QF, and these changes may be predicted in part from NIRS measurements during a single workout. Given I QF is inversely related to running economy and since CKC exercise provides a more proximal pattern of hypertrophy than OKC, it may be more preferential for running. The results from the present study also highlight the potential of NIRS as a tool for predicting patterns of hypertrophy between different exercises and exercise conditions.

Classification Model for Discriminating Trunk Fatigue During Running.

PURPOSE: Fatigue is often associated with increased injury risk. Many studies have focused on fatigue in the lower extremity muscles brought on by running, yet few have examined the relationship between fatigue of the core musculature and associated changes in running gait. To investigate the relationship between trunk fatigue and running dynamics, this study had two goals: (1) to use machine learning to determine which gait parameters are most associated with trunk fatigue; and (2) to develop a machine learning algorithm that uses those parameters to classify individuals with trunk fatigue. We hypothesized that we could effectively differentiate between the non-fatigued and fatigued states using machine learning models derived from running gait parameters. METHODS: Seventy-two individuals performed a trunk fatigue protocol. Lower extremity running biomechanics were collected pre- and post- the trunk fatigue protocol using an instrumented treadmill and 10-camera motion capture system.The fatiguing protocol involved executing a series of trunk fatiguing exercises until established fatigue criteria were reached. Gait variables extracted from the non-fatigued and fatigued states served as model inputs to aid in the development of the machine learning model that would distinguish between non-fatigued and fatigued running. RESULTS: The machine learning protocol determined three variables - stance time, maximum propulsive GRF and maximum braking GRF - to be the best discriminators between non-fatigued and fatigued running. The SVM with Bagging was the best performing model that discriminated between non-fatigued and fatigued running with an accuracy of 82%, precision of 77%, recall of 90%, and area under the receiver operating curve of 0.91. CONCLUSION: The machine learning model was effective in classifying between non-fatigued and fatigued running using three gait parameters extracted from GRF waveforms. The ability to classify fatigue using these easy to measure GRF derived parameters enhances the ability for the model to be integrated into wearable technology and the clinical setting to aid in the detection of fatigue and potentially injury, as fatigue is often a precursor to injury.Clinical Relevance- This model has the potential to be implemented in a clinical setting to determine the onset of trunk fatigue through basic gait analysis, involving only the ground reaction forces. This model would be aimed toward injury prevention since fatigue is linked to increased risk of injury.

A Metric for Identifying Stress Fractures in Runners.

PURPOSE: Stress fractures are common overuse running injuries. Individuals with stress fractures exhibit running biomechanics characterized by elevated impact peak and loading rate. While elevated impact peak and loading rate are associated with stress fractures, there are few established metrics used to identify the presence of stress fractures in individuals. Here this study aims to exploit the linear relationship between the impact peak and loading rate to establish a metric to help identify individuals with stress fractures. We hypothesize that the ratio between the impact peak and loading rate will serve as a metric to delineate between healthy controls and those with stress fractures. METHODS: Fifteen healthy controls and 11 individuals with stress fractures performed a running protocol. A linear regression model fit to the stress fracture impact peak and loading rate data produced a lower 95% confidence limit boundary that served as the demarcation line between the two groups. RESULTS: Individuals with stress fractures tended to reside above the line with the line accurately classifying 82% of the individuals with stress fractures. CONCLUSION: The analysis supported the hypothesis and demonstrated how the relationship between impact peak and loading rate can help identify the presence of stress fractures in individuals.Clinical Relevance- The relationship between impact peak and loading rate has the potential to serve as clinically useful metric to identify stress fractures during running.

Force and Rate Metrics Provide Return-to-Sport Criterion after ACL Reconstruction.

PURPOSE: Peak vertical ground reaction force and linear loading rate can be valuable metrics for return-to-sport assessment because they represent limb loading dynamics; yet, there is no defined cutoff criterion to differentiate between healthy and altered limb loading. Studies have shown that healthy individuals exhibit strong first-order relationships between gait variables whereas individuals with pathological conditions did not. Thus, this study sought to explore and exploit this first-order relationship to define a region of healthy limb dynamics, which individuals with pathological conditions would reside outside of, to rapidly assess individuals with altered limb loading dynamics for return to sport. We hypothesized that there would be a strong first-order linear relationship between vertical ground reaction force peak force and linear loading rate in healthy controls' limbs, which could be exploited to identify abnormal limb loading dynamics in post-anterior cruciate ligament reconstruction (ACLR) individuals. METHODS: Thirty-one post-ACLR individuals and 31 healthy controls performed a running protocol. A first-order regression analysis modeled the relationship between peak vertical ground reaction forces and linear vertical ground reaction force loading rate in the healthy control limbs to define a region of healthy dynamics to evaluate post-ACLR reconstructed limb dynamics. RESULTS: A first-order regression model aided in the determination of cutoff criteria to define a region of healthy limb dynamics. Ninety percent of the post-ACLR reconstructed limbs exhibited abnormal limb dynamics based on their location outside of the region of healthy dynamics. CONCLUSION: This approach successfully delineated between healthy and abnormal limb loadings dynamics in controls and post-ACLR individuals. The findings demonstrate how force and loading rate-dependent metrics can help develop criteria for individualized post-ACLR return-to-sport assessment.

Characterizing gait pattern dynamics during symmetric and asymmetric walking using autoregressive modeling.

Gait asymmetry is often observed in populations with varying degrees of neuromuscular control. While changes in vertical ground reaction force (vGRF) peak magnitude are associated with altered limb loading that can be observed during asymmetric gait, the challenge is identifying techniques with the sensitivity to detect these altered movement patterns. Autoregressive (AR) modeling has successfully delineated between healthy and pathological gait during running; but has been little explored in walking. Thus, AR modeling was implemented to assess differences in vGRF pattern dynamics during symmetric and asymmetric walking. We hypothesized that the AR model coefficients would better detect differences amongst the symmetric and asymmetric walking conditions than the vGRF peak magnitude mean. Seventeen healthy individuals performed a protocol that involved walking on a split-belt instrumented treadmill at different symmetric (0.75m/s, 1.0 m/s, 1.5 m/s) and asymmetric (Side 1: 0.75m/s-Side 2:1.0 m/s; Side 1:1.0m/s-Side 2:1.5 m/s) gait conditions. Vertical ground reaction force peaks extracted during the weight-acceptance and propulsive phase of each step were used to construct a vGRF peak time series. Then, a second order AR model was fit to the vGRF peak waveform data to determine the AR model coefficients. The resulting AR coefficients were plotted on a stationarity triangle and their distance from the triangle centroid was computed. Significant differences in vGRF patterns were detected amongst the symmetric and asymmetric conditions using the AR modeling coefficients (p = 0.01); however, no differences were found when comparing vGRF peak magnitude means. These findings suggest that AR modeling has the sensitivity to identify differences in gait asymmetry that could aid in monitoring rehabilitation progression.

Classification of Post-Anterior Cruciate Ligament Reconstruction Running Dynamics using Non-Traditional Features.

Despite extensive rehabilitation, nearly half of all post-anterior cruciate ligament reconstruction (ACLR) individuals are unable to perform dynamic tasks at the level they did prior to their injury. This inability can be attributed to unresolved neuromuscular deficits that manifest as altered limb dynamics. While traditional discrete metrics; such as peak vertical ground reaction force (vGRF) and peak knee flexion angle, have been used to successfully differentiate between healthy and pathological running dynamics, recent studies have shown that non-traditional metrics derived from autoregressive (AR) modeling and Smoothed Pseudo Wigner-Ville (SPWV) analysis techniques can also successfully delineate between healthy and pathological populations and could potentially possess greater sensitivity than the traditional metrics. Thus, the objective of this study was to compare the performance of classification models generated from traditional and nontraditional metrics collected from healthy controls and post-ACLR individuals during a running protocol. We hypothesized that the non-traditional metric-based classification model would outperform the traditional metric based model. Thirty-one controls and 31 post-ACLR individuals performed a running protocol from which the traditional metrics - peak vGRF, linear vGRF loading rate and peak knee flexion angle - and nontraditional metrics - dynamic vGRF ratio, AR model coefficients, and a SPWV derived low frequency-high frequency ratio - were extracted from vGRF and knee flexion running waveforms. The results indicated that a fine Gaussian SVM classification model derived from the non-traditional metrics had an accuracy of 87%, specificity of 83% and sensitivity of 61% and it outperformed the classification model derived from traditional metrics. These findings indicate that additional, valuable information can be ascertained from non-traditional metrics that evaluate waveform dynamics. Additionally, it suggests that this or similar models can be used to track the restoration of healthy running dynamics in post-ACLR individuals during rehabilitation.

Autoregressive modeling to assess stride time pattern stability in individuals with Huntington's disease.

BACKGROUND: Huntington's disease (HD) is a progressive, neurological disorder that results in both cognitive and physical impairments. These impairments affect an individual's gait and, as the disease progresses, it significantly alters one's stability. Previous research found that changes in stride time patterns can help delineate between healthy and pathological gait. Autoregressive (AR) modeling is a statistical technique that models the underlying temporal patterns in data. Here the AR models assessed differences in gait stride time pattern stability between the controls and individuals with HD. Differences in stride time pattern stability were determined based on the AR model coefficients and their placement on a stationarity triangle that provides a visual representation of how the patterns mean, variance and autocorrelation change with time. Thus, individuals who exhibit similar stride time pattern stability will reside in the same region of the stationarity triangle. It was hypothesized that individuals with HD would exhibit a more altered stride time pattern stability than the controls based on the AR model coefficients and their location in the stationarity triangle. METHODS: Sixteen control and twenty individuals with HD performed a five-minute walking protocol. Time series' were constructed from consecutive stride times extracted during the protocol and a second order AR model was fit to the stride time series data. A two-sample t-test was performed on the stride time pattern data to identify differences between the control and HD groups. RESULTS: The individuals with HD exhibited significantly altered stride time pattern stability than the controls based on their AR model coefficients (AR1 p < 0.001; AR2 p < 0.001). CONCLUSIONS: The AR coefficients successfully delineated between the controls and individuals with HD. Individuals with HD resided closer to and within the oscillatory region of the stationarity triangle, which could be reflective of the oscillatory neuronal activity commonly observed in this population. The ability to quantitatively and visually detect differences in stride time behavior highlights the potential of this approach for identifying gait impairment in individuals with HD.

Autoregressive Modeling as Diagnostic Tool to Identify Postanterior Cruciate Ligament Reconstruction Limb Asymmetry.

Between-limb deficits in vertical ground reaction force (vGRF) production continue to remain years after anterior cruciate ligament rehabilitation, resulting in altered dynamic stability. However, the challenge is in identifying ways to assess this between-limb stability. This study implemented second-order autoregressive [AR(2)] modeling and its stationarity triangle to both quantitatively and visually delineate differences in dynamic stability from peak vGRF data in controls and post-anterior cruciate ligament reconstruction (ACLR) individuals during running. It was hypothesized that post-ACLR individuals would exhibit less dynamic stability than the controls, and that they would reside in a different location on the stationarity triangle, thus denoting differences in stability. The results presented supported the hypothesis that post-ACLR individuals exhibited significantly less dynamic stability than their control counterparts based on their model coefficients (AR1 P < .01; AR2 P = .02). These findings suggested that the post-ACLR individuals adopted a similar running pattern, possibly due to muscle weakness asymmetry, which was less dynamically stable and potentially places them at greater risk for injury. The ability of this approach to both quantitatively and visually delineate differences between these 2 groups indicates its potential as a return-to-sport decision tool.

Altered movement strategy of chronic ankle instability individuals with postural instability classified based on Nyquist and Bode analyses.

BACKGROUND: The aim of the current study was to assess movement strategies during a single leg balance in chronic ankle instability individuals with unstable postural control strategy identified by Nyquist and Bode analyses in conjunction with sample entropy. METHODS: Thirty-three participants with self-reported chronic ankle instability and 22 healthy controls performed single-leg eyes closed static balance trials. The sagittal and frontal plane kinematics in the lower extremity and trunk as well as center of pressure trajectories were recorded during three, 20-second trials. The Nyquist and Bode stability analyses, which classify center of pressure waveforms as stable based on the resulting gain and phase margins, were performed to identify the presence of postural control deficits. Sample entropy was implemented to analyze movement strategies during the task. FINDINGS: Based on the Nyquist and Bode stability analyses, we included 19 out of 33 chronic ankle instability participants with unstable postural control strategy and 16 out of 22 controls with stable postural control strategy in the final analyses. Chronic ankle instability participants demonstrated a significantly lower sample entropy value in sagittal and frontal plane trunk kinematics and sagittal plane hip kinematics compared to the controls. No between-group differences existed in other kinematic measures. INTERPRETATION: The lower sample entropy values in participants with chronic ankle instability indicates that those with postural control deficits may increase reliance on the trunk and hip joint contributions to the maintenance of postural control, reflecting changes in the sensorimotor constraints on movement patterns during the task.

Using Time-Frequency Analysis to Characterize Altered Knee Dynamics in Post ACL Reconstruction Individuals.

More than 250,000 individuals suffer an anterior cruciate ligament (ACL) injury in the United States each year requiring surgery and rehabilitation. However, despite exhaustive rehabilitation individuals are often plagued by neuromuscular deficits that lead to detrimental knee loading and knee osteoarthritis. Traditionally, time domain-based metrics like peak sagittal plane knee angle are used to quantify differences in knee mechanics; however, additional information can potentially be elucidated from time-frequency analyses. Here Smoothed Pseudo Wigner-Ville (SPWV), a time-frequency analysis technique, was used to investigate differences in knee loading dynamics between healthy controls and post ACL reconstruction individuals during running. The results indicated that post ACL reconstruction individuals adopt significantly different loading strategies in their injured limb than their non-injured limb. Individuals adopt a stiffer, more restrictive movement strategy delineated by a stronger low frequency to high frequency (LF/HF) ratio while the non-injured limb exhibit a more oscillatory motion (p<; 0.001). The time domain metrics were unable to identify differences between the ACL injured and non-injured limbs. The ability of SPWV to provide both quantitative and visual means to detect these differences supports its use as a clinical tool to track and monitor joint health.

Identification of knee gait waveform pattern alterations in individuals with patellofemoral pain using fast Fourier transform.

Patellofemoral pain (PFP) is one of the most common overuse injuries of the knee. Previous research has found that individuals with PFP exhibit differences in peak hip kinematics; however, differences in peak knee kinematics, where the pain originates, are difficult to elucidate. To better understand the mechanism behind PFP, we sought to characterize differences in knee gait kinematic waveform patterns in individuals with PFP compared to healthy individuals using fast Fourier transform (FFT). Sixteen control and sixteen individuals with PFP participated in a fast walk protocol. FFT was used to decompose the sagittal, frontal and transverse plane knee gait waveforms into sinusoidal signals. A two-way ANOVA and Bonferroni post hoc analysis compared group, limb and interaction effects on sagittal, frontal and transverse amplitude, frequency and phase components between control and PFP individuals gait waveforms. Differences in frequency and phase values were found in the sagittal and frontal plane knee waveforms between the control and PFP groups. The signal-to-noise ratio also reported significant differences between the PFP and control limbs in the sagittal (p<0.01) and frontal planes (p = 0.04). The findings indicate that differences in gait patterns in the individuals with PFP were not the result of amplitude differences, but differences attributed to temporal changes in gait patterns detected by the frequency and phase metrics. These changes suggest that individuals with PFP adopted a more deliberate, stiffer gait and exhibit altered joint coordination. And the FFT technique could serve as a fast, quantifiable tool for clinicians to detect PFP.

Empirical Based Modeling for the Assessment of Dynamic Knee Stability: Implications for Anterior Cruciate Ligament Injury Risk.

Anterior cruciate ligament (ACL) injuries are common sports injuries, costing the U.S. roughly $1 billion annually. To better understand the underlying injury mechanism, Nyquist and Bode stability criteria were applied to assess frontal plane dynamic knee stability among male Australian Football players during the weight-acceptance phase of single-leg jump landing. Out of 30 landings, 19 were classified as stable and 11 as unstable. Medial and lateral vasti, hamstring and gastrocnemii muscle activation waveforms were analyzed in parallel to determine if individuals with stable and unstable frontal plane joint biomechanics possessed different lower limb neuromuscular strategies. The total quadriceps muscle activation during the stable landings were significantly higher (p=0.02) than during the unstable landings. Additionally, the vasti exhibited a medial dominance during the stable landings compared to the unstable (p=0.06). These results suggest that individuals with unstable frontal plane knee landing mechanics may have reduced recruitment of the muscles crossing the knee; specifically, the medial muscles, which could limit their ability to compress and support the joint. The stability criteria were able to classify stable and unstable knee mechanics. And the differences in muscle activation during these stable and unstable landings provided new insights towards the ACL injury mechanism and possible injury prevention countermeasures.

Nyquist and Bode stability criteria to assess changes in dynamic knee stability in healthy and anterior cruciate ligament reconstructed individuals during walking.

Anterior cruciate ligament (ACL) injuries are one of the most frequently injured knee ligaments. Despite reconstruction, many individuals report difficulty returning to high level activities that require greater dynamic stability. Since few methods have been tested to assess dynamic stability post ACL reconstruction (ACLR), the purpose of this study was to evaluate between and within dynamic knee stability in control and ACLR individuals using Nyquist and Bode stability criteria. Sixteen control and sixteen post ACLR individuals performed a walking protocol. Nyquist and Bode stability criteria were implemented to classify and quantify individual step-to-step sagittal plane dynamic knee stability from the gait waveforms at initial contact, 15% and 30% of stance based on the resulting gain and phase margins. An ANOVA compared differences in phase margins between the control and ACLR limbs and found that the ACLR limbs were overall significantly more unstable than the non-reconstructed and control limbs (p=0.001). The results indicated that the ACLR individuals who exhibited stable steps adopted a more compensatory strategy aimed to stabilize the knee. These methods of evaluating dynamic knee stability may help clinicians to assess dynamic knee stability progression throughout rehabilitation and help assess return-to-sport with minimal risk to the individual.

Impaired Quadriceps Rate of Torque Development and Knee Mechanics After Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft.

BACKGROUND: Rate of torque development (RTD) measures the ability of a muscle to produce torque quickly. Decreased quadriceps RTD may impair performance of sporting tasks after surgery. Currently, little is known about variations in quadriceps RTD between anterior cruciate ligament (ACL)-reconstructed and noninjured limbs. PURPOSE: To determine the differences in RTD of the quadriceps, the rate and timing of knee extensor moment (KEM) development, and knee flexion excursion during running after ACL reconstruction with patellar tendon autograft. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: This study involved 21 patients (11 female) 6 months after ACL reconstruction with patellar tendon autograft (median [IQR]: age, 18 [16-20] years; mass, 68.18 [61.34-75] kg; height, 1.74 [1.66-1.78] m). Patients performed four 5-second maximal voluntary isometric strength trials of both limbs on an isokinetic dynamometer. RTD was calculated as the mean slope of the torque-time curve between 20% and 80% of total time to peak torque. Then, patients underwent 3-dimensional motion analysis while running on an instrumented treadmill at a self-selected running speed (mean ± SD, 2.68 ± 0.28 m/s). The rate of knee extensor moment (RKEM) was calculated as the mean slope of the moment curve between 10% and 30% of stance phase. Between-limb comparisons were determined with a paired t test for peak KEM, RKEM, knee flexion excursion during 10% to 30% of stance, and time to generate KEM. RESULTS: In the reconstructed limb, deficits in the peak rate of quadriceps torque development compared with the noninjured limb existed both isometrically (RTD, 257.56 vs 569.11 Nm/s; P < .001) and dynamically (RKEM, 16.47 vs 22.38 Nm/kg·m·s; P < .001). The reconstructed limb also generated a KEM later in the stance phase compared with the noninjured limb (11.37% vs 9.61% stance; P < .001) and underwent less knee flexion excursion (15.5° vs 19.8°; P < .001). CONCLUSION: After ACL reconstruction with patellar tendon autograft, patients have lower RTD and RKEM in the reconstructed limb. Deviations in RTD and the timing of the KEM can change the way the knee is loaded and can potentially increase injury risk and future development of posttraumatic osteoarthritis. Rehabilitation should consider exercises designed to improve RTD and prepare the limb for the demands of sport performance.

Elevated gastrocnemius forces compensate for decreased hamstrings forces during the weight-acceptance phase of single-leg jump landing: implications for anterior cruciate ligament injury risk.

Approximately 320,000 anterior cruciate ligament (ACL) injuries in the United States each year are non-contact injuries, with many occurring during a single-leg jump landing. To reduce ACL injury risk, one option is to improve muscle strength and/or the activation of muscles crossing the knee under elevated external loading. This study's purpose was to characterize the relative force production of the muscles supporting the knee during the weight-acceptance (WA) phase of single-leg jump landing and investigate the gastrocnemii forces compared to the hamstrings forces. Amateur male Western Australian Rules Football players completed a single-leg jump landing protocol and six participants were randomly chosen for further modeling and simulation. A three-dimensional, 14-segment, 37 degree-of-freedom, 92 muscle-tendon actuated model was created for each participant in OpenSim. Computed muscle control was used to generate 12 muscle-driven simulations, 2 trials per participant, of the WA phase of single-leg jump landing. A one-way ANOVA and Tukey post-hoc analysis showed both the quadriceps and gastrocnemii muscle force estimates were significantly greater than the hamstrings (p<0.001). Elevated gastrocnemii forces corresponded with increased joint compression and lower ACL forces. The elevated quadriceps and gastrocnemii forces during landing may represent a generalized muscle strategy to increase knee joint stiffness, protecting the knee and ACL from external knee loading and injury risk. These results contribute to our understanding of how muscle's function during single-leg jump landing and should serve as the foundation for novel muscle-targeted training intervention programs aimed to reduce ACL injuries in sport.