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Sample records for activity knee motion

  1. Skin mounted accelerometer system for measuring knee range of motion.

    PubMed

    McGinnis, Ryan S; Patel, Shyamal; Silva, Ikaro; Mahadevan, Nikhil; DiCristofaro, Steve; Jortberg, Elise; Ceruolo, Melissa; Aranyosi, A J

    2016-08-01

    Sufficient range of motion of the knee joint is necessary for performing many activities of daily living. Ambulatory monitoring of knee function can provide valuable information about progression of diseases like knee osteoarthritis and recovery after surgical interventions like total knee arthroplasty. In this paper, we describe a skin-mounted, conformal, accelerometer-based system for measuring knee angle and range of motion that does not require a skilled operator to apply devices. We establish the accuracy of this technique with respect to clinical gold standard goniometric measurements on a dataset collected from normative subjects during the performance of repeated bouts of knee flexion and extension tests. Results show that knee angle and range of motion estimates are highly correlated with goniometer measurements, and track differences in knee angle and range of motion to within 1%. These results demonstrate the ability of this system to characterize knee angle and range of motion, enabling future longitudinal monitoring of knee motion in naturalistic environments.

  2. The effect of postoperative range of motion on functional activities after posterior cruciate-retaining total knee arthroplasty.

    PubMed

    Ritter, Merrill A; Lutgring, Joseph D; Davis, Kenneth E; Berend, Michael E

    2008-04-01

    Range of motion is recognized as an important indicator of the success of a total knee replacement; however, an optimal range of motion has yet to be defined. This study was designed to determine the optimal range of motion for knee function after total knee arthroplasty with a posterior cruciate-retaining prosthesis. We retrospectively reviewed 5556 primary total knee arthroplasties performed with posterior cruciate-retaining prostheses between 1983 and 2003. The relationship between postoperative range of motion and pain, walking ability, stair-climbing ability, and knee function scores was examined at three to five years postoperatively. The relationship between a postoperative flexion contracture or hyperextension and knee function was also examined. Patients with 128 degrees to 132 degrees of motion obtained the highest scores for pain, walking, and knee function and the highest Knee Society scores. The outcomes became substantially compromised with motion of <118 degrees . Patients with 133 degrees to 150 degrees of motion had the highest scores for stair-climbing. A postoperative flexion contracture and hyperextension were associated with lower scores for pain, walking, stair-climbing, and knee function. The best functional results following total knee arthroplasty are achieved with 128 degrees to 132 degrees of motion. A postoperative flexion contracture and hyperextension of >or=10 degrees are associated with a poorer outcome except that stair-climbing is improved with more motion.

  3. Knee joint motion: description and measurement.

    PubMed

    Bull, A M; Amis, A A

    1998-01-01

    Knee joint motion has been described in various ways in the literature. These are explained and commented on. Two methods for describing knee joint motion with 6 degrees of freedom (DOF)--Euler angle and the helical axis of motion--are discussed. Techniques to measure joint motion which can either approximate the motion to less than 6 DOF or fully measure the spatial motion are identified. These include electrical linkage methods, radiographic and video techniques, fluoroscopic techniques and electromagnetic devices. In those cases where the full spatial motion is measured, the data are available to describe the motion in simpler terms (or with less DOF) than three rotations with three translations. This is necessary for clinical application and to facilitate communication between the clinician and the engineer.

  4. Thigh Muscle Activity, Knee Motion, and Impact Force During Side-Step Pivoting in Agility-Trained Female Basketball Players

    PubMed Central

    Wilderman, Danielle R; Ross, Scott E; Padua, Darin A

    2009-01-01

    Context: Improving neuromuscular control of hamstrings muscles might have implications for decreasing anterior cruciate ligament injuries in females. Objective: To examine the effects of a 6-week agility training program on quadriceps and hamstrings muscle activation, knee flexion angles, and peak vertical ground reaction force. Design: Prospective, randomized clinical research trial. Setting: Sports medicine research laboratory. Patients or Other Participants: Thirty female intramural basketball players with no history of knee injury (age  =  21.07 ± 2.82 years, height  =  171.27 ± 4.66 cm, mass  =  66.36 ± 7.41 kg). Intervention(s): Participants were assigned to an agility training group or a control group that did not participate in agility training. Participants in the agility training group trained 4 times per week for 6 weeks. Main Outcome Measure(s): We used surface electromyography to assess muscle activation for the rectus femoris, vastus medialis oblique, medial hamstrings, and lateral hamstrings for 50 milliseconds before initial ground contact and while the foot was in contact with the ground during a side-step pivot maneuver. Knee flexion angles (at initial ground contact, maximum knee flexion, knee flexion displacement) and peak vertical ground reaction force also were assessed during this maneuver. Results: Participants in the training group increased medial hamstrings activation during ground contact after the 6-week agility training program. Both groups decreased their vastus medialis oblique muscle activation during ground contact. Knee flexion angles and peak vertical ground reaction force did not change for either group. Conclusions: Agility training improved medial hamstrings activity in female intramural basketball players during a side-step pivot maneuver. Agility training that improves hamstrings activity might have implications for reducing anterior cruciate ligament sprain injury associated with side-step pivots. PMID

  5. Development of a knee joint motion simulator to evaluate deep knee flexion of artificial knee joints.

    PubMed

    Takano, Y; Ueno, M; Kiguchi, K; Ito, J; Mawatari, M; Hotokebuchi, T

    2008-01-01

    A purpose of this study is to examine the effect that quadriceps femoris force gives to rotation angle and joint reaction force of total knee prosthesis during deep knee flexion such as a unique sitting style called 'seiza' in Japanese. For the evaluation, we developed the knee motion simulator which could bend to 180 degrees continually simulating the passive flexion performed by clinicians. A total knee prosthesis, which is a specially-devised posterior stabilized type and capable of flexion up to 180 degrees, was inserted into bone model. And this prosthesis pulled by three kinds of quadriceps femoris forces to perform parameter study. The results obtained in this study were showed the same tendency with those in the past cadaveric experiment. It is suggested that the rotation angle and joint reaction force of total knee prosthesis are affected by shape of prosthesis, a vector of quadriceps femoris force, and bony aliments during deep knee flexion.

  6. Accuracy of knee range of motion assessment after total knee arthroplasty.

    PubMed

    Lavernia, Carlos; D'Apuzzo, Michele; Rossi, Mark D; Lee, David

    2008-09-01

    Measurement of knee joint range of motion (ROM) is important to assess after total knee arthroplasty. Our objective was to determine level of agreement and accuracy between observers with different knowledge on total ROM after total knee arthroplasty. Forty-one patients underwent x-ray of active and passive knee ROM (gold standard). Five different raters evaluated observed and measured ROM: orthopedic surgeon, clinical fellow, physician assistant, research fellow, and a physical therapist. A 1-way analysis of variance was used to determine differences in ROM between raters over both conditions. Limit of agreement for each rater for both active and passive total ROM under both conditions was calculated. Analysis of variance indicated a difference between raters for all conditions (range, P = .004 to P < or =.0001). The trend for all raters was to overestimate ROM at higher ranges. Assessment of ROM through direct observation without a goniometer provides inaccurate findings.

  7. Knee motion variability in patients with knee osteoarthritis: the effect of self-reported instability

    PubMed Central

    Gustafson, Jonathan A.; Robinson, Megan E.; Fitzgerald, G. Kelley; Tashman, Scott; Farrokhi, Shawn

    2015-01-01

    Background Knee osteoarthritis has been previously associated with a stereotypical knee-stiffening gait pattern and reduced knee joint motion variability due to increased antagonist muscle co-contractions and smaller utilized arc of motion during gait. However, episodic self-reported instability may be a sign of excessive motion variability for a large subgroup of patients with knee osteoarthritis. The objective of this work was to evaluate the differences in knee joint motion variability during gait in patients with knee osteoarthritis with and without self-reported instability compared to a control group of older adults with asymptomatic knees. Methods Forty-three subjects, 8 with knee osteoarthritis but no reports of instability (stable), 11 with knee osteoarthritis and self-reported instability (unstable), and 24 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a decline gait task on a treadmill. Knee motion variability was assessed using parametric phase plots during the loading response phase of decline gait. Findings The stable group demonstrated decreased sagittal-plane motion variability compared to the control group (p=0.04), while the unstable group demonstrated increased sagittal-plane motion variability compared to the control (p=0.003) and stable groups (p<0.001). The unstable group also demonstrated increased anterior-posterior joint contact point motion variability for the medial tibiofemoral compartment compared to the control (p=0.03) and stable groups (p=0.03). Interpretation The finding of decreased knee motion variability in patients with knee osteoarthritis without self-reported instability supports previous research. However, presence of self-reported instability is associated with increased knee motion variability in patients with knee osteoarthritis and warrants further investigation. PMID:25796536

  8. [Effectiveness of continuous passive motion after total knee replacement].

    PubMed

    Trzeciak, Tomasz; Richter, Magdalena; Ruszkowski, Krzysztof

    2011-01-01

    Continuous passive motion (CPM) is frequently used method in the early post-operative rehabilitation in patients after knee surgery. Aim of this study was to evaluate the effectiveness of CPM after primary total knee arthroplasty. Efficacy was assesed in terms of clinical score and functional recovery. 93 patients (101 knee joints) undergoing total knee replacement were assigned into two groups. The experimental group received continuous passive motion and active exercises. A control group received conventional physical therapy only. CPM was initiated in the first day after surgery, for 120 minutes, starting with 0-40 degrees range of motion, increased as tolerated (mean 10 degrees per day) and maintained during the hospital stay. Outcome measures were those included in Knee Society Score (KSS). Functional recovery was evaluated using WOMAC. All subjects were evaluated once before the surgery and on 10th day postoperatively. Mean clinical score (KSS) at the day 10 was 70 +/- 15 points in the experimental group and 74 +/- 12 in a control group. There were no statistical difference between the two groups for any outcome measures. CPM group mean range of motion was 83 degrees +/- 14 degrees and a group without CPM 77 degrees +/- 21 degrees. KSS functional score was 66 +/- 9 points in the experimental group compared to 62 +/- 7 points in a control group. Subjective estimation of pain level, joint stiffness and function showed no statistical difference between the two groups regarding total and subscale scores. Mean total score was 24 +/- 19 points in the CPM group and 22 +/- 17 in a group without CPM. These findings show that CPM had no significant advantage in terms of improving clinical measurements. However, there was beneficial effect on subjective assessment of pain level, joint stiffness and functional ability.

  9. Kinematic motion of the anterior cruciate ligament deficient knee during functionally high and low demanding tasks.

    PubMed

    Takeda, Kentaro; Hasegawa, Takayuki; Kiriyama, Yoshimori; Matsumoto, Hideo; Otani, Toshiro; Toyama, Yoshiaki; Nagura, Takeo

    2014-07-18

    The purpose of this study was to determine whether mechanical adaptations were present in patients with anterior cruciate ligament (ACL)-deficient knees during high-demand activities. Twenty-two subjects with unilateral ACL deficiency (11 males and 11 females, 19.6 months after injury) performed five different activities at a comfortable speed (level walking, ascending and descending steps, jogging, jogging to a 90-degree side cutting toward the opposite direction of the tested side). Three-dimensional knee kinematics for the ACL-deficient knees and uninjured contralateral knees were evaluated using the Point Cluster Technique. There was no significant difference in knee flexion angle, but an offset toward the knee in less valgus and more external tibial rotation was observed in the ACL-deficient knee. The tendency was more obvious in high demand motions, and a significant difference was clearly observed in the side cutting motions. These motion patterns, with the knee in less valgus and more external tibial rotation, are proposed to be an adaptive movement to avoid pivot shift dynamically, and reveal evidence in support of a dynamic adaptive motion occurring in ACL-deficient knees.

  10. Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?

    PubMed

    Jakobsen, Thomas Linding; Christensen, Malene; Christensen, Stine Sommer; Olsen, Marie; Bandholm, Thomas

    2010-09-01

    Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra-articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra-tester and inter-tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience. The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were obtained using a universal goniometer and a tape measure, respectively. To establish reliability, intraclass correlation coefficients (ICC(2,1)) and smallest real difference (SRD) were calculated. The knee joint ROM and circumference measurements were generally reliable (ICC > 0.8) within and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6 degrees and 10 degrees (except active knee flexion) and knee joint circumference of more than 1.0 cm and 1.63 cm represent a real clinical improvement (SRD) or deterioration for a single individual within and between physiotherapists, respectively. Generally, the experienced tester recorded larger knee joint ROM and lower circumference values than that of the inexperienced tester. In clinical practice, we suggest that repeated knee goniometric and circumferential measurements should be recorded by the same physiotherapist in individual patients with TKA. Tester experience appears not to influence the degree of reliability. (c) 2009 John Wiley & Sons, Ltd.

  11. Factors affecting postoperative range of motion after total knee arthroplasty.

    PubMed

    Gatha, Nehal M; Clarke, Henry D; Fuchs, Robin; Scuderi, Giles R; Insall, John N

    2004-10-01

    One hundred thirty five patients with osteoarthritis who underwent total knee arthroplasty (TKA) were evaluated to determine whether specific pre- and postoperative variables were correlated with the postoperative range of motion. Age, sex, pre- and postoperative range of motion, pre- and postoperative Knee Society scores, intraoperative patellar thickness before and after resurfacing, pre- and postoperative radiographic patellar height (as determined by the Insall-Salvati and Blackburn-Peel ratios), and preoperative radiographic alignment were recorded for each patient. Regression analysis was performed to identify whether any variables were correlated with the postoperative range of motion or Knee Society scores. The only variable that was significantly correlated with postoperative range of motion was the preoperative range of motion. This study suggests that among the variables evaluated, the preoperative range of motion was the only significant predictor of postoperative range of motion.

  12. Association of knee confidence with pain, knee instability, muscle strength, and dynamic varus-valgus joint motion in knee osteoarthritis.

    PubMed

    Skou, Søren T; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Bennell, Kim L

    2014-05-01

    To investigate associations between self-reported knee confidence and pain, self-reported knee instability, muscle strength, and dynamic varus-valgus joint motion during walking. We performed a cross-sectional analysis of baseline data from 100 participants with symptomatic and radiographic medial tibiofemoral compartment osteoarthritis (OA) and varus malalignment recruited for a randomized controlled trial. The extent of knee confidence, assessed using a 5-point Likert scale item from the Knee Injury and Osteoarthritis Outcome Score, was set as the dependent variable in univariable and multivariable ordinal regression, with pain during walking, self-reported knee instability, quadriceps strength, and dynamic varus-valgus joint motion during walking as independent variables. One percent of the participants were not troubled with lack of knee confidence, 17% were mildly troubled, 50% were moderately troubled, 26% were severely troubled, and 6% were extremely troubled. Significant associations were found between worse knee confidence and higher pain intensity, worse self-reported knee instability, lower quadriceps strength, and greater dynamic varus-valgus joint motion. The multivariable model consisting of the same variables significantly accounted for 24% of the variance in knee confidence (P < 0.001). Worse knee confidence is associated with higher pain, worse self-reported knee instability, lower quadriceps muscle strength, and greater dynamic varus-valgus joint motion during walking. Since previous research has shown that worse knee confidence is predictive of functional decline in knee OA, addressing lack of knee confidence by treating these modifiable impairments could represent a new therapeutic target. Copyright © 2014 by the American College of Rheumatology.

  13. A comparison of knee joint motion patterns between men and women in selected athletic tasks.

    PubMed

    Malinzak, R A; Colby, S M; Kirkendall, D T; Yu, B; Garrett, W E

    2001-06-01

    Women have higher non-contact anterior cruciate ligament injury rate than men do in sport activities. Non-contact anterior cruciate ligament injuries frequently occur in sports requiring cutting tasks. Alternated motor control strategies have identified as a potential risk factor for the non-contact anterior cruciate ligament injuries. The purpose of this study was to compare the patterns of knee kinematics and electromyographic activities in running, side-cutting, and cross-cutting between men and women recreational athletes. Three-dimensional kinematic data of the knee and electromyographic data of selected muscles across the knee joint were collected for 11 men and 9 women recreational athletes in running, side-cutting, and cross-cutting. Regression analyses with dummy variables for comparison of knee motion patterns between men and women. Women tend to have less knee flexion angles, more knee valgus angles, greater quadriceps activation, and lower hamstring activation in comparison to men during the stance phase of each of the three athletic tasks. Literatures suggest these alternated knee motion patterns of women tend to increase the load on the anterior cruciate ligament. Women on average may have certain motor control strategies that may alter their knee motion patterns. Women's altered knee motion patterns may tend to increase the load on the anterior cruciate ligament in the selected athletic tasks, which may contribute to the increased anterior cruciate ligament injury rate among women. Non-contact anterior cruciate ligament injuries frequently occur in sports. Altered motor control strategies and lower extremity motion patterns are likely to play an important role in non-contact anterior cruciate ligament injuries. Non-contact anterior cruciate ligament injuries may be prevented by correcting altered motor control strategies and associated lower extremity motion patterns through certain training programs.

  14. [Physical activity for knee osteoarthritis.

    PubMed

    Nagao, Masashi; Ishijima, Muneaki; Kaneko, Haruka; Takazawa, Yuji; Ikeda, Hiroshi; Kaneko, Kazuo

    Elder populations have been increasing in Japan and estimated 24 million people have knee osteoarthritis(OA). Recently, people have diverse sociological background and demand for participating sports has been growing. People may participate sports to prevent some diseases such as locomotive syndrome. According to the recent studies, excessive high impact sports increase the risk of OA, while daily life exercise decrease the risk. Epidemiological approach demonstrated that reduced knee extension muscle strength increases the risk of OA. We reviewed and discussed the recent topics including efficacy of physical therapy for knee OA and how much sports activities could be beneficial after knee surgery.

  15. External knee joint design based on normal motion.

    PubMed

    Walker, P S; Kurosawa, H; Rovick, J S; Zimmerman, R A

    1985-01-01

    There are several advantages to accurate reproduction of knee motion in an external joint assembly such as a knee brace: reduction of pistoning forces, better ligament protection, kinematic compatability. The geometry and kinematics of the normal human knee were studied and the results applied to external joint design. Geometrically, the posterior portions of the femoral condyles were found to be spherical in shape. These spherical surfaces are projected in sagittal plane radiographs as circles with center points coincident with those of the spheres. A line connecting these centers defines an axis system and enables three-dimensional orientation of the femur on the tibia to be determined using sagittal-plane radiographs. Knee kinematics was determined as a function of flexion angle for 14 fresh cadavers and 8 volunteers. Results were in the form of eulerian rotations and displacements. The data were normalized to the size of the average knee and the results from the 22 trials were averaged. The most obvious motion was internal rotation of the tibia with flexion; however, varus rotation and posterior translation of the origin were also evident. An external joint system was then designed to mimic "average" knee motion during flexion. The joints have been incorporated into a knee brace, and clinical evaluation has begun. Other applications include cast bracing and hinge distraction.

  16. Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?

    PubMed

    Miner, Andrew L; Lingard, Elizabeth A; Wright, Elizabeth A; Sledge, Clement B; Katz, Jeffrey N

    2003-04-01

    We investigated the relationship of knee range of motion (ROM) and function in a prospective, observational study of primary total knee arthroplasty (TKA). Preoperative and 12-month data were collected on 684 patients, including knee ROM, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function questionnaire scores, patient satisfaction, and perceived improvement in quality of life (QOL). Only modest correlations were found between knee ROM and WOMAC function (r<0.34). At 12 months we found significantly worse WOMAC function scores for patients with <95 degrees flexion compared with patients with > or =95 degrees (mean, 61.9 vs 75.0; P<.0001). In linear regression models, WOMAC pain and function scores at 12 months were both correlates of patient satisfaction and perceived improvement in QOL (standardized beta>3.5; P<.0001), but knee flexion was not. For assessment of these outcomes, WOMAC function appears to be more important than knee flexion.

  17. Improvements in knee biomechanics during walking are associated with increased physical activity after total knee arthroplasty.

    PubMed

    Arnold, John B; Mackintosh, Shylie; Olds, Timothy S; Jones, Sara; Thewlis, Dominic

    2015-12-01

    Total knee arthroplasty (TKA) in people with knee osteoarthritis increases knee-specific and general physical function, but it has not been established if there is a relationship between changes in these elements of functional ability. This study investigated changes and relationships between knee biomechanics during walking, physical activity, and use of time after TKA. Fifteen people awaiting TKA underwent 3D gait analysis before and six months after surgery. Physical activity and use of time were determined in free-living conditions from a high resolution 24-h activity recall. After surgery, participants displayed significant improvements in sagittal plane knee biomechanics and improved their physical activity profiles, standing for 105 more minutes (p=0.001) and performing 64 min more inside chores on average per day (p=0.008). Changes in sagittal plane knee range of motion (ROM) and peak knee flexion positively correlated with changes in total daily energy expenditure, time spent undertaking moderate to vigorous physical activity, inside chores and passive transport (r=0.52-0.66, p=0.005-0.047). Restoration of knee function occurs in parallel and is associated with improvements in physical activity and use of time after TKA. Increased functional knee ROM is required to support improvements in total and context specific physical activity. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  18. Measurement of knee joint motion using digital imaging

    PubMed Central

    Hanratty, Brian; Thompson, Neville; Beverland, David

    2008-01-01

    The measurement of joint motion is common practice in many aspects of orthopaedic surgery. A number of techniques and instruments have been developed for this purpose. We describe a method of recording and measuring knee joint motion using digital imaging which demonstrated high inter-observer reliability (r > 0.948) and intra-observer repeatability (r > 0.906). This technique may offer some practical advantages over other methods of measuring joint motion. PMID:19037641

  19. Measurement of knee joint motion using digital imaging.

    PubMed

    Bennett, Damien; Hanratty, Brian; Thompson, Neville; Beverland, David

    2009-12-01

    The measurement of joint motion is common practice in many aspects of orthopaedic surgery. A number of techniques and instruments have been developed for this purpose. We describe a method of recording and measuring knee joint motion using digital imaging which demonstrated high inter-observer reliability (r > 0.948) and intra-observer repeatability (r > 0.906). This technique may offer some practical advantages over other methods of measuring joint motion.

  20. A joint-constraint model-based system for reconstructing total knee motion.

    PubMed

    Hsin-Chen Chen; Chia-Hsing Wu; Chien-Kuo Wang; Chii-Jeng Lin; Yung-Nien Sun

    2014-01-01

    Comprehending knee motion is an essential requirement for studying the causes of knee disorders. In this paper, we propose a new 2-D-3-D registration system based on joint-constraint model for reconstructing total knee motion. The proposed model that contains bone geometries and an articulated joint mechanism is first constructed from multipostural magnetic resonance volumetric images. Then, the bone segments of the model are hierarchically registered to each frame of the given single-plane fluoroscopic video that records the knee activity. The bone posture is iteratively optimized using a modified chamfer matching algorithm to yield the simulated radiograph which is the best fit to the underlying fluoroscopic image. Unlike conventional registration methods computing posture parameters for each bone independently, the proposed femorotibial and patellofemoral joint models properly maintain the articulations between femur, tibia, and patella during the registration processes. As a result, we can obtain a sequence of registered knee postures showing smooth and reasonable physiologic patterns of motion. The proposed system also provides joint-space interpolation to densely generate intermediate postures for motion animation. The effectiveness of the proposed method was validated by computer simulation, animal cadaver, and in vivo knee testing. The mean target registration errors for femur, tibia, and patella were less than 1.5 mm. In particular, small out-of-plane registration errors [less than 1 mm (translation) and 2° (rotation)] were achieved in animal cadaver assessments.

  1. Repeat Manipulation Under Anesthesia For Persistent Stiffness After Total Knee Arthroplasty Achieves Functional Range of Motion.

    PubMed

    Ferrel, Jason R; Davis, Richard L; Agha, Obiajulu A J C; Politi, Joel R

    2015-05-01

    Poor range of motion may decrease a patient's ability to participate in activities of daily living after total knee arthroplasty. Manipulation under anesthesia has been shown to improve range of motion; however, some patients have persistent stiffness even after manipulation. The goal of this study was to evaluate the outcomes and complications of patients who underwent a second manipulation under anesthesia for persistent stiffness after total knee arthroplasty. The review of surgical records of two joint arthroplasty surgeons identified 226 knees in 210 patients who underwent a manipulation under anesthesia for poor range of motion after total knee arthroplasty. Of these patients, 16 patients underwent a second manipulation under anesthesia. For patients undergoing two manipulations under anesthesia procedures, at latest follow up (mean 539 days), mean extension improved from 10.50° to 2.50° (p=0.001) and mean flexion improved from 87.50° to 112.69° (p=0.001) respectively. SF-12 scores were available for 12 of 16 knees with a mean score of 34.42. Two of 16 patients (12.5%) experienced a complication. Three of 16 (18.8%) patients who underwent a second manipulation required a revision arthroplasty procedure. In conclusion, a second manipulation under anesthesia can achieve functional range of motion that is sustained after total knee arthroplasty.

  2. Muscle strength and knee range of motion after femoral lengthening

    PubMed Central

    Bhave, Anil; Shabtai, Lior; Woelber, Erik; Apelyan, Arman; Paley, Dror; Herzenberg, John E

    2017-01-01

    Background and purpose Femoral lengthening may result in decrease in knee range of motion (ROM) and quadriceps and hamstring muscle weakness. We evaluated preoperative and postoperative knee ROM, hamstring muscle strength, and quadriceps muscle strength in a diverse group of patients undergoing femoral lengthening. We hypothesized that lengthening would not result in a significant change in knee ROM or muscle strength. Patients and methods This prospective study of 48 patients (mean age 27 (9–60) years) compared ROM and muscle strength before and after femoral lengthening. Patient age, amount of lengthening, percent lengthening, level of osteotomy, fixation time, and method of lengthening were also evaluated regarding knee ROM and strength. The average length of follow-up was 2.9 (2.0–4.7) years. Results Mean amount of lengthening was 5.2 (2.4–11.0) cm. The difference between preoperative and final knee flexion ROM was 2° for the overall group. Congenital shortening cases lost an average of 5% or 6° of terminal knee flexion, developmental cases lost an average of 3% or 4°, and posttraumatic cases regained all motion. The difference in quadriceps strength at 45° preoperatively and after lengthening was not statistically or clinically significant (2.7 Nm; p = 0.06). Age, amount of lengthening, percent lengthening, osteotomy level, fixation time, and lengthening method had no statistically significant influence on knee ROM or quadriceps strength at final follow-up. Interpretation Most variables had no effect on ROM or strength, and higher age did not appear to be a limiting factor for femoral lengthening. Patients with congenital causes were most affected in terms of knee flexion. PMID:27892743

  3. Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty.

    PubMed

    Bonutti, Peter M; Marulanda, German A; McGrath, Mike S; Mont, Michael A; Zywiel, Michael G

    2010-02-01

    Arthrofibrosis is a relatively common complication after total knee arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory knee stiffness after total knee arthroplasty. Twenty-five patients who had knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3-16 weeks), the median increase in range of motion was 25 degrees (range, 8-82 degrees). The median gain in knee active flexion was 19 degrees (range, 5-80 degrees). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after total knee arthroplasty.

  4. Does a standard outpatient physiotherapy regime improve the range of knee motion after primary total knee arthroplasty?

    PubMed

    Mockford, Brian James; Thompson, Neville W; Humphreys, Patricia; Beverland, David E

    2008-12-01

    The aim of this study was to investigate whether a standard course of outpatient physiotherapy improves the range of knee motion after primary total knee arthroplasty. One hundred and fifty patients were randomly assigned into one of 2 groups. One group received outpatient physiotherapy for 6 weeks (group A). Another received no outpatient physiotherapy (group B). Range of knee motion was measured preoperatively and at 1-year review. Validated knee scores and an SF-12 health questionnaire were also recorded. Although patients in group A achieved a greater range of knee motion than those in group B, this was not statistically significant. No difference either was noted in any of the outcome measures used. In conclusion, outpatient physiotherapy does not improve the range of knee motion after primary total knee arthroplasty.

  5. Posterior cruciate ligament removal contributes to abnormal knee motion during posterior stabilized total knee arthroplasty.

    PubMed

    Cromie, Melinda J; Siston, Robert A; Giori, Nicholas J; Delp, Scott L

    2008-11-01

    Abnormal anterior translation of the femur on the tibia has been observed in mid flexion (20-60 degrees ) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes of this abnormal motion remain unknown. The purpose of this study was to isolate the effects of posterior cruciate ligament removal on knee motion after total knee arthroplasty. We posed two questions: Does removing the posterior cruciate ligament introduce abnormal anterior femoral translation? Does implanting a posterior stabilized prosthesis change the kinematics from the cruciate deficient case? Using a navigation system, we measured passive knee kinematics of ten male osteoarthritic patients during surgery after initial exposure, after removing the anterior cruciate ligament, after removing the posterior cruciate ligament, and after implanting the prosthesis. Passively flexing and extending the knee, we calculated anterior femoral translation and the flexion angle at which femoral rollback began. Removing the posterior cruciate ligament doubled anterior translation (from 5.1 +/- 4.3 mm to 10.4 +/- 5.1 mm) and increased the flexion angle at which femoral rollback began (from 31.2 +/- 9.6 degrees to 49.3 +/- 7.3 degrees). Implanting the prosthesis increased the amount of anterior translation (to 16.1 +/- 4.4 mm), and did not change the flexion angle at which femoral rollback began. Abnormal anterior translation was observed in low and mid flexion (0-60 degrees) after removing the posterior cruciate ligament, and normal motion was not restored by the posterior stabilized prosthesis.

  6. [Recovery from total knee arthroplasty through continuous passive motion].

    PubMed

    Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B

    2015-01-01

    The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion.

  7. Recovery in knee range of motion reaches a plateau by 12 months after total knee arthroplasty.

    PubMed

    Zhou, Zhihong; Yew, Khye Soon Andy; Arul, Earnest; Chin, Pak-Lin; Tay, Keng Jin Darren; Lo, Ngai-Nung; Chia, Shi-Lu; Yeo, Seng Jin

    2015-06-01

    The primary aim of this study was to identify the time point at which improvements in knee range of motion reach a plateau, if any. The secondary aim of this study was to investigate the correlation between the improvements in knee range of motion and patient-reported outcomes [Oxford knee score (OKS) and SF-36]. The hypothesis is that there is a time point at which the recovery in the knee range of motion after total knee arthroplasty (TKA) plateaus. A prospective study of 145 patients who underwent TKA was conducted. All TKAs were performed by the same surgeon. OKS and SF-36 scores were measured preoperatively and at 6, 12, and 24 months. Range of motion was measured preoperatively and at 1, 3, 6, 12, and 24 months postoperatively. This study shows that for surgeon/therapist reported range of motion, a plateau in recovery was reached at 12 months after TKA. It was also found that range of extension is significantly correlated with OKS, whereas range of flexion was not significantly correlated with OKS. Knowledge of when patients fully recover after TKA will allow appropriate counseling of patients during preoperative consultation. Also, this knowledge will enable surgeons/therapists to better monitor the rehabilitation progress of TKA patients, and make adjustments to the rehabilitation protocol. In addition, our study shows that objective surgeon-/therapist-measured outcome (range of motion) has a significant correlation with subjective patient-reported outcomes (OKS). Hence, both outcome measures should be employed in the postoperative monitoring of patient progress. Prospective case series, Level IV.

  8. The influence of pain on knee motion in patients with osteoarthritis undergoing total knee arthroplasty.

    PubMed

    Bennett, Damien; Hanratty, Brian; Thompson, Neville; Beverland, David E

    2009-04-01

    Pain is the predominant symptom of degenerative knee arthritis and the main reason patients undergo total knee arthroplasty (TKA). Variation in patient response to pain has proved difficult to quantify. The effect of removing pain by testing TKA patients' range of motion (ROM) before and after the administration of anesthesia has not previously been analyzed. This study objectively quantifies the effect of eliminating pain on knee joint ROM for a typical group of TKA patients with osteoarthritis. We prospectively recruited 141 patients with osteoarthritis admitted for TKA to assess the inhibitory effect of pain on ROM. Passive maximum flexion, extension, and ROM were measured preoperatively before and after administration of anesthesia (spinal anesthetic followed by femoral and sciatic regional nerve blocks). Following pain abolition, passive maximum flexion increased by an average of 13.4 degrees (SD=11.9 degrees), passive maximum extension improved by an average of 3.0 degrees (SD=4.2 degrees), and passive ROM increased by an average of 16.4 degrees (SD=13.1 degrees). The change in each parameter was statistically significant (P<.0001). Improvements in flexion (P=.01) and ROM (P=.005) were significantly greater in women. Measurements taken before anesthesia reflect knee ROM that the patient will tolerate before pain becomes the limiting factor, while measurements taken after anesthesia is achieved suggest the knee ROM possible once pain is eliminated. Abolition of pain led to significant increases in knee flexion, extension, and ROM, suggesting that pain has a significant inhibitory effect on knee motion.

  9. The effect of a knee ankle foot orthosis incorporating an active knee mechanism on gait of a person with poliomyelitis.

    PubMed

    Arazpour, Mokhtar; Chitsazan, Ahmad; Bani, Monireh Ahmadi; Rouhi, Gholamreza; Ghomshe, Farhad Tabatabai; Hutchins, Stephen W

    2013-10-01

    The aim of this case study was to identify the effect of a powered stance control knee ankle foot orthosis on the kinematics and temporospatial parameters of walking by a person with poliomyelitis when compared to a knee ankle foot orthosis. A knee ankle foot orthosis was initially manufactured by incorporating drop lock knee joints and custom molded ankle foot orthoses and fitted to a person with poliomyelitis. The orthosis was then adapted by adding electrically activated powered knee joints to provide knee extension torque during stance and also flexion torque in swing phase. Lower limb kinematic and kinetic data plus data for temporospatial parameters were acquired from three test walks using each orthosis. Walking speed, step length, and vertical and horizontal displacement of the pelvis decreased when walking with the powered stance control knee ankle foot orthosis compared to the knee ankle foot orthosis. When using the powered stance control knee ankle foot orthosis, the knee flexion achieved during swing and also the overall pattern of walking more closely matched that of normal human walking. The reduced walking speed may have caused the smaller compensatory motions detected when the powered stance control knee ankle foot orthosis was used. The new powered SCKAFO facilitated controlled knee flexion and extension during ambulation for a volunteer poliomyelitis person.

  10. Posterior Cruciate Ligament Removal Contributes to Abnormal Knee Motion during Posterior Stabilized Total Knee Arthroplasty

    PubMed Central

    Cromie, Melinda J.; Siston, Robert A.; Giori, Nicholas J.; Delp, Scott L.

    2017-01-01

    Abnormal anterior translation of the femur on the tibia has been observed in mid flexion (20–60°) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes of this abnormal motion remain unknown. The purpose of this study was to isolate the effects of posterior cruciate ligament removal on knee motion after total knee arthroplasty. We posed two questions: Does removing the posterior cruciate ligament introduce abnormal anterior femoral translation? Does implanting a posterior stabilized prosthesis change the kinematics from the cruciate deficient case? Using a navigation system, we measured passive knee kinematics of ten male osteoarthritic patients during surgery after initial exposure, after removing the anterior cruciate ligament, after removing the posterior cruciate ligament, and after implanting the prosthesis. Passively flexing and extending the knee, we calculated anterior femoral translation and the flexion angle at which femoral rollback began. Removing the posterior cruciate ligament doubled anterior translation (from 5.1±4.3 mm to 10.4±5.1 mm) and increased the flexion angle at which femoral rollback began (from 31.2±9.6° to 49.3±7.3°). Implanting the prosthesis increased the amount of anterior translation (to 16.1±4.4 mm), and did not change the flexion angle at which femoral rollback began. Abnormal anterior translation was observed in low and mid flexion (0–60°) after removing the posterior cruciate ligament, and normal motion was not restored by the posterior stabilized prosthesis. PMID:18464260

  11. Does medio-lateral motion occur in the normal knee? An in-vitro study in passive motion.

    PubMed

    Belvedere, C; Leardini, A; Giannini, S; Ensini, A; Bianchi, L; Catani, F

    2011-03-15

    Medio-lateral translation during knee flexion continues to raise controversy. Small population sizes, small joint flexion ranges, less-reliable measurement techniques and disparate experimental conditions led to inconsistent reports in the past. To study this subject with more accurate and reliable measurements, we carried out femur and tibia tracking in 22 intact cadaver knees during passive joint motion using a state-of-the-art surgical navigation system. Trackers with active light-emitting diodes were fixed onto the femur and tibia, and an instrumented pointer was used to digitize a number of anatomical landmarks. International recommendations were adopted for anatomical-based reference frame definitions and joint kinematic analysis. For the first time, knee joint translations were reported in both the femoral and tibial reference frames, and over a flexion/extension arc as large as 140°. During flexion, in the femoral reference frame, the center of the tibial plateau moved 4.8 ± 2.8mm medially when averaged over the specimens. In the tibial frame, the knee center moved 13.3 ± 5.7 mm laterally. The relative femoral-to-tibial medio-lateral translation was, on average over the specimens, nearly 20% of the width of the tibial plateau, and can be as large as 35%. Medio-lateral translation occurs in the natural normal knee joint. Copyright © 2010 Elsevier Ltd. All rights reserved.

  12. Total knee arthroplasty in Asian subjects: preoperative range of motion determines postoperative range of motion?

    PubMed

    Bin Abd Razak, Hamid Rahmatullah; Han, Xinyun Audrey; Chong, Hwei Chi; Tan, Hwee Chye Andrew

    2014-02-01

    To evaluate whether preoperative range of motion is a key determinant of postoperative range of motion in Asian patients undergoing conventional total knee arthroplasty. A retrospective review of 302 patients who underwent primary total knee arthroplasty performed by a single surgeon was conducted. Patients who had a fixed flexion deformity of ≥15° were excluded. Postoperative range of motion (ROM) was measured prospectively. Patients were stratified into two groups: preoperative ROM < 110° and preoperative ROM ≥ 110°. Postoperative ROM and mean change in ROM at 6 months and 2 years of follow-up were then compared using Student's t-test. Group of ROM < 110° had a poorer postoperative range of motion at both 6-months and 2-years of follow-up than Group of ROM ≥ 110° (P < 0.001). Postoperatively, Group of ROM < 110° had gained range of motion whereas Group of ROM ≥ 110° had lost range of motion (P < 0.001). Similar to the Western population, preoperative range of motion is a key determinant of postoperative range of motion in Asian patients. This should be taken into consideration by surgeons during preoperative planning and in managing patients' expectations. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  13. Dynamic activity dependence of in vivo normal knee kinematics.

    PubMed

    Moro-oka, Taka-aki; Hamai, Satoshi; Miura, Hiromasa; Shimoto, Takeshi; Higaki, Hidehiko; Fregly, Benjamin J; Iwamoto, Yukihide; Banks, Scott A

    2008-04-01

    Dynamic knee kinematics were analyzed for normal knees in three activities, including two different types of maximum knee flexion. Continuous X-ray images of kneel, squat, and stair climb motions were taken using a large flat panel detector. CT-derived bone models were used for model registration-based 3D kinematic measurement. Three-dimensional joint kinematics and contact locations were determined using three methods: bone-fixed coordinate systems, interrogation of CT-based bone model surfaces, and interrogation of MR-based articular cartilage model surfaces. The femur exhibited gradual external rotation throughout the flexion range. Tibiofemoral contact exhibited external rotation, with contact locations translating posterior while maintaining 15 degrees to 20 degrees external rotation from 20 degrees to 80 degrees of flexion. From 80 degrees to maximum flexion, contact locations showed a medial pivot pattern. Kinematics based on bone-fixed coordinate systems differed from kinematics based on interrogation of CT and MR surfaces. Knee kinematics varied significantly by activity, especially in deep flexion. No posterior subluxation occurred for either femoral condyle in maximum knee flexion. Normal knees accommodate a range of motions during various activities while maintaining geometric joint congruency.

  14. Data Collection and Analysis Using Wearable Sensors for Monitoring Knee Range of Motion after Total Knee Arthroplasty.

    PubMed

    Chiang, Chih-Yen; Chen, Kun-Hui; Liu, Kai-Chun; Hsu, Steen Jun-Ping; Chan, Chia-Tai

    2017-02-22

    Total knee arthroplasty (TKA) is the most common treatment for degenerative osteoarthritis of that articulation. However, either in rehabilitation clinics or in hospital wards, the knee range of motion (ROM) can currently only be assessed using a goniometer. In order to provide continuous and objective measurements of knee ROM, we propose the use of wearable inertial sensors to record the knee ROM during the recovery progress. Digitalized and objective data can assist the surgeons to control the recovery status and flexibly adjust rehabilitation programs during the early acute inpatient stage. The more knee flexion ROM regained during the early inpatient period, the better the long-term knee recovery will be and the sooner early discharge can be achieved. The results of this work show that the proposed wearable sensor approach can provide an alternative for continuous monitoring and objective assessment of knee ROM recovery progress for TKA patients compared to the traditional goniometer measurements.

  15. Data Collection and Analysis Using Wearable Sensors for Monitoring Knee Range of Motion after Total Knee Arthroplasty

    PubMed Central

    Chiang, Chih-Yen; Chen, Kun-Hui; Liu, Kai-Chun; Hsu, Steen Jun-Ping; Chan, Chia-Tai

    2017-01-01

    Total knee arthroplasty (TKA) is the most common treatment for degenerative osteoarthritis of that articulation. However, either in rehabilitation clinics or in hospital wards, the knee range of motion (ROM) can currently only be assessed using a goniometer. In order to provide continuous and objective measurements of knee ROM, we propose the use of wearable inertial sensors to record the knee ROM during the recovery progress. Digitalized and objective data can assist the surgeons to control the recovery status and flexibly adjust rehabilitation programs during the early acute inpatient stage. The more knee flexion ROM regained during the early inpatient period, the better the long-term knee recovery will be and the sooner early discharge can be achieved. The results of this work show that the proposed wearable sensor approach can provide an alternative for continuous monitoring and objective assessment of knee ROM recovery progress for TKA patients compared to the traditional goniometer measurements. PMID:28241434

  16. Reliability of digital compass goniometer in knee joint range of motion measurement.

    PubMed

    Yaikwawongs, Nammond; Limpaphayom, Noppachart; Wilairatana, Vajara

    2009-04-01

    To compare the reliability of range of motion measurement in the knee joint using a digital compass goniometer combined with inclinometer with standard range of motion measurement from roentgenographic picture. Range of flexion and extension of the knee joint in volunteer participants was measured by the newly developed digital compass goniometer combined with inclinometer (DCG). The results were compared with range of knee joint motion obtained from standard roentgenographic picture by intraclass correlation coefficient. Range of motion of knee joint measured by DCG correlated very well with the data obtained from standard knee roentgenographic picture. The intraclass correlation coefficient equals 0.973. The digital compass goniometer was a reliable tool to measure knee joint range of motion in flexion and extension plane.

  17. Relationship of spasticity to knee angular velocity and motion during gait in cerebral palsy.

    PubMed

    Damiano, Diane L; Laws, Edward; Carmines, Dave V; Abel, Mark F

    2006-01-01

    This study investigated the effects of spasticity in the hamstrings and quadriceps muscles on gait parameters including temporal spatial measures, knee position, excursion and angular velocity in 25 children with spastic diplegic cerebral palsy (CP) as compared to 17 age-matched peers. While subjects were instructed to relax, an isokinetic device alternately flexed and extended the left knee at one of the three constant velocities 30 degrees/s, 60 degrees/s and 120 degrees/s, while surface electromyography (EMG) electrodes over the biceps femoris and the rectus femoris recorded muscle activity. Patients then participated in 3D gait analysis at a self-selected speed. Results showed that, those with CP who exhibited heightened stretch responses (spasticity) in both muscles, had significantly slower knee angular velocities during the swing phase of gait as compared to those with and without CP who did not exhibit stretch responses at the joint and the tested speeds. The measured amount (torque) of the resistance to passive flexion or extension was not related to gait parameters in subjects with CP; however, the rate of change in resistance torque per unit angle change (stiffness) at the fastest test speed of 120 degrees/s showed weak to moderate relationships with knee angular velocity and motion during gait. For the subset of seven patients with CP who subsequently underwent a selective dorsal rhizotomy, knee angular extension and flexion velocity increased post-operatively, suggesting some degree of causality between spasticity and movement speed.

  18. Knee surgery assistance: patient model construction, motion simulation, and biomechanical visualization.

    PubMed

    Chen, J X; Wechsler, H; Pullen, J M; Zhu, Y; MacMahon, E B

    2001-09-01

    We present a new system that integrates computer graphics, physics-based modeling, and interactive visualization to assist knee study and surgical operation. First, we discuss generating patient-specific three-dimensional (3-D) knee models from patient's magnetic resonant images (MRIs). The 3-D model is obtained by deforming a reference model to match the MRI dataset. Second, we present simulating knee motion that visualizes patient-specific motion data on the patient-specific knee model. Third, we introduce visualizing biomechanical information on a patient-specific model. The focus is on visualizing contact area, contact forces, and menisci deformation. Traditional methods have difficulty in visualizing knee contact area without using invasive methods. The approach presented here provides an alternative of visualizing the knee contact area and forces without any risk to the patient. Finally, a virtual surgery can be performed. The constructed 3-D knee model is the basis of motion simulation, biomechanical visualization, and virtual surgery. Knee motion simulation determines the knee rotation angles as well as knee contact points. These parameters are used to solve the biomechanical model. Our results integrate 3-D construction, motion simulation, and biomechanical visualization into one system. Overall, the methodologies here are useful elements for future virtual medical systems where all the components of visualization, automated model generation, and surgery simulation come together.

  19. Loss of neuromuscular control related to motion in the acutely ACL-injured knee: an experimental study.

    PubMed

    Bonsfills, N; Gómez-Barrena, E; Raygoza, J J; Núñez, A

    2008-10-01

    Ligamentomuscular and muscular stretch reflexes are known to contribute to knee joint stability. After anterior cruciate ligament (ACL) injury, a more intense and adjusted muscular response is required to maintain joint stability, but this neuromuscular control of the knee has not been clearly proved. The aim of the study is to record electromyography (EMG) signal and muscular fibre length variations in quadriceps and hamstrings of the knee with and without ACL, and to analyze and integrate the ligament strain and the muscular reaction to forced anterior tibial translation (ATT). In 17 knees from 12 cats, EMG electrodes and ultrasonomicrometry crystals were inserted into four main periarticular muscles, with strain gauges on periarticular ligament insertions. Their output signal was compared before and after ACL surgical section in series of ATT (at 90 degrees and 30 degrees knee flexion), and also during knee flexion and extension. Linear regression analysis was performed between the EMG signal and muscular fibre length variations, and between the EMG signal and the strain on ligament insertions, in the search of this reflex neuromuscular response. In the ACL deficient knees, the studied muscles showed a poor adjustment to motion of EMG firing, inversely to controls. The muscle stretch reflexes showed poorer correlation with post-peak EMG activity than the ligaments. ATT control depended mainly on hamstrings activity in control knees, whereas in unstable knees, quadriceps activity was associated with more tibial translation. Acute ACL-deficient knees showed poor neuromuscular control with weak ligamentomuscular reflexes and no muscular stretch reflexes, suggesting the ineffectiveness of acute muscular reaction to provide early mechanical knee stabilization after injury.

  20. Is latero-medial patellar mobility related to the range of motion of the knee joint after total knee arthroplasty?

    PubMed

    Ota, Susumu; Nakashima, Takeshi; Morisaka, Ayako; Omachi, Takaaki; Ida, Kunio; Kawamura, Morio

    2010-12-01

    Diminished range of motion (ROM) of the knee joint after total knee arthroplasty (TKA) is thought to be related to reduced patellar mobility. This has not been confirmed clinically due to a lack of quantitative methods adequate for measuring patellar mobility. We investigated the relationship between patellar mobility by a reported quantitative method and knee joint ROM after TKA. Forty-nine patients [osteoarthritis--OA: 29 knees; rheumatoid arthritis--RA: 20 knees] were examined after TKA. Respective medial and lateral patellar mobility was measured 1 and 6 months postoperatively using a patellofemoral arthrometer (PFA). Knee joint ROM was also measured in each of those 2 sessions. Although the flexion and extension of the knee joints improved significantly from 1 to 6 months after TKA, the medial and lateral patellar displacements (LPDs) failed to improve during that same period. Moreover, only the changes in knee flexion and medial patellar displacement (MPD) between the two sessions were positively correlated (r = 0.31, p < 0.05). However, our findings demonstrated that medial and lateral patellar mobility had no sufficient longitudinal relationship with knee ROM after TKA.

  1. Behavioral effect of knee joint motion on body's center of mass during human quiet standing.

    PubMed

    Yamamoto, Akio; Sasagawa, Shun; Oba, Naoko; Nakazawa, Kimitaka

    2015-01-01

    The balance control mechanism during upright standing has often been investigated using single- or double-link inverted pendulum models, involving the ankle joint only or both the ankle and hip joints, respectively. Several studies, however, have reported that knee joint motion during quiet standing cannot be ignored. This study aimed to investigate the degree to which knee joint motion contributes to the center of mass (COM) kinematics during quiet standing. Eight healthy adults were asked to stand quietly for 30s on a force platform. Angular displacements and accelerations of the ankle, knee, and hip joints were calculated from kinematic data obtained by a motion capture system. We found that the amplitude of the angular acceleration was smallest in the ankle joint and largest in the hip joint (ankle < knee < hip). These angular accelerations were then substituted into three biomechanical models with or without the knee joint to estimate COM acceleration in the anterior-posterior direction. Although the "without-knee" models greatly overestimated the COM acceleration, the COM acceleration estimated by the "with-knee" model was similar to the actual acceleration obtained from force platform measurement. These results indicate substantial effects of knee joint motion on the COM kinematics during quiet standing. We suggest that investigations based on the multi-joint model, including the knee joint, are required to reveal the physiologically plausible balance control mechanism implemented by the central nervous system. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. LIMITED HIP AND KNEE FLEXION DURING LANDING IS ASSOCIATED WITH INCREASED FRONTAL PLANE KNEE MOTION AND MOMENTS

    PubMed Central

    Pollard, Christine D.; Sigward, Susan M.; Powers, Christopher M.

    2009-01-01

    Background It has been proposed that female athletes who limit knee and hip flexion during athletic tasks rely more on the passive restraints in the frontal plane to deceleration their body center of mass. This biomechanical pattern is thought to increase the risk for anterior cruciate ligament injury. To date, the relationship between sagittal plane kinematics and frontal plane knee motion and moments has not been explored. Methods Subjects consisted of fifty-eight female club soccer players (age range: 11 to 20 years) with no history of knee injury. Kinematics, ground reaction forces, and surface electromyography were collected while each subject performed a drop landing task. Subjects were divided into two groups based on combined sagittal plane knee and hip flexion angles during the deceleration phase of landing (high flexion and low flexion). Findings Subjects in the low flexion group demonstrated increased knee valgus angles (P = 0.02, effect size 0.27), increased knee adductor moments (P = 0.03, effect size 0.24), decreased energy absorption at the knee and hip (P = 0.02, effect size 0.25; and P< 0.001, effect size 0.59), and increased vastus lateralis EMG when compared to subjects in the high flexion group (P = 0.005, effect size 0.35). Interpretation Female athletes with limited sagittal plane motion during landing exhibit a biomechanical profile that may put these individuals at greater risk for anterior cruciate ligament injury. PMID:19913961

  3. Passive knee kinematics before and after total knee arthroplasty: are we correcting pathologic motion?

    PubMed

    Mihalko, William M; Ali, Mounawar; Phillips, Matthew J; Bayers-Thering, Mary; Krackow, Kenneth A

    2008-01-01

    The change in coronal plane deformity throughout a range of flexion before and after total knee arthroplasty (TKA) has not been reported. Unlike most alignment assessments traditionally reporting coronal plane alignment in a standing position under static conditions, this study reports deformity throughout the flexion arc before and after deformity correction. One hundred fifty-two TKA patients using the anteroposterior axis for femoral component rotation and computer navigation techniques were included in the study. Deformity before TKA ranged from 17.5 degrees varus (deformity apex away from the midline) to 20.5 degrees valgus (deformity apex toward the midline) in full extension. Before TKA, deformity was not constant through an arc of motion and significantly decreased with flexion of 60 degrees and more (P < .01). The deformity after performing a TKA was not different (P = .478) throughout the flexion arc. The data determined that deformity is not constant throughout flexion in osteoarthritic knees preoperatively and that deformity throughout flexion can be corrected with the use of conventional alignment techniques during TKA.

  4. The basic science of continuous passive motion in promoting knee health: a systematic review of studies in a rabbit model.

    PubMed

    Knapik, Derrick M; Harris, Joshua D; Pangrazzi, Garett; Griesser, Michael J; Siston, Robert A; Agarwal, Sudha; Flanigan, David C

    2013-10-01

    To determine whether the basic science evidence supports the use of continuous passive motion (CPM) after articular cartilage injury in the knee. A systematic review was performed identifying and evaluating studies in animal models that focused on the basic science of CPM of the knee. Databases included in this review were PubMed, Biosis Previews, SPORTDiscus, PEDro, and EMBASE. All functional, gross anatomic, histologic, and histochemical outcomes were extracted and analyzed. Primary outcomes of CPM analyzed in rabbit animal models (19 studies) included histologic changes in articular cartilage (13 studies), biomechanical changes and nutrition of intra-articular tissue (3 studies), and anti-inflammatory biochemical changes (3 studies). Nine studies specifically examined osteochondral defects, 6 of which used autogenous periosteal grafts. Other pathologies included were antigen-induced arthritis, septic arthritis, medial collateral ligament reconstruction, hemarthrosis, and chymopapain-induced proteoglycan destruction. In comparison to immobilized knees, CPM therapy led to decreased joint stiffness and complications related to adhesions while promoting improved neochondrogenesis with formation and preservation of normal articular cartilage. CPM was also shown to create a strong anti-inflammatory environment by effectively clearing harmful, inflammatory particles from within the knee. Current basic science evidence from rabbit studies has shown that CPM for the knee significantly improves motion and biological properties of articular cartilage. This may be translated to potentially improved outcomes in the management of articular cartilage pathology of the knee. If the rabbit model is relevant to humans, CPM may contribute to improved knee health by preventing joint stiffness, preserving normal articular tissue with better histologic and biologic properties, and improving range of motion as compared with joint immobilization and intermittent active motion. Copyright

  5. Dynamic Frequency Analyses of Lower Extremity Muscles during Sit-To-Stand Motion for the Patients with Knee Osteoarthritis

    PubMed Central

    Suzuki, Kentaro; Yagi, Masahide

    2016-01-01

    Objective Muscle activities during the sit-to-stand motion (STS) are characterized by coordinated movements between hip extensors and knee extensors. However, previous reports regarding the STS and lower extremity muscle activities have focused on some quantitative assessment, but little qualitative research. This study aimed to examine the muscle activities of the lower extremity both quantitatively and qualitatively. Methods Study participants included 13 patients with knee osteoarthritis (knee OA) and 11 age-matched asymptomatic controls. The task was STS from a chair with a height-adjustable seat. EMG activities were acquired using surface electromyogram. The root mean square signals normalized as a percentage of maximum voluntary isometric contraction values (RMS%MVC) and the mean power frequency (MPF) were calculated. Results During STS, knee OA patients had increased RMS%MVC of the vastus medialis and raised MPF of the rectus femoris before buttocks-off. Conclusion These findings suggest that STS of knee OA patients not only increased relative muscle activity of the vastus medialis, but also enlisted the rectus femoris in knee extension to improve muscle contraction force by activating more type II fibers to accomplish buttocks-off. PMID:26807578

  6. Reliability, Concurrent Validity, and Minimal Detectable Change for iPhone Goniometer App in Assessing Knee Range of Motion.

    PubMed

    Mehta, Saurabh P; Barker, Katherine; Bowman, Brett; Galloway, Heather; Oliashirazi, Nicole; Oliashirazi, Ali

    2016-11-28

    Much of the published works assessing the reliability of smartphone goniometer apps (SG) have poor generalizability since the reliability was assessed in healthy subjects. No research has established the values for standard error of measurement (SEM) or minimal detectable change (MDC) which have greater clinical utility to contextualize the range of motion (ROM) assessed using the SG. This research examined the test-retest reproducibility, concurrent validity, SEM, and MDC values for the iPhone goniometer app (i-Goni; June Software Inc., v.1.1, San Francisco, CA) in assessing knee ROM in patients with knee osteoarthritis or those after total knee replacement. A total of 60 participants underwent data collection which included the assessment of active knee ROM using the i-Goni and the universal goniometer (UG; EZ Read Jamar Goniometer, Patterson Medical, Warrenville, IL), knee muscle strength, and assessment of pain and lower extremity disability using quadruple numeric pain rating scale (Q-NPRS) and lower extremity functional scale (LEFS), respectively. Intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of the knee ROM assessed using the i-Goni and UG. Bland and Altman technique examined the agreement between these knee ROM. The SEM and MDC values were calculated for i-Goni assessed knee ROM to characterize the error in a single score and the index of true change, respectively. Pearson correlation coefficient examined concurrent relationships between the i-Goni and other measures. The ICC values for the knee flexion/extension ROM were superior for i-Goni (0.97/0.94) compared with the UG (0.95/0.87). The SEM values were smaller for i-Goni assessed knee flexion/extension (2.72/1.18 degrees) compared with UG assessed knee flexion/extension (3.41/1.62 degrees). Similarly, the MDC values were smaller for both these ROM for the i-Goni (6.3 and 2.72 degrees) suggesting smaller change required to infer true change in knee ROM. The i

  7. Knee kinematics in medial osteoarthritis during in vivo weight-bearing activities.

    PubMed

    Hamai, Satoshi; Moro-oka, Taka-Aki; Miura, Hiromasa; Shimoto, Takeshi; Higaki, Hidehiko; Fregly, Benjamin J; Iwamoto, Yukihide; Banks, Scott A

    2009-12-01

    Dynamic knee kinematics were analyzed for medial osteoarthritic (OA) knees in three activities, including two types of maximum knee flexion. Continuous x-ray images of kneeling, squatting, and stair climbing motions were taken using a large flat panel detector. CT-derived bone models were used for the model registration-based 3D kinematic measurements. Three-dimensional joint kinematics and contact locations were determined using two methods: bone-fixed coordinate systems and by interrogation of CT-based bone model surfaces. The femur exhibited gradual external rotation with knee flexion for kneeling and squatting activities, and gradual internal rotation with knee extension for stair climbing. From 100 degrees to 120 degrees flexion, contact locations showed a medial pivot pattern similar to normal knees. However, knees with medial OA displayed a femoral internal rotation bias and less posterior translation when compared with normal knees. A classic screw-home movement was not observed in OA knees near extension. Decreased variability with both activities and methods of calculation were demonstrated for all three activities. In conclusion, the weight-bearing kinematics of patients with medial OA differs from normal knees. Pathological changes of the articulating surfaces and the ligaments correspond to observed abnormalities in knee kinematics.

  8. Quantifying the Consistency of Wearable Knee Acoustical Emission Measurements During Complex Motions.

    PubMed

    Toreyin, Hakan; Jeong, Hyeon Ki; Hersek, Sinan; Teague, Caitlin N; Inan, Omer T

    2016-09-01

    Knee-joint sounds could potentially be used to noninvasively probe the physical and/or physiological changes in the knee associated with rehabilitation following acute injury. In this paper, a system and methods for investigating the consistency of knee-joint sounds during complex motions in silent and loud background settings are presented. The wearable hardware component of the system consists of a microelectromechanical systems microphone and inertial rate sensors interfaced with a field programmable gate array-based real-time processor to capture knee-joint sound and angle information during three types of motion: flexion-extension (FE), sit-to-stand (SS), and walking (W) tasks. The data were post-processed to extract high-frequency and short-duration joint sounds (clicks) with particular waveform signatures. Such clicks were extracted in the presence of three different sources of interference: background, stepping, and rubbing noise. A histogram-vector Vn(→) was generated from the clicks in a motion-cycle n, where the bin range was 10°. The Euclidean distance between a vector and the arithmetic mean Vav(→) of all vectors in a recording normalized by the Vav(→) is used as a consistency metric dn. Measurements from eight healthy subjects performing FE, SS, and W show that the mean (of mean) consistency metric for all subjects during SS (μ [ μ (dn)] = 0.72 in silent, 0.85 in loud) is smaller compared with the FE (μ [ μ (dn)] = 1.02 in silent, 0.95 in loud) and W ( μ [ μ (dn)] = 0.94 in silent, 0.97 in loud) exercises, thereby implying more consistent click-generation during SS compared with the FE and W. Knee-joint sounds from one subject performing FE during five consecutive work-days (μ [ μ (dn) = 0.72) and five different times of a day (μ [ μ (dn) = 0.73) suggests high consistency of the clicks on different days and throughout a day. This work represents the first time, to the best of our knowledge, that joint sound consistency has been

  9. Patient Self-Assessed Passive Range of Motion of the Knee Cannot Replace Health Professional Measurements.

    PubMed

    Borgbjerg, Jens; Madsen, Frank; Odgaard, Anders

    2017-03-01

    The purpose of this study was to investigate whether patients can accurately self-assess their knee passive range of motion (PROM). A picture-based questionnaire for patient self-assessment of knee PROM was developed and posted to patients. The self-assessed PROM from 58 patients was compared with surgeon-assessed PROM using a short-arm goniometer. Agreement between the measurement methods was calculated with the Bland-Altman method. We calculated the sensitivity and specificity of patient-assessed PROM in dichotomously detecting knee motion impairment in both flexion (≤ 100 degrees) and extension (≥ 10-degree flexion contracture). Surgeon- and patient-assessed knee PROM showed a mean difference (95% limits of agreement) of -2.1 degrees (-42.5 to 38.3 degrees) for flexion and -8.1 degrees (-28.8 to 12.7 degrees) for extension. The sensitivity of patient self-assessed PROM in identifying knee flexion and extension impairments was 86 and 100%, respectively, whereas its specificity was 84 and 43%, respectively. Although wide limits of agreement were observed between surgeon- and patient-assessed knee PROM, the picture-based questionnaire for patient assessment of knee ROM was found to be a valid tool for dichotomously detecting knee motion impairment in flexion (≤ 100 degrees). However, the specificity of the questionnaire for detection of knee extension impairments (≥ 10-degree flexion contracture) was low, which limits is practical utility for this purpose.

  10. Knee biomechanics during popular recreational and daily activities in older men.

    PubMed

    Pfeiffer, Julie L; Zhang, Songning; Milner, Clare E

    2014-06-01

    Physical activity is recommended for older adults, including those with knee pathology. However, demands on the knee during popular recreational activities are unclear. The study purpose was to determine knee biomechanics in healthy older men during golf and bowling and compare them to activities of daily living. Three-dimensional motion analysis was used to determine knee biomechanics in 19 healthy males (45-73 years): 11 golfers and eight bowlers. Subjects performed walking, stair ascent, stair descent, and either golf or bowling. Comparisons were made between the recreational activity and activities of daily living. During bowling, flexion angle at peak extensor moment was as high as during stair descent, and peak extensor moment was as high as during stair ascent. For the golf lead knee, flexion angle at peak extensor moment and peak extensor moment were as high as during stair ascent, and peak abduction moment, internal and external rotation angles were larger than during all activities of daily living. Peak external rotation angle for the golf trail knee was larger than all activities of daily living. The greatest challenge for the knee of healthy older males during bowling is eccentric control of knee flexion. Golf poses challenges in all three planes of motion for the lead knee and in the transverse plane for the trail knee. Comparing mechanical demands on the knee during bowling and golf to those of stair negotiation provides a reference for clinicians when recommending recreational activities for older adults with knee pathology. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Coupling motion between rearfoot and hip and knee joints during walking and single-leg landing.

    PubMed

    Koshino, Yuta; Yamanaka, Masanori; Ezawa, Yuya; Okunuki, Takumi; Ishida, Tomoya; Samukawa, Mina; Tohyama, Harukazu

    2017-09-22

    The objective of the current study was to investigate the kinematic relationships between the rearfoot and hip/knee joint during walking and single-leg landing. Kinematics of the rearfoot relative to the shank, knee and hip joints during walking and single-leg landing were analyzed in 22 healthy university students. Kinematic relationships between two types of angular data were assessed by zero-lag cross-correlation coefficients and coupling angles, and were compared between joints and between tasks. During walking, rearfoot eversion/inversion and external/internal rotation were strongly correlated with hip adduction/abduction (R=0.69 and R=0.84), whereas correlations with knee kinematics were not strong (R≤0.51) and varied between subjects. The correlations with hip adduction/abduction were stronger than those with knee kinematics (P<0.001). Most coefficients during single-leg landing were strong (R≥0.70), and greater than those during walking (P<0.001). Coupling angles indicated that hip motion relative to rearfoot motion was greater than knee motion relative to rearfoot motion during both tasks (P<0.001). Interventions to control rearfoot kinematics may affect hip kinematics during dynamic tasks. The coupling motion between the rearfoot and hip/knee joints, especially in the knee, should be considered individually. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Continuous passive motion following total knee replacement: a prospective randomized trial with follow-up to 1 year.

    PubMed

    Leach, W; Reid, J; Murphy, F

    2006-10-01

    We have carried out a prospective randomised, single blind clinical trial to investigate the effect of continuous passive motion on range of knee flexion, lack of extension, pain levels and analgesic use after total knee replacement surgery. 85 subjects were randomly allocated to control or study group. All subjects followed the existing rehabilitation protocol, which permits immediate active range of motion exercises and mobilisation with the study group using continuous passive motion for 1 h, twice a day. Outcome measures employed were range of motion, pain assessed on a visual analogue scale and analgesic use according to the WHO ladder. Blinded evaluation was carried out preoperatively, at time of discharge from hospital, 6 weeks, 6 and 12 months postoperation. No significant difference was observed between groups at all time intervals for each outcome variable using Wilcoxon Rank sum tests. The results substantiate previous findings that short duration continuous passive motion following total knee arthroplasty does not influence outcome of range of motion or reported pain.

  13. Normal hip, knee and ankle range of motion in the Turkish population.

    PubMed

    Hallaçeli, Hasan; Uruç, Vedat; Uysal, Halil Hakan; Ozden, Raif; Hallaçeli, Ciğdem; Soyuer, Ferhan; Ince Parpucu, Tuba; Yengil, Erhan; Cavlak, Uğur

    2014-01-01

    The aim of this study was to ascertain the effect of gender and cultural habits on hip, knee and ankle range of motion (ROM) and to determine the differences between the ROM of right and left side symmetric joints of the lower extremities. The study included 987 (513 males and 474 females) healthy volunteers. Individuals with a history of illness, prior surgery or trauma involving any joint of either lower extremity were excluded from the study. The terminology and techniques of measurements used were those suggested by the American Academy of Orthopedic Surgeons. Left side passive hip flexion and active internal rotation was higher than the right side. Passive flexion of the hip joint was higher in male subjects and internal and external rotation was higher in female subjects. In the knee joint, passive extension was higher in males. Plantarflexion and inversion of the ankle joint were higher in male subjects and dorsiflexion and eversion were higher in female subjects. The differences were considered insignificant in clinical terms as all were less than 3 degrees. There is no clinically significantly difference between right and left side hip, knee and ankle joints ROM. Gender and cultural habits do not appear to have clinically significantly effects on lower extremity joint ROM.

  14. Pathological Knee Joint Motion Analysis By High Speed Cinephotography

    NASA Astrophysics Data System (ADS)

    Baumann, Jurg U.

    1985-02-01

    The use of cinephotography for evaluation of disturbed knee joint function was compared in three groups of patients. While a sampling rate of 50 images per second was adequate for patients with neuromuscular disorders, a higher frequency of around 300 i.p.s. is necessary in osteoarthritis and ligamentous knee joint injuries, but the task of digitizing is prohibitive unless automated.

  15. The effects of kinesiology taping therapy on degenerative knee arthritis patients’ pain, function, and joint range of motion

    PubMed Central

    Lee, Kwansub; Yi, Chae-Woo; Lee, Sangyong

    2016-01-01

    [Purpose] The purpose of the present study was to examine the effects of kinesiology taping therapy on degenerative knee arthritis patients’ pain, function, and joint range of motion. [Subjects] To conduct the experiment in the present study, 30 patients with degenerative knee arthritis were divided into a control group (the conservative treatment group) of 15 patients, who received conservative physical therapy, and an experimental group (the kinesiology taping group) of 15 patients, who received kinesiology taping therapy. [Methods] All patients received treatment three times per week for four weeks. The kinesiology taping group had elastic tapes applied to the hamstring muscles, anterior tibialis, quadriceps femoris, and gastrocnemius. The range of motion was measured using joint goniometers, pain was measured using visual analog scales, and functional evaluation was conducted using the Korean Western Ontario and McMaster Universities Osteoarthritis Index. [Results] In intragroup comparisons of the kinesiology taping group and the conservative treatment group, the visual analog scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores significantly decreased, and the range of motion increased more than significantly. In intergroup comparisons, the kinesiology taping group showed significantly lower visual analog scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores and significantly larger ranges of motion than the conservative treatment group. [Conclusion] Kinesiology taping therapy is considered to be an effective nonsurgical intervention method for pain relief, daily living activities, and range of motion of degenerative knee arthritis patients. PMID:26957729

  16. The effects of kinesiology taping therapy on degenerative knee arthritis patients' pain, function, and joint range of motion.

    PubMed

    Lee, Kwansub; Yi, Chae-Woo; Lee, Sangyong

    2016-01-01

    [Purpose] The purpose of the present study was to examine the effects of kinesiology taping therapy on degenerative knee arthritis patients' pain, function, and joint range of motion. [Subjects] To conduct the experiment in the present study, 30 patients with degenerative knee arthritis were divided into a control group (the conservative treatment group) of 15 patients, who received conservative physical therapy, and an experimental group (the kinesiology taping group) of 15 patients, who received kinesiology taping therapy. [Methods] All patients received treatment three times per week for four weeks. The kinesiology taping group had elastic tapes applied to the hamstring muscles, anterior tibialis, quadriceps femoris, and gastrocnemius. The range of motion was measured using joint goniometers, pain was measured using visual analog scales, and functional evaluation was conducted using the Korean Western Ontario and McMaster Universities Osteoarthritis Index. [Results] In intragroup comparisons of the kinesiology taping group and the conservative treatment group, the visual analog scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores significantly decreased, and the range of motion increased more than significantly. In intergroup comparisons, the kinesiology taping group showed significantly lower visual analog scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores and significantly larger ranges of motion than the conservative treatment group. [Conclusion] Kinesiology taping therapy is considered to be an effective nonsurgical intervention method for pain relief, daily living activities, and range of motion of degenerative knee arthritis patients.

  17. The effects of ankle bracing on motion of the knee and the hip joint during trunk rotation tasks.

    PubMed

    Santos, Marcio J; McIntire, Kevin; Foecking, Joseph; Liu, Wen

    2004-11-01

    The use of prophylactic ankle braces is common during athletic activities since the ankle is one of the most commonly injured joints. Past studies have focused on the effects of ankle braces on ankle movement restriction, preventing injuries, proprioception, balance and athletic performance. However, the influence of ankle restriction on other joints has not been studied. The constraint of ankle movement may lead to an increased loading on the knee joint, which could be a potential risk of knee injuries during athletic activities. The primary goal of the current study was to determine quantitatively the effect of an ankle brace on the knee axial rotation during two different trunk turning tasks. Ten healthy subjects performed trunk turning movements while standing on one leg: turning sideways to catch a ball and turning sideways to touch a target with the shoulder. The tasks were performed with and without an ankle brace worn on the supporting leg. The trunk axial rotation in reference to the floor and three dimensional joint angular motions of the ankle, knee and hip were determined. The use of an ankle brace resulted in reduced trunk axial rotation during the ball catching tasks, and increased knee axial rotation during the target touching tasks. The results of this study showed that the effect of the ankle brace on the knee axial rotation depended on the context of the tasks performed. Under situations that required forceful trunk turning movement while standing on a single leg, the ankle braces may cause an increase in the knee axial rotation indicating higher risk of knee injury.

  18. Oxford medial unicompartmental knees display contact-loss during step-cycle motion and bicycle motion: A dynamic radiostereometric study.

    PubMed

    Horsager, Kristian; Kaptein, Bart L; Jørgensen, Peter B; Jepsen, Claus F; Stilling, Maiken

    2017-06-02

    The Oxford medial unicompartmental knee is designed fully congruent, with the purpose of maintaining a large contact-area throughout motion and minimize wear. No other study has investigated this design feature in-vivo. We aimed to evaluate if contact-loss was introduced between the articulating surfaces of the Oxford medial unicompartmental knee during bicycle- and step-cycle motion, and whether this correlated with essential implant parameters, such as polyethylene (PE) wear, knee-loadings, and clinical outcome. To study contact-loss, 15 patients (12 males, mean age 69 years) with an Oxford medial unicompartmental knee (7 cemented, mean follow-up 4.4 years) were examined with use of dynamic radiostereometry (RSA) (10 frames/s). PE wear was measured from static RSA and clinical outcome was evaluated with American Knee Society Score (AKSS) and Oxford Knee Score (OKS). Data on knee-loadings were acquired from the literature. Contact-loss was deteced in all patients during both exercises, and the trend of contact-loss correlated with the knee-loadings. Median contact-loss was 0.8 mm (95%PI: 0.3; 1.5) for bicycle motion and 0.3 mm (95%PI: 0.24; 0.35) for step-cycle motion, and did not correlate with the PE wear rate of mean 0.06 mm/year. Possible in-congruency was seen in three patients. Clinical outcome scores correlated with contact-loss during step-cycle motion. In conclusion, contact-loss was seen in all patients indicating a clinical tolerance during load. Contact-loss followed the knee-loadings, which could explain why no correlation was seen with PE wear, as an increase in load was acommadated by an increase in contact-area (contact-loss reduction). The size of contact-loss may reflect clinical outcome. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res . © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  19. Primary and coupled motions of the native knee in response to applied varus and valgus load.

    PubMed

    Gladnick, Brian P; Boorman-Padgett, James; Stone, Kyle; Kent, Robert N; Cross, Michael B; Mayman, David J; Pearle, Andrew D; Imhauser, Carl W

    2016-06-01

    Knowledge of the complex kinematics of the native knee is a prerequisite for a successful reconstructive procedure. The aim of this study is to describe the primary and coupled motions of the native knee throughout the range of knee flexion, in response to applied varus and valgus loads. Twenty fresh-frozen cadaver knees were affixed to a six degree of freedom robotic arm with a universal force-moment sensor, and loaded with a 4Nm moment in varus and valgus at 0, 15, 30, 45, and 90° of knee flexion. The resulting tibiofemoral angulation, displacement, and rotation were recorded. For each parameter investigated, the knee joint demonstrated more laxity at higher flexion angles. Varus angulation increased progressively from zero (2.0° varus) to 90 (5.2° varus) degrees of knee flexion (p<0.001). Valgus angulation also increased progressively, from zero (1.5° valgus) to 90 (3.9° valgus) degrees of knee flexion (p<0.001). At all flexion angles, the magnitude of tibiofemoral angle deviation was larger with varus than with valgus loading (p<0.05). We conclude that the native knee exhibits small increases in coronal plane laxity as the flexion angle increases, and that the knee has generally more laxity under varus load than with valgus load throughout the Range of Motion (ROM). Larger differences in laxity of more than 2 to 3°, or peak laxity specifically during the range of mid-flexion, were not found in our cadaver model and are not likely to represent normal coronal plane kinematics. Level V, biomechanical cadaveric study. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Cruciate Retaining Implant With Biomimetic Articular Surface to Reproduce Activity Dependent Kinematics of the Normal Knee.

    PubMed

    Varadarajan, Kartik Mangudi M; Zumbrunn, Thomas; Rubash, Harry E; Malchau, Henrik; Li, Guoan; Muratoglu, Orhun K

    2015-12-01

    Alterations in normal knee kinematics following total knee arthroplasty (TKA) arise in part from the non-anatomic articular geometry of contemporary implants. In this study, the kinematics of a novel posterior cruciate-retaining (CR) implant with anatomic (biomimetic) articular surface, were compared to that of contemporary CR implants during various simulated activities. Across different simulated activities the biomimetic-CR mimicked normal kinematic patterns more closely than contemporary CR implants. In particular, during deep knee bend and chair-sit, the biomimetic-CR showed medial pivot motion, while other CR implants showed abnormal motion including lateral pivot or no pivot, and paradoxical anterior sliding. Further in vivo and clinical studies are needed to determine whether such biomimetic implants can truly help to achieve a more normal feeling knee and improved patient satisfaction.

  1. The effect of age and knee osteoarthritis on muscle activation patterns and knee joint biomechanics during dual belt treadmill gait.

    PubMed

    Rutherford, Derek; Baker, Matthew; Wong, Ivan; Stanish, William

    2017-06-01

    To compare a group of individuals with moderate medial compartment knee osteoarthritis (OA) to both an age-matched asymptomatic group of older adults and younger adults to determine whether differences in knee joint muscle activation patterns and joint biomechanics exist during gait between these three groups. 20 young adults, 20 older adults, and 40 individuals with moderate knee OA were recruited. Using standardized procedures, surface electromyograms were recorded from the vastus lateralis and medialis, rectus femoris and the medial and lateral hamstrings. All individuals walked on a dual belt instrumented treadmill while segment motions and ground reaction forces were recorded. Sagittal plane motion and net external sagittal and frontal plane moments were calculated. Discrete measures and principal component analyses extracted amplitude and temporal waveform features. Analysis of Variance models using Bonferroni corrections determined between and within group differences in these gait features (α=0.05). Individuals with knee OA have distinct biomechanics and muscle activation patterns when compared to age-matched asymptomatic adults and younger adults whereas differences between the young and older adults were few and included only measures of muscle activation amplitude. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Arthroscopic lysis of adhesions improves knee range of motion after fixation of intra-articular fractures about the knee.

    PubMed

    Gittings, Daniel; Hesketh, Patrick; Dattilo, Jonathan; Zgonis, Miltiadis; Kelly, John; Mehta, Samir

    2016-12-01

    Post-traumatic stiffness after open reduction and internal fixation of fractures about the knee can have dramatic effects on function. Traditionally, open quadricepsplasty has been the treatment of choice, but is associated with significant morbidity. The purpose of this study is to examine the immediate and sustainable range of motion (ROM) changes after surgical arthroscopic lysis of knee adhesions (SALKA) for post-traumatic knee stiffness after open reduction internal fixation (ORIF). We retrospectively reviewed a consecutive series of patients at a single institution who underwent SALKA for knee stiffness after intra-articular fractures about the knee treated with ORIF from 2009 to 2015. Pre-operative and immediate post-operative total ROM was assessed while patients were sedated during the SALKA procedure. Total ROM was assessed in the office pre-operatively and compared to the latest post-operative follow-up visit. Immediate post-operative ROM was also compared to the latest post-operative follow-up visit. Two-tailed paired Student's t test was calculated for analysis. Of the 14 patients included in the study, 10 (71 %) had tibial plateau ORIF, 3 (21 %) had patella ORIF, and 1 (8 %) had intra-articular distal femur ORIF. The mean time between ORIF and SALKA was 244 days. The mean follow-up time after SALKA was 135 days. Under sedation during SALKA, the mean total ROM increased from 72° to 127° immediately post-operatively (p < 0.01). The mean pre-operative in-office total ROM was 73° and increased to 104° at the latest follow-up visit (p < 0.01). The mean immediate post-operative ROM was 127° and decreased to 104° at the latest follow-up visit (p = 0.01). Lysis of adhesions utilizing SALKA after ORIF about the knee improves knee ROM immediately post-operatively and in the short-term follow-up. However, there is a decrease in the gains in the range of motion over time. Patients should be counseled as such. Lysis of adhesions utilizing

  3. Range of Motion of the Ankle According to Pushing Force, Gender and Knee Position

    PubMed Central

    Cho, Kang Hee; Lee, Hyunkeun

    2016-01-01

    Objective To investigate the difference of range of motion (ROM) of ankle according to pushing force, gender and knee position. Methods One hundred and twenty-eight healthy adults (55 men, 73 women) between the ages of 20 and 51, were included in the study. One examiner measured the passive range of motion (PROM) of ankle by Dualer IQ Inclinometers and Commander Muscle Testing. ROM of ankle dorsiflexion (DF) and plantarflexion (PF) according to change of pushing force and knee position were measured at prone position. Results There was significant correlation between ROM and pushing force, the more pushing force leads the more ROM at ankle DF and ankle PF. Knee flexion of 90° position showed low PF angle and high ankle DF angle, as compared to the at neutral position of knee joint. ROM of ankle DF for female was greater than for male, with no significant difference. ROM of ankle PF for female was greater than male regardless of the pushing force. Conclusion To our knowledge, this is the first study to assess the relationship between pushing force and ROM of ankle joint. There was significant correlation between ROM of ankle and pushing force. ROM of ankle PF for female estimated greater than male regardless of the pushing force and the number of measurement. The ROM of the ankle is measured differently according to the knee joint position. Pushing force, gender and knee joint position are required to be considered when measuring the ROM of ankle joint. PMID:27152277

  4. Remobilization does not restore immobilization-induced adhesion of capsule and restricted joint motion in rat knee joints.

    PubMed

    Ando, Akira; Suda, Hideaki; Hagiwara, Yoshihiro; Onoda, Yoshito; Chimoto, Eiichi; Itoi, Eiji

    2012-01-01

    Joint immobilization, which is used in orthopaedic treatments and observed in bedridden people, usually causes restricted joint motion. Decreased joint motion diminishes activities of daily living and increases burden of nursing-care. The purpose of this study was to clarify the reversibility of immobilization-induced capsular changes and restricted joint motion in rat knee joints. The unilateral knee joints of adult male rats were immobilized with an internal fixator for 1, 2, 4, 8, and 16 weeks as a model of immobilization after surgery or disuse of the joint. After the fixation devices were removed, the rats were allowed to move freely for 16 weeks. Sham-operated rats were used as controls. Sagittal sections at medial midcondylar regions were made and assessed with histological, histomorphometric, and immunohistochemical methods. Joint motion was measured using a custom-made device under x-ray control after removal of the periarticular muscles. In the 1/16-week and 2/16-week immobilization-remobilization (Im-Rm) groups, cord-like structures connecting the superior and inferior portions of the posterior capsule (partial adhesion) were observed without restricted joint motion. In the 4/16-, 8/16-, and 16/16-week Im-Rm groups, global adhesion of the posterior capsule and restricted joint motion were observed. The restricted joint motion was not completely restored after incision of the posterior capsule. These data indicate that immobilization alone causes irreversible capsular changes and arthrogenic restricted joint motion. Besides the joint capsule, other arthrogenic factors such as ligaments might influence the restricted joint motion. Prolonged immobilization over 4 weeks should be avoided to prevent irreversible joint contracture.

  5. Influence of footwear and equipment on stride length and range of motion of ankle, knee and hip joint.

    PubMed

    Schulze, Christoph; Lindner, Tobias; Woitge, Sandra; Schulz, Katharina; Finze, Susanne; Mittelmeier, Wolfram; Bader, Rainer

    2014-01-01

    Footwear and equipment worn by military personnel is of importance for them to be able to meet the physical demands specific to their profession daily activities. The aim of the present study was to investigate by means of gait analysis how army-provided footwear and equipment influence the range of motion of hip, knee and ankle joints as well as stride length. Thirty-two soldiers were subjected to gait analysis on a treadmill by way of video recordings and goniometric measurements. The stride length increased when military shoes are worn. We found no influence on stride length in connection to increased loading. The weight of the shoes represents the decisive factor. Neither shoes nor equipment changed the range of motion of the knee joint. Weight of equipment affected range of motion of the hip joint. The range of motion of the upper and lower ankle joints was mainly influenced by the properties of the shoes. Military footwear and weight of equipment influence stride length and range of motion of joints of the lower extremities in a specific way. Shape of material is the decisive factor.

  6. Eccentric loading and range of knee joint motion effects on performance enhancement in vertical jumping.

    PubMed

    Moran, Kieran A; Wallace, Eric S

    2007-12-01

    The aim of the study was to determine the effects of variations in eccentric loading and knee joint range of motion on performance enhancement associated with the stretch-shortening cycle in vertical jumping. Seventeen male elite volleyball players performed three variations of the vertical jump which served as the research model: the squat jump (SJ), countermovement jump (CMJ) and drop jump from a height of 30 cm (DJ30). Knee joint angle (70 degrees and 90 degrees of flexion) at the commencement of the propulsive phase for each jump type was experimentally controlled, with the trunk kept as erect as possible. Force and motion data were recorded for each performance and used to compute a range of kinematic and kinetic variables, including hip, knee and ankle angles, angular velocities, work done, net joint moments and a number of temporal variables. The average of 12 trials for each participant was used in a series of repeated measures ANOVA's (jump xk nee, alpha=.05). From both knee joint angles, an increase in eccentric loading resulted in a significant increase in jump height (DJ30>CMJ>SJ; p<.05). These enhancements were significantly greater (p<.05) for 70 degrees in comparison to 90 degrees of knee flexion. From 70 degrees of knee flexion, these enhancements were due to significant increases in work done at all three joints; while from 90 degrees of knee flexion, only the hip and ankle joints appeared to contribute (p<.05). The amount of enhancement associated with employing the SSC in jumping is dependent upon the interaction of the magnitude of eccentric loading and the range of motion used.

  7. Knee rotationplasty: motion of the body centre of mass during walking

    PubMed Central

    Rota, Viviana; Okita, Yusuke; Manfrini, Marco; Tesio, Luigi

    2016-01-01

    Knee rotationplasty (KRP) is a type of surgery in which the rotated ankle serves as a new knee after being removed for bone tumor. Although this limb salvage surgery is rarely indicated in properly selected patients, it may offer functional advantages over transfemoral amputation, and more durable results compared with a prosthesis. The walking mechanics of adult patients after KRP is believed to be close to that of below-knee amputees. In this study, we evaluated steady-state walking of KRP patients from the viewpoint of the overall muscle power needed to keep the body centre of mass in motion. Three adult patients after KRP, all athletes, were evaluated. Ground reactions during walking were recorded during six subsequent strides on a force treadmill. The positive mechanical work and power sustaining the motion of the centre of mass and the recovery of muscle energy due to the pendulum-like mechanism of walking were computed and compared with those obtained in previous studies from above-knee, below-knee amputees and healthy individuals. In KRP patients, walking was sustained by a muscle power output which was 1.4–3.6 times lower during the step performed on the rotated limb than on the subsequent step. The recovery of muscle energy was slightly lower (0.9) or higher (1.3–1.4 times) on the affected side. In two out of the three KRP patients, our findings were more similar to those from above-knee amputees than to those from below-knee amputees. After KRP, the rotated limb does not necessarily provide the same power provided by below-knee amputation. This may have a relevance for the paralympic classification of KRP athletes. PMID:27685013

  8. Knee Joint Contact Mechanics during Downhill Gait and its Relationship with Varus/Valgus Motion and Muscle Strength in Patients with Knee Osteoarthritis

    PubMed Central

    Farrokhi, Shawn; Voycheck, Carrie A.; Gustafson, Jonathan A.; Fitzgerald, G. Kelley; Tashman, Scott

    2015-01-01

    Objective The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). Methods Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. Group differences in contact mechanics and frontal-plane motion excursions were compared using analysis of covariance with adjustments for body mass index. Differences in strength were compared using independent sample t-tests. Additionally, linear associations between contact mechanics with frontal-plane knee motion and muscle strength were evaluated using Pearson's correlation coefficients. Results Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p<0.02) and greater heel-strike joint contact point velocities (p<0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p=0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p<0.01) and greater quadriceps and hip abductor muscle weakness (p=0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p<0.04) but not with quadriceps or hip abductor strength. Conclusion Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with

  9. The effects of knee direction, physical activity and age on knee joint position sense.

    PubMed

    Relph, Nicola; Herrington, Lee

    2016-06-01

    Previous research has suggested a decline in knee proprioception with age. Furthermore, regular participation in physical activity may improve proprioceptive ability. However, there is no large scale data on uninjured populations to confirm these theories. The aim of this study was to provide normative knee joint position data (JPS) from healthy participants aged 18-82years to evaluate the effects of age, physical activity and knee direction. A sample of 116 participants across five age groups was used. The main outcome measures were knee JPS absolute error scores into flexion and extension, Tegner activity levels and General Practitioner Physical Activity Questionnaire results. Absolute error scores in to knee flexion were 3.6°, 3.9°, 3.5°, 3.7° and 3.1° and knee extension were 2.7°, 2.5°, 2.9°, 3.4° and 3.9° for ages 15-29, 30-44, 45-59, 60-74 and 75 years old respectively. Knee extension and flexion absolute error scores were significantly different when age group data were pooled. There was a significant effect of age and activity level on joint position sense into knee extension. Age and lower Tegner scores were also negatively correlated to joint position sense into knee extension. The results provide some evidence for a decline in knee joint position sense with age. Further, active populations may have heightened static proprioception compared to inactive groups. Normative knee joint position sense data is provided and may be used by practitioners to identify patients with reduced proprioceptive ability. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis.

    PubMed

    Selistre, Luiz Fernando Approbato; Mattiello, Stela Márcia; Nakagawa, Theresa Helissa; Gonçalves, Glaucia Helena; Petrella, Marina; Jones, Richard Keith

    2017-04-01

    External knee moments are reliable to measure knee load but it does not take into account muscle activity. Considering that muscle co-activation increases compressive forces at the knee joint, identifying relationships between muscle co-activations and knee joint load would complement the investigation of the knee loading in subjects with knee osteoarthritis. The purpose of this study was to identify relationships between muscle co-activation and external knee moments during walking in subjects with medial knee osteoarthritis. 19 controls (11 males, aged 56.6±5, and BMI 25.2±3.3) and 25 subjects with medial knee osteoarthritis (12 males, aged 57.3±5.3, and BMI 28.2±4) were included in this study. Knee adduction and flexion moments, and co-activation (ratios and sums of quadriceps, hamstring, and gastrocnemius) were assessed during walking and compared between groups. The relationship between knee moments and co-activation was investigated in both groups. Subjects with knee osteoarthritis presented a moderate and strong correlation between co-activation (ratios and sums) and knee moments. Muscle co-activation should be used to measure the contribution of quadriceps, hamstring, and gastrocnemius on knee loading. This information would cooperate to develop a more comprehensive approach of knee loading in this population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Rabbit knee model of post-traumatic joint contractures: the long-term natural history of motion loss and myofibroblasts.

    PubMed

    Hildebrand, Kevin A; Sutherland, Craig; Zhang, Mei

    2004-03-01

    Our objective is to describe the natural history of motion loss with time and myofibroblast numbers in a rabbit knee model of post-traumatic joint contractures. Twenty-eight skeletally mature New Zealand White female rabbits had five-mm-squares of cortical bone removed from the medial and lateral femoral condyles of the right knee. A Kirschner wire (K-wire) was used to immobilize the knee joint in maximum flexion. A second operation was performed 8 weeks later to remove the K-wire. The rabbits were divided into four groups depending on the time of remobilization; 0, 8, 16 or 32 weeks. The average flexion contracture of the experimental knees in the 0-week and 8-week remobilization groups (38 degrees and 33 degrees, respectively) were significantly greater when compared with the values of the unoperated contralateral knees (8 degrees). The average flexion contractures of the experimental knees in the 16-week and 32-week remobilization groups were also greater than the unoperated contralateral knees, although they were not statistically significant. The average flexion contractures of the 16-week and 32-week groups were 19 degrees and 18 degrees, respectively, indicating a stabilization of the motion loss. Myofibroblast numbers in the posterior joint capsules were elevated 4-5x in the knees with contractures when compared to the contralateral knees. The initial decrease in severity followed by stabilization of motion loss and the association of motion loss with myofibroblasts mimics the human scenario of permanent post-traumatic joint contractures.

  12. Is digital photography an accurate and precise method for measuring range of motion of the hip and knee?

    PubMed

    Russo, Russell R; Burn, Matthew B; Ismaily, Sabir K; Gerrie, Brayden J; Han, Shuyang; Alexander, Jerry; Lenherr, Christopher; Noble, Philip C; Harris, Joshua D; McCulloch, Patrick C

    2017-09-07

    Accurate measurements of knee and hip motion are required for management of musculoskeletal pathology. The purpose of this investigation was to compare three techniques for measuring motion at the hip and knee. The authors hypothesized that digital photography would be equivalent in accuracy and show higher precision compared to the other two techniques. Using infrared motion capture analysis as the reference standard, hip flexion/abduction/internal rotation/external rotation and knee flexion/extension were measured using visual estimation, goniometry, and photography on 10 fresh frozen cadavers. These measurements were performed by three physical therapists and three orthopaedic surgeons. Accuracy was defined by the difference from the reference standard, while precision was defined by the proportion of measurements within either 5° or 10°. Analysis of variance (ANOVA), t-tests, and chi-squared tests were used. Although two statistically significant differences were found in measurement accuracy between the three techniques, neither of these differences met clinical significance (difference of 1.4° for hip abduction and 1.7° for the knee extension). Precision of measurements was significantly higher for digital photography than: (i) visual estimation for hip abduction and knee extension, and (ii) goniometry for knee extension only. There was no clinically significant difference in measurement accuracy between the three techniques for hip and knee motion. Digital photography only showed higher precision for two joint motions (hip abduction and knee extension). Overall digital photography shows equivalent accuracy and near-equivalent precision to visual estimation and goniometry.

  13. Partial knee replacement

    MedlinePlus

    ... minor deformity in the knee. You have good range of motion in your knee. The ligaments in your knee ... You will also need physical therapy to improve range of motion and strengthen the muscles around the knee.

  14. Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort.

    PubMed

    van der Esch, Martin; Knoop, Jesper; van der Leeden, Marike; Voorneman, Ramon; Gerritsen, Martijn; Reiding, Dick; Romviel, Suzanne; Knol, Dirk L; Lems, Willem F; Dekker, Joost; Roorda, Leo D

    2012-10-01

    The objective of this study was to evaluate whether self-reported knee instability is associated with activity limitations in patients with knee osteoarthritis (OA), in addition to knee pain and muscle strength. A cohort of 248 patients diagnosed with knee OA was examined. Self-reported knee instability was defined as the perception of any episode of buckling, shifting, or giving way of the knee in the past 3 months. Knee pain was assessed using a numeric rating scale, and knee extensor and flexor strength were measured using an isokinetic dynamometer. Activity limitations were measured by using the Western Ontario and McMasters Universities Osteoarthritis Index physical function questionnaire, the timed Get Up and Go, and the timed stair climbing and three questionnaires evaluating walking, climbing stairs, and rising from a chair. Other potential determinants of activity limitations were also collected, including joint proprioception, joint laxity, age, sex, body mass index (BMI), disease duration, and radiographic disease severity. Regression analyses evaluated the effect of adding self-reported knee instability to knee pain and muscle strength, when examining associations with the activity limitations measures. Self-reported knee instability was common (65 %) in this cohort of patients with knee OA. Analyses revealed that self-reported knee instability is significantly associated with activity limitations, even after controlling for knee pain and muscle strength. Joint proprioception, joint laxity, age, sex, BMI, duration of complaints, and radiographic severity did not confound the associations. In conclusion, self-reported knee instability is associated with activity limitations in patients with knee OA, in addition to knee pain and muscle strength. Clinically, self-reported knee instability should be assessed in addition to knee pain and muscle strength.

  15. Clinical evaluation of 292 Genesis II posterior stabilized high-flexion total knee arthroplasty: range of motion and predictors.

    PubMed

    Fuchs, Mathijs C H W; Janssen, Rob P A

    2015-01-01

    The primary aim of the study was to evaluate the range of motion and complications after Genesis II total knee arthroplasty with high-flexion tibia insert (TKA-HF). Furthermore, difference in knee flexion between high flexion and standard inserts was compared. The hypothesis was that knee flexion is better after high-flexion TKA. A total of 292 TKA-HF were retrospectively reviewed. Mean follow-up was 24.3 months. The range of motion was compared between TKA-HF (high-flexion group) and a comparable cohort of 86 Genesis II TKA with a standard tibia insert (control group). Surgeries were performed by one experienced knee orthopedic surgeon. Knee flexion in the high-flexion group increased from 114.8° preoperatively to 118.0° postoperatively (P < 0.01). Knee extension in the high-flexion group increased from -4.5° preoperatively to -0.4° after surgery (P < 0.01). Mean knee flexion was 5.52° (± 1.46°) better in the high-flexion group compared with the control group (P < 0.01). Preoperative range of motion, body mass index, diabetes mellitus and patellofemoral pain significantly influenced range of motion. Few complications occurred after TKA-HF. The Genesis II TKA-HF showed good short-term results with limited complications. Knee flexion after Genesis II TKA-HF was better compared with a standard tibia insert.

  16. Total Knee Arthroplasty in Hemophiliacs: Gains in Range of Motion Realized beyond Twelve Months Postoperatively

    PubMed Central

    Horneff, John G.; Forsyth, Angela; Nikci, Valdet; Nelson, Charles L.

    2012-01-01

    Background Hemophiliacs have extrinsic tightness from quadriceps and flexion contractures. We sought to examine the effect of a focused physical therapy regimen geared to hemophilic total knee arthroplasty. Methods Twenty-four knees undergoing intensive hemophiliac-specific physical therapy after total knee arthroplasty, at an average age of 46 years, were followed to an average 50 months. Results For all patients, flexion contracture improved from -10.5 degrees preoperatively to -5.1 degrees at final follow-up (p = 0.02). Knees with preoperative flexion less than 90 degrees were compared to knees with preoperative flexion greater than 90 degrees. Patients with preoperative flexion less than 90 degrees experienced improved flexion (p = 0.02), along with improved arc range of motion (ROM) and decreased flexion contracture. For those patients with specific twelve-month and final follow-up data points, there was a significant gain in flexion between twelve months and final follow-up (p = 0.02). Conclusions Hemophiliacs with the poorest flexion benefited most from focused quadriceps stretching to a more functional length, with gains not usually seen in the osteoarthritic population. This data may challenge traditional views that ROM gains are not expected beyond 12-18 months. PMID:22662297

  17. Multibody muscle driven model of an instrumented prosthetic knee during squat and toe rise motions.

    PubMed

    Stylianou, Antonis P; Guess, Trent M; Kia, Mohammad

    2013-04-01

    Detailed knowledge of knee joint kinematics and dynamic loading is essential for improving the design and outcomes of surgical procedures, tissue engineering applications, prosthetics design, and rehabilitation. The need for dynamic computational models that link kinematics, muscle and ligament forces, and joint contacts has long been recognized but such body-level forward dynamic models do not exist in recent literature. A main barrier in using computational models in the clinic is the validation of the in vivo contact, muscle, and ligament loads. The purpose of this study was to develop a full body, muscle driven dynamic model with subject specific leg geometries and validate it during squat and toe-rise motions. The model predicted loads were compared to in vivo measurements acquired with an instrumented knee implant. Data for this study were provided by the "Grand Challenge Competition to Predict In-Vivo Knee Loads" for the 2012 American Society of Mechanical Engineers Summer Bioengineering Conference. Data included implant and bone geometries, ground reaction forces, EMG, and the instrumented knee implant measurements. The subject specific model was developed in the multibody framework. The knee model included three ligament bundles for the lateral collateral ligament (LCL) and the medial collateral ligament (MCL), and one bundle for the posterior cruciate ligament (PCL). The implanted tibia tray was segmented into 326 hexahedral elements and deformable contacts were defined between the elements and the femoral component. The model also included 45 muscles on each leg. Muscle forces were computed for the muscle driven simulation by a feedback controller that used the error between the current muscle length in the forward simulation and the muscle length recorded during a kinematics driven inverse simulation. The predicted tibia forces and torques, ground reaction forces, electromyography (EMG) patterns, and kinematics were compared to the experimentally

  18. Can an anterior quadriceps release improve range of motion in the stiff arthritic knee?

    PubMed

    Tarabichi, Samih; Tarabichi, Yasir

    2010-06-01

    We hypothesize that tethering adhesions of the quadriceps muscle are the major pathological structures responsible for a limited range of motion in the stiff arthritic knee. Forty-two modified quadriceps muscle releases were performed on 24 patients with advanced osteoarthritis scheduled for total knee arthroplasty. The ranges of motion were documented intraoperatively both before and immediately after the release. Passive flexion improved significantly in all patients (mean, 32.4 degrees of improvement, P < .001) following a modified quadriceps release, despite any presence of osteophytes or severe deformities. These results strongly implicate adhesions of the quadriceps muscle to the underlying femur, which prevent the distal excursion of the quadriceps tendon, as the restrictive pathology preventing deep flexion in patients with osteoarthritis.

  19. Unilateral eccentric exercise of the knee flexors affects muscle activation during gait.

    PubMed

    Dover, Geoffrey C; Legge, Laura; St-Onge, Nancy

    2012-05-01

    Uni-lateral muscle soreness is common yet the effects on gait or electromyographic (EMG) activity are unknown. The purpose of our study was to induce delayed onset muscle soreness (DOMS) in the knee flexor group and measure the resultant change in EMG activity and knee motion during gait. Nine healthy subjects participated in the study. Measures of function, evoked tenderness of the biceps femoris, as well as knee angle, and EMG activity during gait were assessed prior and 48 h after an eccentric exercise protocol. DOMS was induced unilaterally in the knee flexors using an isokinetic dynamometer and subjects exercised until they could not generate 50% of their maximal voluntary isometric contraction (MVIC). There was a significant decrease in biceps femoris activity after DOMS during the last phase of gait. Moreover, there was a day × phase interaction for gastrocnemius activity with the last two phases displaying an increase in activity. There was no significant change in knee angle during gait. The decrease in biceps femoris activity as well as the increase in gastrocnemius activity could be evidence of a protective mechanism designed to decrease activity of the sore muscle while increasing the activity of a synergistic muscle. Copyright © 2012 Elsevier B.V. All rights reserved.

  20. Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis.

    PubMed

    Farrokhi, Shawn; Voycheck, Carrie A; Gustafson, Jonathan A; Fitzgerald, G Kelley; Tashman, Scott

    2016-01-01

    The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p < 0.02) and greater heel-strike joint contact point velocities (p < 0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p = 0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p < 0.01) and greater quadriceps and hip abductor muscle weakness (p = 0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p < 0.04) but not with quadriceps or hip abductor strength. Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.

  1. Robot-aided motion planning for knee joint rehabilitation with two robot-manipulators.

    PubMed

    Pei, Y; Kim, Y; Obinata, G; Genda, E; Stefanov, D

    2013-01-01

    In this paper, we propose a simultaneous design method of motion and external force trajectories for knee joint rehabilitation based on the biomechanical analysis of the lower limb. In this method we assume to use two robots manipulators which provide forces and moments at shank and thigh. We developed a 7 degree of freedom musculoskeletal model of lower limb with 19 muscles. The valuation function of rehabilitation efficiency e has been maximized by Genetic Algorithm (GA) that refers to the musculoskeletal model and tunes motion trajectory of the robots and forces acting on the shank and thigh.

  2. Changes in knee motion over the first 3 years with a mobile-bearing prosthesis.

    PubMed

    Russo, Alessandro; Montagna, Luisa; Bragonzoni, Laura; Visani, Andrea; Marcacci, Maurilio

    2006-08-01

    The present work aims to evaluate the mobility of the polyethylene bearing in 25 patients implanted with a mobile-bearing PCL-retaining TKR (Interax ISA, Striker Howmedica) under in vivo, weight-bearing conditions over 3 years' follow-up. We compared the bearing motion in response to specific tests in two consecutive follow-ups with Roentgen Stereophotogrammetric Analysis (RSA). Results showed that polyethylene continued to displace on the tibial baseplate over time: longitudinal rotations and medio-lateral translations tended to increase at the second follow-up (mean increases 0.7+/-2.5 degrees and 0.34+/-1.08 mm, respectively), while sagittal translations did not show any relevant change. Longitudinal rotations and AP translations were preserved when present at both follow-ups. Nevertheless, no statistical evidence of repeatable pattern of motion was found, since bearings frequently reversed their pattern of motion between the two follow-ups. The unconstrained polyethylene mobility resulted in an unrepeatable, erratic pattern of bearing motion intra-patient and over time. The changes in knee motion were found not to affect the clinical results over the first 3 years of follow-up. As in a fixed-bearing design, mobile-bearing design was not able to reproduce normal knee kinematics.

  3. Relationships between Muscle Architecture of Rectus Femoris and Functional Parameters of Knee Motion in Adults with Down Syndrome.

    PubMed

    Valle, Maria Stella; Casabona, Antonino; Micale, Marco; Cioni, Matteo

    2016-01-01

    This study was designed to measure in vivo muscle architecture of the rectus femoris in adults with Down syndrome, testing possible relationships with functional parameters of the knee motion. Ten adults with Down syndrome and ten typically developed participated in the study. Pennation angle and thickness of the rectus femoris and subcutaneous layer of the thigh were measured via ultrasound imaging. Knee kinematics and electromyographic activity of the rectus femoris were recorded during free leg dropping. Muscle thickness was reduced and subcutaneous layer was thicker in persons with Down syndrome with respect to typically developed adults, but there were no differences in the pennation angle. The area of the rectus femoris EMG activity during the leg flexion was greater in Down syndrome with respect to typically developed adults. The leg movement velocity was lower in Down people than in controls, but the knee excursion was similar between the groups. Functional parameters correlated with pennation angle in the persons with Down syndrome and with muscle thickness in typically developed persons. The description of muscle architecture and the relationships between morphological and functional parameters may provide insights on the limits and the opportunities to overcome the inherent biomechanical instability in Down syndrome.

  4. Relationships between Muscle Architecture of Rectus Femoris and Functional Parameters of Knee Motion in Adults with Down Syndrome

    PubMed Central

    Micale, Marco; Cioni, Matteo

    2016-01-01

    This study was designed to measure in vivo muscle architecture of the rectus femoris in adults with Down syndrome, testing possible relationships with functional parameters of the knee motion. Ten adults with Down syndrome and ten typically developed participated in the study. Pennation angle and thickness of the rectus femoris and subcutaneous layer of the thigh were measured via ultrasound imaging. Knee kinematics and electromyographic activity of the rectus femoris were recorded during free leg dropping. Muscle thickness was reduced and subcutaneous layer was thicker in persons with Down syndrome with respect to typically developed adults, but there were no differences in the pennation angle. The area of the rectus femoris EMG activity during the leg flexion was greater in Down syndrome with respect to typically developed adults. The leg movement velocity was lower in Down people than in controls, but the knee excursion was similar between the groups. Functional parameters correlated with pennation angle in the persons with Down syndrome and with muscle thickness in typically developed persons. The description of muscle architecture and the relationships between morphological and functional parameters may provide insights on the limits and the opportunities to overcome the inherent biomechanical instability in Down syndrome. PMID:27896273

  5. [Sport activity after hip and knee arthroplasty].

    PubMed

    Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael

    2013-11-01

    Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them.

  6. Design of a mechanism for converting the energy of knee motions by using electroactive polymers.

    PubMed

    Armbruster, Pascal; Oster, Yannick; Vogt, Marcel; Pylatiuk, Christian

    2017-03-04

    Harvesting energy from human body motions has become a promising option to prolong battery life for powering medical devices for autonomy. Up to now, different generating principles including dielectric electroactive polymers (DEAPs) have been suggested for energy conversion. However, there is a lack of mechanisms that are specifically designed to convert energy with DEAPs. In a proof of concept study, a mechanical system was designed for stretching DEAPs in those phases of the gait cycle, in which the muscles mainly perform negative work. Rotational movements of the knee joint are transformed into linear movements by using a cable pull. The DEAP can be charged during the stretching phase and discharged during releasing and allows for the conversion of kinetic energy into electric energy. To evaluate the concept, tests were conducted. It was found that the developed body energy harvesting (BEH) system has a performance in the range of 24-40 μW at normal walking speed. The converted energy is sufficient for powering sensors in medical devices such as active orthoses or prostheses.

  7. The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion.

    PubMed

    Engebretsen, L; Lew, W D; Lewis, J L; Hunter, R E

    1990-01-01

    Lateral extraarticular reconstructions are used as isolated procedures in knees with moderate rotatory instability and as "backups" in knees requiring primary repair or intraarticular reconstruction for major rotatory instability. We used an experimental knee testing system to analyze the immediate postoperative mechanical effect of an iliotibial band tenodesis on an intraarticular reconstruction of the ACL in fresh cadaver knees using a composite graft consisting of a bone-patellar tendonbone segment augmented with the Kennedy Ligament Augmentation Device (LAD, 3M Co., St. Paul, MN). The intraarticular graft was standardized by using a forcesetting technique. Ligament and graft forces were measured using buckle transducers, and joint motion was measured using an instrumented spatial linkage as 90 N anteriorly directed tibial loads were applied to seven fresh knee specimens at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion. The following knee states were tested in each specimen: intact ACL, excised ACL, intraarticular reconstruction, intraarticular reconstruction with the tenodesis added, and tenodesis with the intraarticular reconstruction added. Adding the iliotibial band tenodesis to an existing standardized intraarticular reconstruction significantly decreased the force in the ACL composite graft by an average of 43%. When the standardized intraarticular reconstruction was added to an existing tenodesis, the graft forces were an average of 15% below the level of when the reconstruction was performed alone. The force in the tenodesis was significantly less than the composite graft force at extension; however, the differences between the tenodesis and total graft force were not significant from 30 degrees to 90 degrees of flexion.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Designing for scale: development of the ReMotion Knee for global emerging markets.

    PubMed

    Hamner, Samuel R; Narayan, Vinesh G; Donaldson, Krista M

    2013-09-01

    Amputees living in developing countries have a profound need for affordable and reliable lower limb prosthetic devices. The World Health Organization estimates there are approximately 30 million amputees living in low-income countries, with up to 95% lacking access to prosthetic devices. Effective prosthetics can significantly affect the lives of these amputees by increasing opportunity for employment and providing improvements to long-term health and well-being. However, current solutions are inadequate: state-of-the-art solutions from the US and Europe are cost-prohibitive, while low-cost devices have been challenged by poor quality and/or unreliable performance, and have yet to achieve large scale impact. The introduction of new devices is hampered by the lack of a cohesive prosthetics industry in low-income areas; the current network of low-cost prosthetic clinics is informal and loosely organized with significant disparities in geography, patient volume and demographics, device procurement, clinical and logistical infrastructure, and funding. At D-Rev (Design Revolution) we are creating the ReMotion Knee, which is an affordable polycentric prosthetic knee joint that performs on par with devices in more industrialized regions, like the US and Europe. As of September 2012, over 4200 amputees have been fitted with the initial version of the ReMotion Knee through a partnership with the JaipurFoot Organization, with an 79% compliance rate after 2 years. We are currently scaling production of the ReMotion Knee using centralized manufacturing and distribution to serve the existing clinics in low-income countries and increase the availability of devices for amputees without access to appropriate care. At D-Rev, we develop products that target these customers through economically-sustainable models and provide a measurable impact in the lives of the world's amputees.

  9. Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing–Lunge Ankle-Dorsiflexion Range of Motion

    PubMed Central

    Dill, Karli E.; Begalle, Rebecca L.; Frank, Barnett S.; Zinder, Steven M.; Padua, Darin A.

    2014-01-01

    Context: Ankle-dorsiflexion (DF) range of motion (ROM) may influence movement variables that are known to affect anterior cruciate ligament loading, such as knee valgus and knee flexion. To our knowledge, researchers have not studied individuals with limited or normal ankle DF-ROM to investigate the relationship between those factors and the lower extremity movement patterns associated with anterior cruciate ligament injury. Objective: To determine, using 2 different measurement techniques, whether knee- and ankle-joint kinematics differ between participants with limited and normal ankle DF-ROM. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Forty physically active adults (20 with limited ankle DF-ROM, 20 with normal ankle DF-ROM). Main Outcome Measure(s): Ankle DF-ROM was assessed using 2 techniques: (1) nonweight-bearing ankle DF-ROM with the knee straight, and (2) weight-bearing lunge (WBL). Knee flexion, knee valgus-varus, knee internal-external rotation, and ankle DF displacements were assessed during the overhead-squat, single-legged squat, and jump-landing tasks. Separate 1-way analyses of variance were performed to determine whether differences in knee- and ankle-joint kinematics existed between the normal and limited groups for each assessment. Results: We observed no differences between the normal and limited groups when classifying groups based on nonweight-bearing passive-ankle DF-ROM. However, individuals with greater ankle DF-ROM during the WBL displayed greater knee-flexion and ankle-DF displacement and peak knee flexion during the overhead-squat and single-legged squat tasks. In addition, those individuals also demonstrated greater knee-varus displacement during the single-legged squat. Conclusions: Greater ankle DF-ROM assessed during the WBL was associated with greater knee-flexion and ankle-DF displacement during both squatting tasks as well as greater knee-varus displacement during

  10. Relationship between knee alignment and the electromyographic activity of quadriceps muscles in patients with knee osteoarthritis

    PubMed Central

    Lim, Seong Hoon; Hong, Bo Young; Oh, Jee Hae; Lee, Jong In

    2015-01-01

    [Purpose] We evaluated the relationship between knee alignment and the electromyographic (EMG) activity of the vastus medialis (VM) to the vastus lateralis (VL) muscles in patients with knee osteoarthritis (OA) in a cross-sectional study. [Subjects and Methods] Forty subjects with knee OA were assessed by anatomic radiographic knee alignment and the VM/VL ratio was calculated. Surface EMG from both the VM and VL muscles were evaluated during maximal isometric contraction at 60° knee flexion. Simultaneously, peak quadriceps torque was assessed using an isokinetic dynamometer. Subjects were categorized into low, moderate, and high varus groups according to knee malalignment. The peak quadriceps torque and VM/VL ratio across groups, and their relationships with varus malalignment were analyzed. [Results] All subjects had medial compartment OA and the VM/VL ratio of all subjects was 1.31 ± 0.28 (mean ± SD). There were no significant differences in the peak quadriceps torque or VM/VL ratios across the groups nor were there any significant relationships with varus malalignment. [Conclusion] The VM/VL ratio and peak quadriceps torque were not associated with the severity of knee varus malalignment. PMID:25995602

  11. Roller-Massager Application to the Quadriceps and Knee-Joint Range of Motion and Neuromuscular Efficiency During a Lunge

    PubMed Central

    Bradbury-Squires, David J.; Noftall, Jennifer C.; Sullivan, Kathleen M.; Behm, David G.; Power, Kevin E.; Button, Duane C.

    2015-01-01

    Context: Roller massagers are used as a recovery and rehabilitative tool to initiate muscle relaxation and improve range of motion (ROM) and muscular performance. However, research demonstrating such effects is lacking. Objective: To determine the effects of applying a roller massager for 20 and 60 seconds on knee-joint ROM and dynamic muscular performance. Design: Randomized controlled clinical trial. Setting: University laboratory. Patients or Other Participants: Ten recreationally active men (age = 26.6 ± 5.2 years, height = 175.3 ± 4.3 cm, mass = 84.4 ± 8.8 kg). Intervention(s): Participants performed 3 randomized experimental conditions separated by 24 to 48 hours. In condition 1 (5 repetitions of 20 seconds) and condition 2 (5 repetitions of 60 seconds), they applied a roller massager to the quadriceps muscles. Condition 3 served as a control condition in which participants sat quietly. Main Outcome Measure(s): Visual analog pain scale, electromyography (EMG) of the vastus lateralis (VL) and biceps femoris during roller massage and lunge, and knee-joint ROM. Results: We found no differences in pain between the 20-second and 60-second roller-massager conditions. During 60 seconds of roller massage, pain was 13.5% (5.7 ± 0.70) and 20.6% (6.2 ± 0.70) greater at 40 seconds and 60 seconds, respectively, than at 20 seconds (P < .05). During roller massage, VL and biceps femoris root mean square (RMS) EMG was 8% and 7%, respectively, of RMS EMG recorded during maximal voluntary isometric contraction. Knee-joint ROM was 10% and 16% greater in the 20-second and 60-second roller-massager conditions, respectively, than the control condition (P < .05). Finally, average lunge VL RMS EMG decreased as roller-massage time increased (P < .05). Conclusions: Roller massage was painful and induced muscle activity, but it increased knee-joint ROM and neuromuscular efficiency during a lunge. PMID:25415414

  12. An examination of Cyriax's passive motion tests with patients having osteoarthritis of the knee.

    PubMed

    Hayes, K W; Petersen, C; Falconer, J

    1994-08-01

    We explored the construct validity and test-retest reliability of the passive motion component of the Cyriax soft tissue diagnosis system. We compared the hypothesized and actual patterns of restriction, end-feel, and pain/resistance sequence (P/RS) of 79 subjects with osteoarthritis (OA) of the knee and examined associations among these indicators of dysfunction and related constructs of joint motion, pain intensity, and chronicity. Subjects had a mean age of 68.5 years (SD = 13.3, range = 28-95), knee stiffness for an average of 83.6 months (SD = 122.4, range = 1-612), knee pain averaging 5.6 cm (SD = 3.1, range = 0-10) on a 10-cm visual analogue scale, and at least a 10-degree limitation in passive range of motion (ROM) of the knee. Passive ROM (goniometry, n = 79), end-feel (n = 79), and P/RS during end-feel testing (n = 62) were assessed for extension and flexion on three occasions by one of four experienced physical therapists. Test-retest reliability was estimated for the 2-month period between the last two occasions. Consistent with hypotheses based on Cyriax's assertions about patients with OA, most subjects had capsular end-feels for extension; subjects with tissue approximation end-feels for flexion had more flexion ROM than did subjects with capsular end-feels, and the P/RS was significantly correlated with pain intensity (rho = .35, extension; rho = .30, flexion). Contrary to hypotheses based on Cyriax's assertions, most subjects had noncapsular patterns, tissue approximation end-feels for flexion, and what Cyriax called pain synchronous with resistance for both motions. Pain intensity did not differ depending on end-feel. The P/RS was not correlated with chronicity (rho = .03, extension; rho = .01, flexion). Reliability, as analyzed by intraclass correlation coefficients (ICC[3,1]) and Cohen's kappa coefficients, was acceptable (> or = .80) or nearly acceptable for ROM (ICC = .71-.86, extension; ICC = .95-.99, flexion) but not for end-feel (kappa

  13. Effect of anterior-posterior and internal-external motion restraint during knee wear simulation on a posterior stabilised knee design.

    PubMed

    Grupp, Thomas M; Saleh, Khaled J; Mihalko, William M; Hintner, Martin; Fritz, Bernhard; Schilling, Christoph; Schwiesau, Jens; Kaddick, Christian

    2013-02-01

    The objective of our study was to examine the effect of biphaseal AP translation and IE rotation restraint, using a system defined specifically for posterior stabilised knee designs, on wear, kinematics and particle release in comparison to linear motion restraint as required by the established ISO 14243-1:2002(E) protocol. In the ISOlinear groups, an AP motion restraint of 30 N/mm and an IE rotation restraint of 0.6 Nm/° were applied in the knee wear simulation. In the ISOgap biphaseal groups with PCL sacrificing implants, the restraining AP force was zero in a ±2.5mm range with, externally, a constant of 9.3N/mm applied proportionally to the AP translation of the tibia plateau, whereas the restraining IE torque was zero in a ±6° range with, externally, a constant of 0.13 Nm/° applied proportionally to the IE rotation of the tibia plateau. Using the ISOgap biphaseal protocol on a posterior stabilised knee design, we found an increase of 41% in AP translation and of 131% in IE rotation, resulting in a 3.2-fold higher wear rate compared to the results obtained using the ISOlinear protocol. Changes in AP translation and IE rotation ligament motion restraints have a high impact on knee joint kinematics and wear behaviour of a fixed bearing posterior stabilised knee design.

  14. The effects of electrical stimulation combined with continuous passive motion versus isometric exercise on symptoms, functional capacity, quality of life and balance in knee osteoarthritis: randomized clinical trial.

    PubMed

    Tok, Fatih; Aydemir, Koray; Peker, Fatma; Safaz, Ismail; Taşkaynatan, Mehmet Ali; Ozgül, Ahmet

    2011-02-01

    The aim of this study was to evaluate effects of electrical stimulation combined with continuous passive motion (CPM-ES) versus isometric exercise on symptoms, functional capacity, quality of life, muscle strength, knee and thigh circle measurements, and balance in knee osteoarthritis (OA). This is a randomized clinical trial. The study was done in Gulhane Military Medical Academy (GMMA) Rehabilitation Center. Forty patients with knee OA were included in this study. Participants were randomly assigned to two groups: 20 patients placed in Group 1 were treated with conventional physical therapy and CPM-ES combination; 20 patients in Group 2 were treated with conventional physical therapy and isometric exercise. Therapies were applied 3 weeks, 5 days per week. The following main outcome measures were done: values of pain (VAS was used), WOMAC, SF-36, knee and thigh circle measurements, isokinetic tests, dynamic and static balance tests were determined at baseline and after the treatment. There were no statistically significant differences in the tested variables between the groups for post-treatment values. Dynamic and static balance test improved statistically strongly significantly in both groups. The findings of this study demonstrate that knee OA patients could improve their balance function in both static and dynamic conditions after CPM-ES combination or isometric exercise therapy. The improvement might prevent knee OA patients from falling down and increase their sense of security during physical activities.

  15. Muscle activity during knee-extension strengthening exercise performed with elastic tubing and isotonic resistance.

    PubMed

    Jakobsen, Markus Due; Sundstrup, Emil; Andersen, Christoffer H; Bandholm, Thomas; Thorborg, Kristian; Zebis, Mette K; Andersen, Lars L

    2012-12-01

    While elastic resistance training, targeting the upper body is effective for strength training, the effect of elastic resistance training on lower body muscle activity remains questionable. The purpose of this study was to evaluate the EMG-angle relationship of the quadriceps muscle during 10-RM knee-extensions performed with elastic tubing and an isotonic strength training machine. 7 women and 9 men aged 28-67 years (mean age 44 and 41 years, respectively) participated. Electromyographic (EMG) activity was recorded in 10 muscles during the concentric and eccentric contraction phase of a knee extension exercise performed with elastic tubing and in training machine and normalized to maximal voluntary isometric contraction (MVC) EMG (nEMG). Knee joint angle was measured during the exercises using electronic inclinometers (range of motion 0-90°). When comparing the machine and elastic resistance exercises there were no significant differences in peak EMG of the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM) during the concentric contraction phase. However, during the eccentric phase, peak EMG was significantly higher (p<0.01) in RF and VM when performing knee extensions using the training machine. In VL and VM the EMG-angle pattern was different between the two training modalities (significant angle by exercise interaction). When using elastic resistance, the EMG-angle pattern peaked towards full knee extension (0°), whereas angle at peak EMG occurred closer to knee flexion position (90°) during the machine exercise. Perceived loading (Borg CR10) was similar during knee extensions performed with elastic tubing (5.7±0.6) compared with knee extensions performed in training machine (5.9±0.5). Knee extensions performed with elastic tubing induces similar high (>70% nEMG) quadriceps muscle activity during the concentric contraction phase, but slightly lower during the eccentric contraction phase, as knee extensions performed using an isotonic

  16. The relationship between transverse plane leg rotation and transverse plane motion at the knee and hip during normal walking.

    PubMed

    Nester, C

    2000-12-01

    The purpose of this study was to test the clinical hypothesis that the magnitude and temporal characteristics of rearfoot complex motion are closely correlated with those of the transverse plane motion at the knee and hip. Twenty subjects underwent kinematic assessment during walking at 108 steps/minute. The transverse plane rotation of the leg relative to the foot was used to indicate rearfoot complex pronation and supination. Taking into account errors inherent in kinematic assessment involving skin mounted markers, it is unlikely that a correlation exists between the range of internal leg rotation during the contact phase and the total range of transverse plane leg rotation during gait and the corresponding values for the transverse plane motion at the knee and hip. Correlation tests were performed to assess the temporal characteristics of the motions at the joints that showed that there was no correlation between the transverse plane motion in the rearfoot complex, knee and hip. Thus the hypothesis that the magnitude and temporal characteristics of rearfoot complex motion are closely correlated with the transverse plane motion at the knee and hip was rejected.

  17. Daily Spousal Influence on Physical Activity in Knee Osteoarthritis

    PubMed Central

    Martire, Lynn M.; Stephens, Mary Ann Parris; Mogle, Jacqueline; Schulz, Richard; Brach, Jennifer; Keefe, Francis J.

    2012-01-01

    Background Physical activity is critical for the management of knee osteoarthritis, and the spouse may play a role in encouraging or discouraging physical activity. Purpose To examine four types of spousal influence—spouses' daily activity, autonomy support, pressure, and persuasion--on the daily physical activity of adults living with knee osteoarthritis. Methods A total of 141 couples reported their daily experiences for 22 days using a handheld computer, and wore an accelerometer to measure moderate activity and steps. Results Spouses' autonomy support for patient physical activity, as well as their own level of activity, was concurrently associated with patients' greater daily moderate activity and steps. In addition, on days when male patients perceived that spouses exerted more pressure to be active, they spent less time in moderate activity. Conclusions Couple-oriented interventions for knee osteoarthritis should target physical activity in both partners and spousal strategies for helping patients stay active. PMID:23161472

  18. Association of radiographic osteoarthritis, pain on passive movement and knee range of motion: a cross-sectional study.

    PubMed

    Hilfiker, Roger; Jüni, Peter; Nüesch, Eveline; Dieppe, Paul A; Reichenbach, Stephan

    2015-04-01

    Knee pain is associated with radiographic knee osteoarthritis, but the relationships between physical examination, pain and radiographic features are unclear. To examine whether deficits in knee extension or flexion were associated with radiographic severity and pain during clinical examination in persons with knee pain or radiographic features of osteoarthritis. Cross-sectional data of the Somerset and Avon Survey of Health (SASH) cohort study. Participants with knee pain or radiographic features of osteoarthritis were included. We assessed the range of passive knee flexion and extension, pain on movement and Kellgren and Lawrence (K/L) grades. Odds ratios were calculated for the association between range of motion and pain as well as radiographic severity. Of 1117 participants with a clinical assessment, 805 participants and 1530 knees had complete data and were used for this analysis. Pain and radiographic changes were associated with limited range of motion. In knees with pain on passive movement, extension and flexion were reduced per one grade of K/L by -1.4° (95% CI -2.2 to -0.5) and -1.6° (95% CI -2.8 to -0.4), while in knees without pain the reduction was -0.3° (95% CI -0.6 to -0.1) (extension) and -1.1° (-1.8 to -0.3) (flexion). The interaction of pain with K/L was significant (p = 0.021) for extension but not for flexion (p = 0.333). Pain during passive movement, which may be an indicator of reversible soft-tissue changes, e.g., reversible through physical therapy, is independently associated with reduced flexion and extension of the knee. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Validity and inter-rater reliability of medio-lateral knee motion observed during a single-limb mini squat.

    PubMed

    Ageberg, Eva; Bennell, Kim L; Hunt, Michael A; Simic, Milena; Roos, Ewa M; Creaby, Mark W

    2010-11-16

    Muscle function may influence the risk of knee injury and outcomes following injury. Clinical tests, such as a single-limb mini squat, resemble conditions of daily life and are easy to administer. Fewer squats per 30 seconds indicate poorer function. However, the quality of movement, such as the medio-lateral knee motion may also be important. The aim was to validate an observational clinical test of assessing the medio-lateral knee motion, using a three-dimensional (3-D) motion analysis system. In addition, the inter-rater reliability was evaluated. Twenty-five (17 women) non-injured participants (mean age 25.6 years, range 18-37) were included. Visual analysis of the medio-lateral knee motion, scored as knee-over-foot or knee-medial-to-foot by two raters, and 3-D kinematic data were collected simultaneously during a single-limb mini squat. Frontal plane 2-D peak tibial, thigh, and knee varus-valgus angles, and 3-D peak hip internal-external rotation, and knee varus-valgus angles were calculated. Ten subjects were scored as having a knee-medial-to-foot position and 15 subjects a knee-over-foot position assessed by visual inspection. In 2-D, the peak tibial angle (mean 89.0 (SE 0.7) vs mean 86.3 (SE 0.4) degrees, p = 0.001) and peak thigh angle (mean 77.4 (SE 1.0) vs mean 81.2 (SE 0.5) degrees, p = 0.001) with respect to the horizontal, indicated that the knee was more medially placed than the ankle and thigh, respectively. Thus, the knee was in more valgus (mean 11.6 (SE 1.5) vs 5.0 (SE 0.8) degrees, p < 0.001) in subjects with the knee-medial-to-foot than in those with a knee-over-foot position. In 3-D, the hip was more internally rotated in those with a knee-medial-to-foot than in those with a knee-over-foot position (mean 10.6 (SE 2.1) vs 4.8 (SE 1.8) degrees, p = 0.049), but there was no difference in knee valgus (mean 6.1 (SE 1.8) vs mean 5.0 (SE 1.2) degrees, p = 0.589). The kappa value and percent agreement, respectively, was >0.90 and 96 between raters

  20. Validity and inter-rater reliability of medio-lateral knee motion observed during a single-limb mini squat

    PubMed Central

    2010-01-01

    Background Muscle function may influence the risk of knee injury and outcomes following injury. Clinical tests, such as a single-limb mini squat, resemble conditions of daily life and are easy to administer. Fewer squats per 30 seconds indicate poorer function. However, the quality of movement, such as the medio-lateral knee motion may also be important. The aim was to validate an observational clinical test of assessing the medio-lateral knee motion, using a three-dimensional (3-D) motion analysis system. In addition, the inter-rater reliability was evaluated. Methods Twenty-five (17 women) non-injured participants (mean age 25.6 years, range 18-37) were included. Visual analysis of the medio-lateral knee motion, scored as knee-over-foot or knee-medial-to-foot by two raters, and 3-D kinematic data were collected simultaneously during a single-limb mini squat. Frontal plane 2-D peak tibial, thigh, and knee varus-valgus angles, and 3-D peak hip internal-external rotation, and knee varus-valgus angles were calculated. Results Ten subjects were scored as having a knee-medial-to-foot position and 15 subjects a knee-over-foot position assessed by visual inspection. In 2-D, the peak tibial angle (mean 89.0 (SE 0.7) vs mean 86.3 (SE 0.4) degrees, p = 0.001) and peak thigh angle (mean 77.4 (SE 1.0) vs mean 81.2 (SE 0.5) degrees, p = 0.001) with respect to the horizontal, indicated that the knee was more medially placed than the ankle and thigh, respectively. Thus, the knee was in more valgus (mean 11.6 (SE 1.5) vs 5.0 (SE 0.8) degrees, p < 0.001) in subjects with the knee-medial-to-foot than in those with a knee-over-foot position. In 3-D, the hip was more internally rotated in those with a knee-medial-to-foot than in those with a knee-over-foot position (mean 10.6 (SE 2.1) vs 4.8 (SE 1.8) degrees, p = 0.049), but there was no difference in knee valgus (mean 6.1 (SE 1.8) vs mean 5.0 (SE 1.2) degrees, p = 0.589). The kappa value and percent agreement, respectively, was >0

  1. Association of postural control with muscle strength, proprioception, self-reported knee instability and activity limitations in patients with knee osteoarthritis.

    PubMed

    Sanchez-Ramirez, Diana C; van der Leeden, Marike; Knol, Dirk L; van der Esch, Martin; Roorda, Leo D; Verschueren, Sabine; van Dieën, Jaap; Lems, Willem F; Dekker, Joost

    2013-02-01

    To determine the association of postural control with muscle strength, proprioception, self-reported knee instability and activity limitations in patients with knee osteoarthritis. A total of 284 patients with knee osteoarthritis from the Amsterdam Osteoarthritis cohort were included. Postural control was assessed using the One-Leg Stand Test (OLST), in which the patients were asked to stand on one leg for 30 s. Muscle strength (isokinetic dynamometer), proprioception (joint motion detection threshold) and self-reported knee instability (episodes of buckling, shifting or giving way) were also assessed. Activity limitations were assessed using the Get Up and Go (GUG) test, the walking up-down stairs test, and Western Ontario and McMaster University Osteoarthritis Index - Physical Function subscale. Regression analyses were used to assess the associations. Muscle weakness (p = 0.02) and proprioceptive inaccuracy (p < 0.001) were associated with decreased postural control. Decreased postural control was associated with less time performing the GUG test (p < 0.001) and the walking up-down stairs test (p < 0.001). These associations were found after adjustment for relevant confounders. In patients with knee osteoarthritis, decreased postural control is associated with muscle weakness, proprioceptive inaccuracy and performance-based activity limitations. These results highlight the importance of including assessment and training of postural control in this group of patients.

  2. Catecholamine secretion and adrenal nerve activity in response to movements of normal and inflamed knee joints in cats.

    PubMed Central

    Sato, A; Sato, Y; Schmidt, R F

    1986-01-01

    The effects of articular stimulation on adrenal catecholamine secretion and adrenal sympathetic nerve activity were studied using halothane anaesthetized cats. Various natural passive movements were applied to the normal and inflamed knee joints. Rhythmic flexions and extensions as well as rhythmic inward and outward rotation of normal knee joints within their physiological range of motion did not change nerve activity or the secretion of adrenal catecholamines. Static outward rotation in the normal working range was also ineffective. However, as soon as this static rotation was extended into the noxious range, significant increases in both of these variables were elicited. In the acutely inflamed knee joint, various passive movements produced increases in both adrenal sympathetic and catecholamine secretion. Especially noteworthy was the finding that movements of the inflamed knee joint that were within the normal range of motion produced increases in all variables. Articularly induced increases in adrenal sympathetic nerve activity were diminished by severing various hind-limb somatic afferent nerves and abolished by complete denervation of the knee joint. Additionally, section of the adrenal sympathetic nerves eliminated the catecholamine secretion response. From these data it was concluded that the responses observed in these experiments were reflexes having an afferent limb in hind-limb nerves and an efferent limb in the adrenal sympathetic nerves. A contribution of supraspinal structures was suggested for the reflex responses of sympatho-adrenal medullary function evoked by knee joint stimulations, since spinal transection at the C2 level completely abolished the responses. PMID:3795070

  3. Greater Hip Extension but Not Hip Abduction Explosive Strength Is Associated With Lesser Hip Adduction and Knee Valgus Motion During a Single-Leg Jump-Cut

    PubMed Central

    Cronin, Baker; Johnson, Samuel T.; Chang, Eunwook; Pollard, Christine D.; Norcross, Marc F.

    2016-01-01

    Background: The relationships between hip abductor and extensor strength and frontal plane hip and knee motions that are associated with anterior cruciate ligament injury risk are equivocal. However, previous research on these relationships has evaluated relatively low-level movement tasks and peak torque rather than a time-critical strength measure such as the rate of torque development (RTD). Hypothesis: Females with greater hip abduction and extension RTD would exhibit lesser frontal plane hip and knee motion during a single-leg jump-cutting task. Study Design: Descriptive laboratory study. Methods: Forty recreationally active females performed maximal isometric contractions and single-leg jump-cuts. From recorded torque data, hip extension and abduction RTD was calculated from torque onset to 200 ms after onset. Three-dimensional motion analysis was used to quantify frontal plane hip and knee kinematics during the movement task. For each RTD measure, jump-cut biomechanics were compared between participants in the highest (high) and lowest (low) RTD tertiles. Results: No differences in frontal plane hip and knee kinematics were identified between high and low hip abduction RTD groups. However, those in the high hip extension RTD group exhibited lower hip adduction (high, 3.8° ± 3.0°; low, 6.5° ± 3.0°; P = .019) and knee valgus (high, –2.5° ± 2.3°; low, –4.4° ± 3.2°; P = .046) displacements during the jump-cut. Conclusion: In movements such as cutting that are performed with the hip in a relatively abducted and flexed position, the ability of the gluteus medius to control hip adduction may be compromised. However, the gluteus maximus, functioning as a hip abductor, may take on a pivotal role in controlling hip adduction and knee valgus motion during these types of tasks. Clinical Relevance: Training with a specific emphasis on increasing explosive strength of the hip extensors may be a means through which to improve frontal plane hip and knee

  4. Correlation between hip function and knee kinematics evaluated by three-dimensional motion analysis during lateral and medial side-hopping.

    PubMed

    Itoh, Hiromitsu; Takiguchi, Kohei; Shibata, Yohei; Okubo, Satoshi; Yoshiya, Shinichi; Kuroda, Ryosuke

    2016-09-01

    [Purpose] Kinematic and kinetic characteristics of the limb during side-hopping and hip/knee interaction during this motion have not been clarified. The purposes of this study were to examine the biomechanical parameters of the knee during side hop and analyze its relationship with clinical measurements of hip function. [Subjects and Methods] Eleven male college rugby players were included. A three-dimensional motion analysis system was used to assess motion characteristics of the knee during side hop. In addition, hip range of motion and muscle strength were evaluated. Subsequently, the relationship between knee motion and the clinical parameters of the hip was analyzed. [Results] In the lateral touchdown phase, the knee was positioned in an abducted and externally rotated position, and increasing abduction moment was applied to the knee. An analysis of the interaction between knee motion and hip function showed that range of motion for hip internal rotation was significantly correlated with external rotation angle and external rotation/abduction moments of the knee during the lateral touchdown phase. [Conclusion] Range of motion for hip internal rotation should be taken into consideration for identifying the biomechanical characteristics in the side hop test results.

  5. Correlation between hip function and knee kinematics evaluated by three-dimensional motion analysis during lateral and medial side-hopping

    PubMed Central

    Itoh, Hiromitsu; Takiguchi, Kohei; Shibata, Yohei; Okubo, Satoshi; Yoshiya, Shinichi; Kuroda, Ryosuke

    2016-01-01

    [Purpose] Kinematic and kinetic characteristics of the limb during side-hopping and hip/knee interaction during this motion have not been clarified. The purposes of this study were to examine the biomechanical parameters of the knee during side hop and analyze its relationship with clinical measurements of hip function. [Subjects and Methods] Eleven male college rugby players were included. A three-dimensional motion analysis system was used to assess motion characteristics of the knee during side hop. In addition, hip range of motion and muscle strength were evaluated. Subsequently, the relationship between knee motion and the clinical parameters of the hip was analyzed. [Results] In the lateral touchdown phase, the knee was positioned in an abducted and externally rotated position, and increasing abduction moment was applied to the knee. An analysis of the interaction between knee motion and hip function showed that range of motion for hip internal rotation was significantly correlated with external rotation angle and external rotation/abduction moments of the knee during the lateral touchdown phase. [Conclusion] Range of motion for hip internal rotation should be taken into consideration for identifying the biomechanical characteristics in the side hop test results. PMID:27799670

  6. Female recreational athletes demonstrate different knee biomechanics from male counterparts during jumping rope and turning activities.

    PubMed

    Tanikawa, Hidenori; Matsumoto, Hideo; Harato, Kengo; Kiriyama, Yoshimori; Suda, Yasunori; Toyama, Yoshiaki; Nagura, Takeo

    2014-01-01

    A variety of athletic exercises are performed in sports training or rehabilitation after knee injuries. However, it remains unclear whether males and females exhibit similar joint loading during the various athletic motions. The purpose of this study was to identify gender differences in knee biomechanics during the athletic motions. Three-dimensional knee kinematics and kinetics were investigated in 20 recreational athletes (10 males and 10 females) while jumping rope, backward running, side running, side-to-side running, side-to-forward running, inside turning, and outside turning. The strengths of the quadriceps and hamstring muscles, the knee joint force, the knee joint angle, and the knee joint moment were compared between males and females using one-tailed t tests. Peak knee anterior force was greater in female recreational athletes than in their male counterparts during jumping rope, side-to-forward running, inside turning, and outside turning. Female subjects displayed greater peak knee abduction angles and greater peak knee flexion moments while jumping rope compared to their male counterparts. There were no significant differences between the sexes in knee kinematics and kinetics in the frontal and transverse planes during running and turning motions. Female recreational athletes exhibited significantly different knee biomechanics compared with male counterparts during jumping rope and turning motions.

  7. Does proprioceptive acuity during active knee rotation in the transverse plane vary at different ranges?

    PubMed

    Muaidi, Qassim I

    2016-11-21

    Knee proprioception in the sagittal plane has been widely investigated in prospective studies, however limited information is known about proprioceptive acuity during active knee rotation and the way most commonly injured. To investigate whether proprioceptive acuity during active internal and external knee rotation varies at different ranges in the transverse plane. Healthy volunteers (N: 26) without previous injury or surgery of the knee joint participated in the study.Knee rotation proprioceptive acuity was measured using a custom-designed device. The measure of proprioceptive acuity used in this study was the just-noticeable-difference (JND). Participants actively rotated the knee at different intervals(initial, mid, and terminal internal or external rotation range) to one of four movement blocks and the magnitude of the permitted motion was judged. The means of the JND for proprioceptive acuity at initial internal rotation (0.80° ± 0.06) were significantly (p< 0.002) lower than for mid (1.62° ± 0.18), and terminal (2.08° ± 0.35) internal rotation. The means of the JND for proprioceptive acuity at initial external rotation (1.16° ± 0.10) were significantly (p< 0.04) lower than for mid (1.95° ± 0.30), and terminal (1.97° ± 0.24) internal rotation. Participants perceived smaller differences between active internal and external rotation movements at initial rotation range than at the mid and terminal rotation range of movement. This suggests better proprioceptive acuity at the initial rotation range of movement in the transverse plane.

  8. The Association of Ankle Dorsiflexion Range of Motion With Hip and Knee Kinematics During the Lateral Step-down Test.

    PubMed

    Rabin, Alon; Portnoy, Sigal; Kozol, Zvi

    2016-11-01

    Study Design Controlled laboratory study. Background Altered hip and knee kinematics have been associated with several knee disorders, including anterior cruciate ligament tear, patellofemoral pain, and iliotibial band syndrome. Limited ankle dorsiflexion (DF) range of motion (ROM), which has been linked with some of these disorders, has also been associated with altered knee kinematics. Objective To explore the association of ankle DF ROM with hip and knee kinematics during a step-down task. Methods Thirty healthy participants underwent a 3-D analysis of hip and knee kinematics during a lateral step-down test, followed by measurement of ankle DF ROM in weight bearing (WB) and non-weight bearing (NWB). Participants were dichotomized using the median values into low- and high-DF subgroups within both WB and NWB. Hip and knee kinematics were compared between the low- and high-DF subgroups. Results Participants in the low-DF subgroups exhibited greater peak hip adduction (WB, P = .02; NWB, P<.01) and greater peak knee external rotation (WB, P = .02; NWB, P<.01) compared with participants in the high-DF subgroups. In addition, participants in the low-DF WB subgroup exhibited decreased peak knee flexion compared with participants in the high-DF WB subgroup (P<.01). Conclusion Individuals with lower ankle DF ROM exhibited hip and knee kinematics previously associated with several knee disorders, suggesting that this impairment may be involved in the pathogenesis of the same disorders. Assessment of ankle DF ROM may be useful as part of a preparticipation screening. Furthermore, deficits in ankle DF ROM may need to be addressed in individuals with altered movement patterns. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6621.

  9. Relationship between joint gap difference and range of motion in total knee arthroplasty: a prospective randomised study between different platforms.

    PubMed

    Higuchi, Hiroshi; Hatayama, Kazuhisa; Shimizu, Masaki; Kobayashi, Atsushi; Kobayashi, Tsutomu; Takagishi, Kenji

    2009-08-01

    The objective of this study was to investigate the range of motion (ROM) of the knee before and four years after total knee arthroplasty (TKA) with a mobile or fixed type of platform and to prospectively evaluate whether there was a difference in ligament balance between the platform types. The subjects were 68 patients involving 76 joints. The mobile type was used in 31 joints and fixed type in 45 joints by employing a prospective randomised method. The passive maximum ROM was measured using a goniometer before and four years after surgery. Also, the intraoperative knee ligament balance was measured. The postoperative extension ROM was significantly improved after TKA using a mobile bearing type compared with that employing a fixed bearing type. In TKA using the former, the intraoperative gap difference was not related to the postoperative flexion angle of the knee. However, they were related in TKA using a fixed bearing type, with a positive correlation regarding the flexion gap.

  10. Knee arthritis pain is reduced and range of motion is increased following moderate pressure massage therapy.

    PubMed

    Field, Tiffany; Diego, Miguel; Gonzalez, Gladys; Funk, C G

    2015-11-01

    The literature on massage therapy effects on knee pain suggests that pain was reduced based on self-report, but little is known about range of motion (ROM) effects. Medical School staff and faculty who had knee arthritis pain were randomly assigned to a moderate pressure massage therapy or a waitlist control group (24 per group). Self-reports included the WOMAC (pain, stiffness and function) and the Pittsburgh Sleep Quality Index. ROM and ROM-related pain were assessed before and after the last sessions. The massage group showed an immediate post-massage increase in ROM and a decrease in ROM-associated pain. On the last versus the first day of the study, the massage group showed greater increases in ROM and decreases in ROM-related pain as well as less self-reported pain and sleep disturbances than the waitlist control group. These data highlight the effectiveness of moderate pressure massage therapy for increasing ROM and lessening ROM-related pain and long-term pain and sleep disturbances. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. The effect of timing of manipulation under anesthesia to improve range of motion and functional outcomes following total knee arthroplasty.

    PubMed

    Issa, Kimona; Banerjee, Samik; Kester, Mark A; Khanuja, Harpal S; Delanois, Ronald E; Mont, Michael A

    2014-08-20

    Manipulation under anesthesia has been reported to improve range of motion when other rehabilitative efforts fail to obtain adequate motion after total knee arthroplasty. The purpose of this study was to evaluate the effects of the timing of the manipulation on knee range of motion and clinical outcomes. All 2128 total knee arthroplasties performed at our institution from 2005 to 2011 were reviewed to determine the number of patients who had undergone manipulation under anesthesia. A total of 144 manipulations in eighty-eight women and forty-five men were reviewed. Manipulations under anesthesia that were performed within the first twelve weeks after total knee arthroplasty were considered early and those after that period were considered late. Patients were further substratified according to the timing of the manipulation: Group I included those who had the manipulation within six weeks; Group II, at seven to twelve weeks; Group III, at thirteen to twenty-six weeks; and Group IV, after twenty-six weeks. Outcomes evaluated included gains in flexion and final range of motion, and Knee Society objective and function scores between early and late manipulation, using various adjusted multivariable regression models and at a mean follow-up of fifty-one months (range, twelve to eighty-one months). Mediation analysis was used to investigate whether gains in range of motion from the manipulations under anesthesia alone had mediated the effect between the timing of the manipulation and the clinical outcomes. Patients who underwent early manipulation had a significantly higher mean gain in flexion (36.5° versus 17°), higher final range of motion (119° versus 95°), and higher Knee Society objective (89 versus 84 points) and function scores (88 versus 83 points) than those who had late manipulation under anesthesia. There were no significant differences in the outcomes of Groups I and II. Manipulations after twenty-six weeks resulted in unsatisfactory clinical outcomes

  12. Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism

    PubMed Central

    Hewett, T E; Torg, J S; Boden, B P

    2014-01-01

    Background The combined positioning of the trunk and knee in the coronal and sagittal planes during non-contact anterior cruciate ligament (ACL) injury has not been previously reported. Hypothesis During ACL injury female athletes demonstrate greater lateral trunk and knee abduction angles than ACL-injured male athletes and uninjured female athletes. Design Cross-section control-cohort design. Methods Analyses of still captures from 23 coronal (10 female and 7 male ACL-injured players and 6 female controls) or 28 sagittal plane videos performing similar landing and cutting tasks. Significance was set at p ≤ 0.05. Results Lateral trunk and knee abduction angles were higher in female compared to male athletes during ACL injury (p ≤ 0.05) and trended toward being greater than female controls (p = 0.16, 0.13, respectively). Female ACL-injured athletes showed less forward trunk lean than female controls (mean (SD) initial contact (IC): 1.6 (9.3)° vs 14.0 (7.3)°, p ≤ 0.01). Conclusion Female athletes landed with greater lateral trunk motion and knee abduction during ACL injury than did male athletes or control females during similar landing and cutting tasks. Clinical relevance Lateral trunk and knee abduction motion are important components of the ACL injury mechanism in female athletes as observed from video evidence of ACL injury. PMID:19372088

  13. The efficacy of continuous passive motion after total knee arthroplasty: a comparison of three protocols.

    PubMed

    Boese, C Kent; Weis, Marcia; Phillips, Tamra; Lawton-Peters, Sheila; Gallo, Theresa; Centeno, Leslie

    2014-06-01

    We conducted a randomized, controlled trial to determine the efficacy of CPM following total knee arthroplasty (TKA). Postoperative outcomes of interest were: swelling, drop in hemoglobin, self-reported pain scores, range of motion, and hospital length of stay. A total of 160 subjects were randomized into one of three treatment groups: CPM device on and moving from the immediate post-operative period, CPM device on and stationary at 90 degree flexion for the first night and then moving throughout the rest of their stay, and no CPM (N = 55, 51, and 54, respectfully). Subjects were followed during the first and second postoperative day until their first follow-up appointment approximately 3-4 weeks post-operatively. Cost of CPM was further evaluated. CPM provided no benefit to patients recovering from TKA.

  14. Antagonistic active knee prosthesis. A metabolic cost of walking comparison with a variable-damping prosthetic knee.

    PubMed

    Martinez-Villalpando, Ernesto C; Mooney, Luke; Elliott, Grant; Herr, Hugh

    2011-01-01

    This paper examines the impact of a biomimetic active knee prosthesis on the metabolic costs associated with a unilateral transfemoral amputee walking at self selected speed. In this study we compare the antagonistic active knee prosthesis developed at MIT to an electronically controlled, variable-damping commercial knee prosthesis, the Otto Bock C-leg. Use of the active knee prosthesis resulted in both, a 17% increase in an amputee's average self selected walking speed from 1.12 m/s to 1.31 m/s, and a 6.8% reduction in metabolic cost. The results of this study suggest that an agonist-antagonist active knee prosthesis design with variable impedance control can offer walking energetic advantages over commercially available systems.

  15. Effects of Group-Based Exercise on Range of Motion, Muscle Strength, Functional Ability, and Pain During the Acute Phase After Total Knee Arthroplasty: A Controlled Clinical Trial.

    PubMed

    Hiyama, Yoshinori; Kamitani, Tsukasa; Wada, Osamu; Mizuno, Kiyonori; Yamada, Minoru

    2016-09-01

    Study Design Prospective observational study including a historical control group. Background The extent to which group-based exercise (G-EXE) improves knee range of motion (ROM), quadriceps strength, and gait ability is similar to that of individualized exercise (I-EXE) at 6 weeks and 8 months after total knee arthroplasty (TKA). However, the benefits of G-EXE for patients during the acute recovery phase after TKA remain unclear. Objective To determine the effects of G-EXE during the acute recovery phase after TKA on knee ROM, quadriceps strength, functional ability, and knee pain. Methods Two hundred thirty-one patients participated in G-EXE in addition to regular ambulation and activities-of-daily-living exercises twice daily during the hospital stay. Outcomes were compared to those of a retrospectively identified, historical control group (I-EXE group [n = 206]) that included patients who performed exercises identical to those performed by the G-EXE group. The outcomes included knee ROM, quadriceps strength, pain intensity, and timed up-and-go test score at 1 month before surgery and at discharge. Analyses were adjusted for age, body mass index, sex, length of hospital stay, and preoperative values. Results Changes in ROM of knee flexion and extension (P<.001) and quadriceps strength (P<.001) were significantly better in the G-EXE group than those in the I-EXE group at discharge. The pain intensity improved more in the G-EXE group than in the I-EXE group at discharge (P<.001). However, the changes in the timed up-and-go scores were not significantly different. Conclusion Patients performing G-EXE in addition to regular ambulation and activities-of-daily-living exercises demonstrated greater changes in knee ROM, quadriceps strength, and knee pain than those performing I-EXE in addition to regular ambulation and activities-of-daily-living exercises. The nonrandomized, asynchronous design decreases certainty of these findings. Level of Evidence Therapy, level 2b

  16. GROUND MOTION ACTIVITIES AT DESY - AN OVERVIEW.

    SciTech Connect

    MONTAG,C.

    2002-09-02

    Ground motion studies have been performed at DESY for more than a decade, covering beam motion in the two-ring e-p collider NEW, luminosity preservation in Linear Colliders, and active stabilization methods. An overview of past and present activities will be given.

  17. Analysis of in-vivo articular cartilage contact surface of the knee during a step-up motion.

    PubMed

    Yin, Peng; Li, Jing-Sheng; Kernkamp, Willem A; Tsai, Tsung-Yuan; Baek, Seung-Hoon; Hosseini, Ali; Lin, Lin; Tang, Peifu; Li, Guoan

    2017-09-08

    Numerous studies have reported on the tibiofemoral articular cartilage contact kinematics, however, no data has been reported on the articular cartilage geometry at the contact area. This study investigated the in-vivo tibiofemoral articular cartilage contact biomechanics during a dynamic step-up motion. Ten healthy subjects were imaged using a validated magnetic resonance and dual fluoroscopic imaging technique during a step-up motion. Three-dimensional bone and cartilage models were constructed from the magnetic resonance images. The cartilage contact along the motion path was analyzed, including cartilage contact location and the cartilage surface geometry at the contact area. The cartilage contact excursions were similar in anteroposterior and mediolateral directions in the medial and lateral compartments of the tibia plateau (P>0.05). Both medial and lateral compartments were under convex (femur) to convex (tibia) contact in the sagittal plane, and under convex (femur) to concave (tibia) contact in the coronal plane. The medial tibial articular contact radius was larger than the lateral side in the sagittal plane along the motion path (P<0.001). These data revealed that both the medial and lateral compartments of the knee experienced convex (femur) to convex (tibia) contact in sagittal plane (or anteroposterior direction) during the dynamic step-up motion. These data could provide new insight into the in-vivo cartilage contact biomechanics research, and may provide guidelines for development of anatomical total knee arthroplasties that are aimed to reproduce normal knee joint kinematics. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. The influence of posterior tibial slope changes on joint gap and range of motion in unicompartmental knee arthroplasty.

    PubMed

    Takayama, Koji; Matsumoto, Tomoyuki; Muratsu, Hirotsugu; Ishida, Kazunari; Araki, Daisuke; Matsushita, Takehiko; Kuroda, Ryosuke; Kurosaka, Masahiro

    2016-06-01

    The effect of posterior slope on joint gap in unicompartmental knee arthroplasty (UKA) has yet to be quantified. The purpose of this study was to quantify the effect of the tibial slope on the joint component gap and postoperative range of motion in UKA. Forty consecutive patients were prospectively enrolled. The correlation between the tibial slope changes and the component gap, the component gap difference between flexion angles, the postoperative extension or flexion angles was examined. The correlation of joint looseness with tibial slope changes and postoperative extension angle was also examined. Increased tibial slope positively correlated with the differences between the component gap at 90° and 10°, 120° and 10°, or 135° and 10° knee flexion angle. Although tibial slope change did not affect postoperative flexion angle, increased tibial slope reduced postoperative extension angle. Moreover, increased tibial slope resulted in decreased joint looseness during 10° of knee flexion and decreased joint looseness during 10° of knee flexion resulted in reduced postoperative extension angle. Increased tibial slope resulted in tight component gap at knee extension compared with that at knee flexion. Furthermore, tight component gap at extension lead to decreased postoperative extension angle. These results indicate that an individual anatomical tibial slope should be considered when tibial sagittal osteotomy was performed and increasing tibial slope should be avoided to achieve full extension angle after UKA. II. Copyright © 2016. Published by Elsevier B.V.

  19. High Activity Arthroplasty Score has a lower ceiling effect than standard scores after knee arthroplasty.

    PubMed

    Jenny, Jean-Yves; Louis, Pascal; Diesinger, Yann

    2014-04-01

    The tested hypothesis was following: the High Activity Arthroplasty Score has a significant lower ceiling effect than American Knee Society Score and Oxford Knee Score after total knee arthroplasty. One hundred patients operated on for total knee arthroplasty with more than one-year follow-up have been included. The ceiling effect was 53% for the American Knee Society Score, 33% for the Oxford Knee Score, and 0% for the High Activity Arthroplasty Score. High Activity Arthroplasty Score had a significantly lower ceiling effect than American Knee Society Score and Oxford Knee Score. High Activity Arthroplasty Score has the potential to detect more subtle differences in level of function than standard scoring systems among a non-selected total knee arthroplasty population. © 2014.

  20. Accuracy of a custom physical activity and knee angle measurement sensor system for patients with neuromuscular disorders and gait abnormalities.

    PubMed

    Feldhege, Frank; Mau-Moeller, Anett; Lindner, Tobias; Hein, Albert; Markschies, Andreas; Zettl, Uwe Klaus; Bader, Rainer

    2015-05-06

    Long-term assessment of ambulatory behavior and joint motion are valuable tools for the evaluation of therapy effectiveness in patients with neuromuscular disorders and gait abnormalities. Even though there are several tools available to quantify ambulatory behavior in a home environment, reliable measurement of joint motion is still limited to laboratory tests. The aim of this study was to develop and evaluate a novel inertial sensor system for ambulatory behavior and joint motion measurement in the everyday environment. An algorithm for behavior classification, step detection, and knee angle calculation was developed. The validation protocol consisted of simulated daily activities in a laboratory environment. The tests were performed with ten healthy subjects and eleven patients with multiple sclerosis. Activity classification showed comparable performance to commercially available activPAL sensors. Step detection with our sensor system was more accurate. The calculated flexion-extension angle of the knee joint showed a root mean square error of less than 5° compared with results obtained using an electro-mechanical goniometer. This new system combines ambulatory behavior assessment and knee angle measurement for long-term measurement periods in a home environment. The wearable sensor system demonstrated high validity for behavior classification and knee joint angle measurement in a laboratory setting.

  1. Accuracy of a Custom Physical Activity and Knee Angle Measurement Sensor System for Patients with Neuromuscular Disorders and Gait Abnormalities

    PubMed Central

    Feldhege, Frank; Mau-Moeller, Anett; Lindner, Tobias; Hein, Albert; Markschies, Andreas; Zettl, Uwe Klaus; Bader, Rainer

    2015-01-01

    Long-term assessment of ambulatory behavior and joint motion are valuable tools for the evaluation of therapy effectiveness in patients with neuromuscular disorders and gait abnormalities. Even though there are several tools available to quantify ambulatory behavior in a home environment, reliable measurement of joint motion is still limited to laboratory tests. The aim of this study was to develop and evaluate a novel inertial sensor system for ambulatory behavior and joint motion measurement in the everyday environment. An algorithm for behavior classification, step detection, and knee angle calculation was developed. The validation protocol consisted of simulated daily activities in a laboratory environment. The tests were performed with ten healthy subjects and eleven patients with multiple sclerosis. Activity classification showed comparable performance to commercially available activPAL sensors. Step detection with our sensor system was more accurate. The calculated flexion-extension angle of the knee joint showed a root mean square error of less than 5° compared with results obtained using an electro-mechanical goniometer. This new system combines ambulatory behavior assessment and knee angle measurement for long-term measurement periods in a home environment. The wearable sensor system demonstrated high validity for behavior classification and knee joint angle measurement in a laboratory setting. PMID:25954954

  2. Dynamic splinting for knee flexion contracture following total knee arthroplasty: a case report.

    PubMed

    Finger, Eric; Willis, F Buck

    2008-12-29

    Total Knee Arthroplasty operations are increasing in frequency, and knee flexion contracture is a common pathology, both pre-existing and post-operative. A 61-year-old male presented with knee flexion contracture following a total knee arthroplasty. Physical therapy alone did not fully reduce the contracture and dynamic splinting was then prescribed for daily low-load, prolonged-duration stretch. After 28 physical therapy sessions, the active range of motion improved from -20 degrees to -12 degrees (stiff knee still lacking full extension), and after eight additional weeks with nightly wear of dynamic splint, the patient regained full knee extension, (active extension improved from -12 degrees to 0 degrees ).

  3. Intravoxel incoherent motion magnetic resonance imaging of the knee joint in children with juvenile idiopathic arthritis.

    PubMed

    Hilbert, Fabian; Holl-Wieden, Annette; Sauer, Alexander; Köstler, Herbert; Neubauer, Henning

    2017-05-01

    MRI of synovitis relies on use of a gadolinium-based contrast agent. Diffusion-weighted MRI (DWI) visualises thickened synovium but is of limited use in the presence of joint effusion. To investigate the feasibility and diagnostic accuracy of diffusion-weighted MRI with intravoxel incoherent motion (IVIM) for diagnosing synovitis in the knee joint of children with juvenile idiopathic arthritis. Twelve consecutive children with confirmed or suspected juvenile idiopathic arthritis (10 girls, median age 11 years) underwent MRI with contrast-enhanced T1-weighted imaging and DWI at 1.5 T. Read-out segmented multi-shot DWI was acquired at b values of 0 s/mm(2), 200 s/mm(2), 400 s/mm(2) and 800 s/mm(2). We calculated the IVIM parameters perfusion fraction (f) and tissue diffusion coefficient (D). Diffusion-weighted images at b=800 s/mm(2), f parameter maps and post-contrast T1-weighted images were retrospectively assessed by two independent readers for synovitis using the Juvenile Arthritis MRI Scoring system. Seven (58%) children showed synovial hypertrophy on contrast-enhanced imaging. Diagnostic ratings for synovitis on DWI and on f maps were fully consistent with contrast-enhanced imaging, the diagnostic reference. Two children had equivocal low-confidence assessments on DWI. Median f was 6.7±2.0% for synovitis, 2.1±1.2% for effusion, 5.0±1.0% for muscle and 10.6±5.7% for popliteal lymph nodes. Diagnostic confidence was higher based on f maps in three (25%) children and lower in one child (8%), as compared to DWI. DWI with IVIM reliably visualises synovitis of the knee joint. Perfusion fraction maps differentiate thickened synovium from joint effusion and hence increase diagnostic confidence.

  4. Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis.

    PubMed

    Ritter, Merrill A; Harty, Leesa D; Davis, Kenneth E; Meding, John B; Berend, Michael E

    2003-07-01

    Range of motion is a crucial measure of the outcome of total knee arthroplasty. The purpose of this study was to determine which factors are predictive of the postoperative range of motion. We retrospectively studied 3066 patients (4727 knees) who had a primary total knee arthroplasty with the same type of implant at the same center between 1983 and 1998. Statistical clustering analysis paired with log-linear regression was used to determine groupings along continuous variables. Regression tree analysis was used to characterize the combinations of variables influencing the postoperative range of motion. The variables considered were preoperative and intraoperative flexion and extension, preoperative alignment, age, gender, and soft-tissue releases. Preoperative flexion was the strongest predictor of the postoperative flexion regardless of preoperative alignment. Other factors that were significantly related to reduced flexion were intraoperative flexion (p < 0.0001), gender (p < 0.0001), preoperative tibiofemoral alignment (p = 0.0005), age (p < 0.0001), and posterior capsular release (p < 0.0001). The removal of posterior osteophytes was related to the greatest increase in postoperative flexion in the group of patients with a varus tibiofemoral alignment preoperatively. The principal predictive factor of the postoperative range of motion was the preoperative range of motion. Removal of posterior osteophytes and release of the deep medial collateral ligament, the semimembranosus tendon, and the pes anserinus tendon in patients with large preoperative varus alignment and the attainment of a good intraoperative range of motion improved the likelihood that a good postoperative range of motion would be achieved.

  5. A pneumatically powered knee-ankle-foot orthosis (KAFO) with myoelectric activation and inhibition

    PubMed Central

    Sawicki, Gregory S; Ferris, Daniel P

    2009-01-01

    Background The goal of this study was to test the mechanical performance of a prototype knee-ankle-foot orthosis (KAFO) powered by artificial pneumatic muscles during human walking. We had previously built a powered ankle-foot orthosis (AFO) and used it effectively in studies on human motor adaptation, locomotion energetics, and gait rehabilitation. Extending the previous AFO to a KAFO presented additional challenges related to the force-length properties of the artificial pneumatic muscles and the presence of multiple antagonistic artificial pneumatic muscle pairs. Methods Three healthy males were fitted with custom KAFOs equipped with artificial pneumatic muscles to power ankle plantar flexion/dorsiflexion and knee extension/flexion. Subjects walked over ground at 1.25 m/s under four conditions without extensive practice: 1) without wearing the orthosis, 2) wearing the orthosis with artificial muscles turned off, 3) wearing the orthosis activated under direct proportional myoelectric control, and 4) wearing the orthosis activated under proportional myoelectric control with flexor inhibition produced by leg extensor muscle activation. We collected joint kinematics, ground reaction forces, electromyography, and orthosis kinetics. Results The KAFO produced ~22%–33% of the peak knee flexor moment, ~15%–33% of the peak extensor moment, ~42%–46% of the peak plantar flexor moment, and ~83%–129% of the peak dorsiflexor moment during normal walking. With flexor inhibition produced by leg extensor muscle activation, ankle (Pearson r-value = 0.74 ± 0.04) and knee ( r = 0.95 ± 0.04) joint kinematic profiles were more similar to the without orthosis condition compared to when there was no flexor inhibition (r = 0.49 ± 0.13 for ankle, p = 0.05, and r = 0.90 ± 0.03 for knee, p = 0.17). Conclusion The proportional myoelectric control with flexor inhibition allowed for a more normal gait than direct proportional myoelectric control. The current orthosis design

  6. A pneumatically powered knee-ankle-foot orthosis (KAFO) with myoelectric activation and inhibition.

    PubMed

    Sawicki, Gregory S; Ferris, Daniel P

    2009-06-23

    The goal of this study was to test the mechanical performance of a prototype knee-ankle-foot orthosis (KAFO) powered by artificial pneumatic muscles during human walking. We had previously built a powered ankle-foot orthosis (AFO) and used it effectively in studies on human motor adaptation, locomotion energetics, and gait rehabilitation. Extending the previous AFO to a KAFO presented additional challenges related to the force-length properties of the artificial pneumatic muscles and the presence of multiple antagonistic artificial pneumatic muscle pairs. Three healthy males were fitted with custom KAFOs equipped with artificial pneumatic muscles to power ankle plantar flexion/dorsiflexion and knee extension/flexion. Subjects walked over ground at 1.25 m/s under four conditions without extensive practice: 1) without wearing the orthosis, 2) wearing the orthosis with artificial muscles turned off, 3) wearing the orthosis activated under direct proportional myoelectric control, and 4) wearing the orthosis activated under proportional myoelectric control with flexor inhibition produced by leg extensor muscle activation. We collected joint kinematics, ground reaction forces, electromyography, and orthosis kinetics. The KAFO produced approximately 22%-33% of the peak knee flexor moment, approximately 15%-33% of the peak extensor moment, approximately 42%-46% of the peak plantar flexor moment, and approximately 83%-129% of the peak dorsiflexor moment during normal walking. With flexor inhibition produced by leg extensor muscle activation, ankle (Pearson r-value = 0.74 +/- 0.04) and knee ( r = 0.95 +/- 0.04) joint kinematic profiles were more similar to the without orthosis condition compared to when there was no flexor inhibition (r = 0.49 +/- 0.13 for ankle, p = 0.05, and r = 0.90 +/- 0.03 for knee, p = 0.17). The proportional myoelectric control with flexor inhibition allowed for a more normal gait than direct proportional myoelectric control. The current orthosis

  7. Does the Q - H index show a stronger relationship than the H:Q ratio in regard to knee pain during daily activities in patients with knee osteoarthritis?

    PubMed

    Fujita, Remi; Matsui, Yasumoto; Harada, Atsushi; Takemura, Marie; Kondo, Izumi; Nemoto, Tetsuya; Sakai, Tadahiro; Hiraiwa, Hideki; Ota, Susumu

    2016-12-01

    [Purpose] The purpose of this study was to elucidate the relationship between knee muscle strength and knee pain in activities of daily living, based on consideration of the difference between extension and flexion strength (Q - H) and the hamstring:quadriceps (H:Q) ratio in patients with knee osteoarthritis. [Subjects and Methods] The participants were 78 females with knee osteoarthritis, and a total of 133 knees that had not been treated surgically were the targets of this research. The legs were divided according to dominance. Isometric knee extension and flexion muscle strength and knee pain during activities of daily living were measured. The H:Q ratio (flexion/extension muscle strength) and the difference between extension and flexion strength, (extension muscle strength/weight) minus (flexion muscle strength/weight), that is, Q - H, were calculated. The correlation between these indices and the knee pain score during activities of daily living was investigated. [Results] Greater knee pain during activities of daily living was related to lower knee extension muscle strength and Q - H in both the dominant and nondominant legs. Knee flexion muscle strength and the H:Q ratio were not significantly correlated with knee pain during any activities of daily living. [Conclusion] Knee extension muscle strength and Q - H were found to be significantly correlated with knee pain during activities of daily living, whereas the H:Q ratio was not.

  8. 78 FR 38098 - Proposed Information Collection (Knee and Lower Leg Disability Benefits Questionnaire) Activity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-25

    ... AFFAIRS Proposed Information Collection (Knee and Lower Leg Disability Benefits Questionnaire) Activity... Disability Benefits Questionnaire)'' in any correspondence. During the comment period, comments may be viewed.... SUPPLEMENTARY INFORMATION: Title: Knee and Lower Leg Conditions Disability Benefits Questionnaire, VA Form...

  9. Can generic knee joint models improve the measurement of osteoarthritic knee kinematics during squatting activity?

    PubMed

    Clément, Julien; Dumas, Raphaël; Hagemeister, Nicola; de Guise, Jaques A

    2017-01-01

    Knee joint kinematics derived from multi-body optimisation (MBO) still requires evaluation. The objective of this study was to corroborate model-derived kinematics of osteoarthritic knees obtained using four generic knee joint models used in musculoskeletal modelling - spherical, hinge, degree-of-freedom coupling curves and parallel mechanism - against reference knee kinematics measured by stereo-radiography. Root mean square errors ranged from 0.7° to 23.4° for knee rotations and from 0.6 to 9.0 mm for knee displacements. Model-derived knee kinematics computed from generic knee joint models was inaccurate. Future developments and experiments should improve the reliability of osteoarthritic knee models in MBO and musculoskeletal modelling.

  10. Walking at the preferred stride frequency maximizes local dynamic stability of knee motion.

    PubMed

    Russell, Daniel M; Haworth, Joshua L

    2014-01-03

    Healthy humans display a preference for walking at a stride frequency dependent on the inertial properties of their legs. Walking at preferred stride frequency (PSF) is predicted to maximize local dynamic stability, whereby sensitivity to intrinsic perturbations arising from natural variability inherent in biological motion is minimized. Previous studies testing this prediction have employed different variability measures, but none have directly quantified local dynamic stability by computing maximum finite-time Lyapunov exponent (λ(Max)), which quantifies the rate of divergence of nearby trajectories in state space. Here, ten healthy adults walked 45 m overground while sagittal motion of both knees was recorded via electrogoniometers. An auditory metronome prescribed 7 different frequencies relative to each individual's PSF (PSF; ±5, ±10, ±15 strides/min). Stride frequencies were performed under both freely adopted speed (FS) and controlled speed (CS: set at the speed of PSF trials) conditions. Local dynamic stability was maximal (λ(Max) was minimal) at the PSF, becoming less stable for higher and lower stride frequencies. This occurred under both FS and CS conditions, although controlling speed further reduced local dynamic stability at non-preferred stride frequencies. In contrast, measures of variability revealed effects of stride frequency and speed conditions that were distinct from λ(Max). In particular, movement regularity computed by approximate entropy (ApEn) increased for slower walking speeds, appearing to depend on speed rather than stride frequency. The cadence freely adopted by humans has the benefit of maximizing local dynamic stability, which can be interpreted as humans tuning to their resonant frequency of walking. © 2013 Elsevier Ltd. All rights reserved.

  11. Biofeedback relaxation for pain associated with continuous passive motion in Taiwanese patients after total knee arthroplasty.

    PubMed

    Wang, Tsae-Jyy; Chang, Ching-Fen; Lou, Meei-Fang; Ao, Man-Kuan; Liu, Chiung-Chen; Liang, Shu-Yuan; Wu, Shu-Fang Vivienne; Tung, Heng-Hsing

    2015-02-01

    Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f = 29.70, p < 0.001). The study results provide preliminary support for biofeedback relaxation, a non-invasive and non-pharmacological intervention, as a complementary treatment option for pain management in this population.

  12. Assessment of transfemoral amputees using a passive microprocessor-controlled knee versus an active powered microprocessor-controlled knee for level walking.

    PubMed

    Creylman, Veerle; Knippels, Ingrid; Janssen, Paul; Biesbrouck, Evelyne; Lechler, Knut; Peeraer, Louis

    2016-12-19

    In transfemoral (TF) amputees, the forward propulsion of the prosthetic leg in swing has to be mainly carried out by hip muscles. With hip strength being the strongest predictor to ambulation ability, an active powered knee joint could have a positive influence, lowering hip loading and contributing to ambulation mobility. To assess this, gait of four TF amputees was measured for level walking, first while using a passive microprocessor-controlled prosthetic knee (P-MPK), subsequently while using an active powered microprocessor-controlled prosthetic knee (A-MPK). Furthermore, to assess long-term effects of the use of an A-MPK, a 4-weeks follow-up case study was performed. The kinetics and kinematics of the gait of four TF amputees were assessed while walking with subsequently the P-MPK and the A-MPK. For one amputee, a follow-up study was performed: he used the A-MPK for 4 weeks, his gait was measured weekly. The range of motion of the knee was higher on both the prosthetic and the sound leg in the A-MPK compared to the P-MPK. Maximum hip torque (HT) during early stance increased for the prosthetic leg and decreased for the sound leg with the A-MPK compared to the P-MPK. During late stance, the maximum HT decreased for the prosthetic leg. The difference between prosthetic and sound leg for HT disappeared when using the A-MPK. Also, an increase in stance phase duration was observed. The follow-up study showed an increase in confidence with the A-MPK over time. Results suggested that, partially due to an induced knee flexion during stance, HT can be diminished when walking with the A-MPK compared to the P-MPK. The single case follow-up study showed positive trends indicating that an adaptation time is beneficial for the A-MPK.

  13. Evaluation of Postoperative Range of Motion and Functional Outcomes after Cruciate-Retaining and Posterior-Stabilized High-Flexion Total Knee Arthroplasty

    PubMed Central

    Han, Chang Wook; Yang, Ick Hwan; Lee, Woo Suk; Park, Kwan Kyu

    2012-01-01

    Purpose The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. Materials and Methods Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. Results After the 2-year postoperative period, the mean range of motion was 131° in the CR-Flex group and 133° in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2±9.1 points) than in the PS-Flex group (11.9±9.6 points); however, this difference was not statistically significant (p=non-significant). Conclusion The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty. PMID:22665348

  14. Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series

    PubMed Central

    Hommel, Hagen; Wilke, Kai

    2017-01-01

    Background: Previous studies have shown a high incidence of complications with a bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design, which led to recent modifications of the design by the manufacturer. Objective: The current study was undertaken to assess whether the use of this TKA system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature. Material and Methods: This retrospective study enrolled 257 consecutive patients (257 knees) undergoing TKA for osteoarthritis of the knee, with the first 153 receiving cemented Journey BCS I implants and the remaining 104 receiving cemented Journey BCS II implants when these became available. Results: Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness. Incidence of iliotibial friction syndrome was considered low: three (2.0%) knees in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no clinically relevant differences in any of the clinical outcomes. Conclusion: When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant. PMID:28400873

  15. Provocative mechanical tests of the peripheral nervous system affect the joint torque-angle during passive knee motion.

    PubMed

    Andrade, R J; Freitas, S R; Vaz, J R; Bruno, P M; Pezarat-Correia, P

    2015-06-01

    This study aimed to determine the influence of the head, upper trunk, and foot position on the passive knee extension (PKE) torque-angle response. PKE tests were performed in 10 healthy subjects using an isokinetic dynamometer at 2°/s. Subjects lay in the supine position with their hips flexed to 90°. The knee angle, passive torque, surface electromyography (EMG) of the semitendinosus and quadriceps vastus medialis, and stretch discomfort were recorded in six body positions during PKE. The different maximal active positions of the cervical spine (neutral; flexion; extension), thoracic spine (neutral; flexion), and ankle (neutral; dorsiflexion) were passively combined for the tests. Visual analog scale scores and EMG were unaffected by body segment positioning. An effect of the ankle joint was verified on the peak torque and knee maximum angle when the ankle was in the dorsiflexion position (P < 0.05). Upper trunk positioning had an effect on the knee submaximal torque (P < 0.05), observed as an increase in the knee passive submaximal torque when the cervical and thoracic spines were flexed (P < 0.05). In conclusion, other apparently mechanical unrelated body segments influence torque-angle response since different positions of head, upper trunk, and foot induce dissimilar knee mechanical responses during passive extension.

  16. Well-tolerated strategies for managing knee osteoarthritis: a manual physical therapist approach to activity, exercise, and advice.

    PubMed

    Deyle, Gail D; Gill, Norman W

    2012-09-01

    The orthopedic manual physical therapist approach to knee osteoarthritis (OA) is an effective, well-tolerated, and comprehensive strategy that provides a spectrum of intervention measures, which include guidance on activity selection, as well as selection of manual treatment and exercises to systematically address impairments and increase strength and movement in the knee and other related body regions. This approach integrates manually applied treatment while reinforcing exercise and functional activities that are tailored in scope and dose to each patient. Concepts used in the careful design of this exercise program include emphasizing minimal dosing, avoiding exacerbation, using exercises with multiple effects, effective functional positioning, emphasizing the importance of mid-range movements and end-range challenges, and strategic timing of exercises. Focusing on motion and strength gains through range of motion, along with functional or reinforcing activities, such as walking or biking to maintain motion and strength gains, are keys to long-term success. The overarching theme is that well-tolerated strategies using manual treatment, exercise, and activity require deliberate design and targeting of the most common impairments and functional limitations seen in the knee OA population and, more importantly, tailoring to the individual patient.

  17. Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides.

    PubMed

    Zdzieblik, Denise; Oesser, Steffen; Gollhofer, Albert; König, Daniel

    2017-06-01

    The aim of the study was to evaluate the use of specific collagen peptides in reducing pain in athletes with functional knee problems during sport. Athletic subjects (n = 139) with functional knee pain ingested 5 g of bioactive collagen peptides (BCP) or a placebo per day for 12 weeks. The primary outcome of the study was a change in pain intensity during activity, which was evaluated by the participants and the attending physicians using a visual analogue scale (VAS). As secondary endpoints, pain intensity under resting conditions, the range of motion of the knee joint, and the use of additional therapeutic options were assessed. The results revealed a statistically significant improvement in activity-related pain intensity in the verum group compared with placebo. (ΔVASBCP = 19.5 ± 2.4; ΔVASPlacebo = 13.9 ± 2.1; p = 0.046). The results were confirmed by the physician's assessment. (ΔVASBCP = 16.7 ± 1.8; ΔVASPlacebo = 12.2 ± 1.8; p = 0.021). Pain under resting conditions was also improved, but no significance compared with placebo was detected (ΔVASBCP = 10.2 ± 18.4; ΔVASPlacebo = 7.4 ± 15.2; p = 0.209). Due to the high joint mobility at baseline, no significant changes of this parameter could be detected. The use of additional treatment options was significantly reduced after BCP intake. The study demonstrated that the supplementation of specific collagen peptides in young adults with functional knee problems led to a statistically significant improvement of activity-related joint pain.

  18. Quadriceps Activation Following Knee Injuries: A Systematic Review

    PubMed Central

    Hart, Joseph M.; Pietrosimone, Brian; Hertel, Jay; Ingersoll, Christopher D.

    2010-01-01

    Abstract Context: Arthrogenic muscle inhibition is an important underlying factor in persistent quadriceps muscle weakness after knee injury or surgery. Objective: To determine the magnitude and prevalence of volitional quadriceps activation deficits after knee injury. Data Sources: Web of Science database. Study Selection: Eligible studies involved human participants and measured quadriceps activation using either twitch interpolation or burst superimposition on patients with knee injuries or surgeries such as anterior cruciate ligament deficiency (ACLd), anterior cruciate ligament reconstruction (ACLr), and anterior knee pain (AKP). Data Extraction: Means, measures of variability, and prevalence of quadriceps activation (QA) failure (<95%) were recorded for experiments involving ACLd (10), ACLr (5), and AKP (3). Data Synthesis: A total of 21 data sets from 18 studies were initially identified. Data from 3 studies (1 paper reporting data for both ACLd and ACLr, 1 on AKP, and the postarthroscopy paper) were excluded from the primary analyses because only graphical data were reported. Of the remaining 17 data sets (from 15 studies), weighted mean QA in 352 ACLd patients was 87.3% on the involved side, 89.1% on the uninvolved side, and 91% in control participants. The QA failure prevalence ranged from 0% to 100%. Weighted mean QA in 99 total ACLr patients was 89.2% on the involved side, 84% on the uninvolved side, and 98.5% for the control group, with prevalence ranging from 0% to 71%. Thirty-eight patients with AKP averaged 78.6% on the involved side and 77.7% on the contralateral side. Bilateral QA failure was commonly reported in patients. Conclusions: Quadriceps activation failure is common in patients with ACLd, ACLr, and AKP and is often observed bilaterally. PMID:20064053

  19. Perioperative rehabilitation using a knee extension device and arthroscopic debridement in the treatment of arthrofibrosis.

    PubMed

    Biggs-Kinzer, Angie; Murphy, Brian; Shelbourne, K Donald; Urch, Scott

    2010-09-01

    Arthrofibrosis is a postoperative complication of intra-articular knee surgery that can be difficult to treat. Evidence suggests that maximizing knee range of motion may improve outcomes in patients with arthrofibrosis who undergo arthroscopic debridement. Patients who achieve greater knee range of motion will have better subjective scores. Retrospective case series analysis. A review of records was performed for 33 patients with arthrofibrosis who underwent knee arthroscopy and scar resection coupled with perioperative rehabilitation to maximize knee range of motion. Patient demographics and preoperative and postoperative range of motion measurements were extracted from the records. The International Knee Documentation Committee (IKDC) Subjective Knee Form was administered to assess pain, activity, and knee function. Patients performed a preoperative and postoperative rehabilitation program utilizing a knee extension device to maximize knee extension. According to the IKDC range of motion criteria, 27 of 33 patients achieved normal knee extension, and 14 of 33 achieved normal knee flexion at a mean of 8.6 months after surgery. Patients with normal knee motion had a mean IKDC Subjective Knee Form score of 72.6 ± 13.6, which was significantly higher than patients who did not achieve normal motion (P = .04). Overall, mean IKDC Subjective Knee Form scores improved from 45.3 ± 16.7 preoperatively to 67.1 ± 18.0 postoperatively (P < .01) at a mean of 14.7 months after surgery. Perioperative rehabilitation that emphasizes restoration of normal knee range of motion appears to improve outcomes in patients with arthrofibrosis who undergo arthroscopic scar resection. In support of our hypothesis, patients who achieved greater knee range of motion had better subjective knee scores.

  20. Perioperative Rehabilitation Using a Knee Extension Device and Arthroscopic Debridement in the Treatment of Arthrofibrosis

    PubMed Central

    Biggs-Kinzer, Angie; Murphy, Brian; Shelbourne, K. Donald; Urch, Scott

    2010-01-01

    Background: Arthrofibrosis is a postoperative complication of intra-articular knee surgery that can be difficult to treat. Evidence suggests that maximizing knee range of motion may improve outcomes in patients with arthrofibrosis who undergo arthroscopic debridement. Hypothesis: Patients who achieve greater knee range of motion will have better subjective scores. Study Design: Retrospective case series analysis. Methods: A review of records was performed for 33 patients with arthrofibrosis who underwent knee arthroscopy and scar resection coupled with perioperative rehabilitation to maximize knee range of motion. Patient demographics and preoperative and postoperative range of motion measurements were extracted from the records. The International Knee Documentation Committee (IKDC) Subjective Knee Form was administered to assess pain, activity, and knee function. Patients performed a preoperative and postoperative rehabilitation program utilizing a knee extension device to maximize knee extension. Results: According to the IKDC range of motion criteria, 27 of 33 patients achieved normal knee extension, and 14 of 33 achieved normal knee flexion at a mean of 8.6 months after surgery. Patients with normal knee motion had a mean IKDC Subjective Knee Form score of 72.6 ± 13.6, which was significantly higher than patients who did not achieve normal motion (P = .04). Overall, mean IKDC Subjective Knee Form scores improved from 45.3 ± 16.7 preoperatively to 67.1 ± 18.0 postoperatively (P < .01) at a mean of 14.7 months after surgery. Conclusions: Perioperative rehabilitation that emphasizes restoration of normal knee range of motion appears to improve outcomes in patients with arthrofibrosis who undergo arthroscopic scar resection. In support of our hypothesis, patients who achieved greater knee range of motion had better subjective knee scores. PMID:23015970

  1. Effect of Planning on Trunk Motion and Knee Moments During a Side Step Cut Task

    NASA Astrophysics Data System (ADS)

    Houck, Jeff; Gorniak, Stacey; Nicholson, Kristen

    2004-03-01

    Recent studies suggest that alterations in knee biomechanics associated with unanticipated cutting tasks place athletes at higher risk of knee injuries. Besier et al observed alterations in knee moments during unanticipated cutting tasks that were consistent with in-vitro ACL injury mechanisms. During similar tasks, Patla et al observed lateral trunk lean and decreased foot placement, suggesting that full body center of mass control is perturbed during such tasks. The purpose of this study was to compare the trunk and knee frontal plane moments and evaluate a relationship between the two during unanticipated cutting tasks. The results of this study suggest that there is a relationship between the trunk and knee frontal plane moments during the first 200-400ms of the stance phase of gait.

  2. Effect of repeated manipulation on range of motion in patients with stiff total knee arthroplasty.

    PubMed

    Choi, Ho-Rim; Siliski, John M; Malchau, Henrik; Kwon, Young-Min

    2015-03-01

    Although manipulation under anesthesia (MUA) has been considered effective first-line treatment for stiff total knee arthroplasty (TKA), there is no consensus regarding the usefulness of repeated MUA. The purpose of this study was to investigate the usefulness of repeated MUA performed for patients in whom satisfactory range of motion (ROM) was not achieved by MUA. The authors retrospectively reviewed 15 patients who underwent repeated MUA after failure of initial MUA for stiff TKA. Demographic and ROM data were collected. A final ROM of less than 90° was considered a failed manipulation (failure group) and a final ROM of 90° or more was considered a successful manipulation (success group). Average pre-repeated MUA ROM (72.3°±19.5°) immediately improved to 112.3°±9.7° (P<.001) in the operating room, and final ROM was 89.6°±23.9°, an overall gain of 17.3° (P=.04). However, despite this overall ROM increase, a successful final ROM (90° or more) was achieved in approximately half of patients (7 of 13; 54%). There were no significant differences in demographics between the success and failure groups, except that there was significantly less pre-TKA ROM in the failure group (P=.02). There were no complications related to either the first or the repeated MUA procedures. The findings of this study suggest that repeated MUA can improve overall ROM for stiff TKA. The success rate of repeated MUA was less than that of primary MUA; however, it is a useful treatment modality for stiff TKA. Decreased pre-TKA ROM appeared to be associated with poor outcomes after repeated MUA.

  3. Gait and muscle activation changes in men with knee osteoarthritis.

    PubMed

    Liikavainio, Tuomas; Bragge, Timo; Hakkarainen, Marko; Karjalainen, Pasi A; Arokoski, Jari P

    2010-01-01

    The aim was to examine the biomechanics of level- and stair-walking in men with knee osteoarthritis (OA) at different pre-determined gait speeds and to compare the results with those obtained from healthy control subjects. Special emphasis was placed on the estimation of joint loading. Fifty-four men with knee OA (50-69 years) and 53 healthy age- and sex-matched controls were enrolled in the study. The participants walked barefoot in the laboratory (1.2 m/s+/-5%), corridor (1.2; 1.5 and 1.7 m/s+/-5%), and climbing and coming down stairs (0.5 and 0.8 m/s+/-5%) separately. Joint loading was assessed with skin mounted accelerometers (SMAs) attached just above and below the more affected knee joint. The 3-D ground reaction forces (GRFs) and muscle activation with surface-electromyography (EMG) from vastus medialis (VM) and biceps femoris (BF) were also measured simultaneously. There were no differences in SMA variables between groups during level-walking, but maximal loading rate (LR(max)) was higher bilaterally in the controls (P<.05). Patients loaded their lower extremity more forcefully especially during stair descent at faster speed. The distinctions in muscle activation both at level- and stair ambulation in VM and BF muscles revealed that the patients used different strategies to execute the same walking tasks. It is concluded that the differences in measured SMA and GRF parameters between the knee OA patients and the controls were only minor at constant gait speeds. It is speculated that the faster speeds in the stair descent subjected the compensatory mechanisms to the maximum highlighting the differences between groups.

  4. Physical activity after total knee arthroplasty: A critical review

    PubMed Central

    Paxton, Roger J; Melanson, Edward L; Stevens-Lapsley, Jennifer E; Christiansen, Cory L

    2015-01-01

    Total knee arthroplasty (TKA) is the most commonly performed elective surgery in the United States. TKA typically improves functional performance and reduces pain associated with knee osteoarthritis. Little is known about the influence of TKA on overall physical activity levels. Physical activity, defined as “any bodily movement produced by skeletal muscles that results in energy expenditure”, confers many health benefits but typically decreases with endstage osteoarthritis. The purpose of this review is to describe the potential benefits (metabolic, functional, and orthopedic) of physical activity to patients undergoing TKA, present results from recent studies aimed to determine the effect of TKA on physical activity, and discuss potential sources of variability and conflicting results for physical activity outcomes. Several studies utilizing self-reported outcomes indicate that patients perceive themselves to be more physically active after TKA than they were before surgery. Accelerometry-based outcomes indicate that physical activity for patients after TKA remains at or below pre-surgical levels. Several different factors likely contributed to these variable results, including the use of different instruments, duration of follow-up, and characteristics of the subjects studied. Comparison to norms, however, suggests that daily physical activity for patients following TKA may fall short of healthy age-matched controls. We propose that further study of the relationship between TKA and physical activity needs to be performed using accelerometry-based outcome measures at multiple post-surgical time points. PMID:26396937

  5. Physical activity after total knee arthroplasty: A critical review.

    PubMed

    Paxton, Roger J; Melanson, Edward L; Stevens-Lapsley, Jennifer E; Christiansen, Cory L

    2015-09-18

    Total knee arthroplasty (TKA) is the most commonly performed elective surgery in the United States. TKA typically improves functional performance and reduces pain associated with knee osteoarthritis. Little is known about the influence of TKA on overall physical activity levels. Physical activity, defined as "any bodily movement produced by skeletal muscles that results in energy expenditure", confers many health benefits but typically decreases with endstage osteoarthritis. The purpose of this review is to describe the potential benefits (metabolic, functional, and orthopedic) of physical activity to patients undergoing TKA, present results from recent studies aimed to determine the effect of TKA on physical activity, and discuss potential sources of variability and conflicting results for physical activity outcomes. Several studies utilizing self-reported outcomes indicate that patients perceive themselves to be more physically active after TKA than they were before surgery. Accelerometry-based outcomes indicate that physical activity for patients after TKA remains at or below pre-surgical levels. Several different factors likely contributed to these variable results, including the use of different instruments, duration of follow-up, and characteristics of the subjects studied. Comparison to norms, however, suggests that daily physical activity for patients following TKA may fall short of healthy age-matched controls. We propose that further study of the relationship between TKA and physical activity needs to be performed using accelerometry-based outcome measures at multiple post-surgical time points.

  6. Active Brownian motion tunable by light.

    PubMed

    Buttinoni, Ivo; Volpe, Giovanni; Kümmel, Felix; Volpe, Giorgio; Bechinger, Clemens

    2012-07-18

    Active Brownian particles are capable of taking up energy from their environment and converting it into directed motion; examples range from chemotactic cells and bacteria to artificial micro-swimmers. We have recently demonstrated that Janus particles, i.e. gold-capped colloidal spheres, suspended in a critical binary liquid mixture perform active Brownian motion when illuminated by light. In this paper, we investigate in more detail their swimming mechanism, leading to active Brownian motion. We show that the illumination-borne heating induces a local asymmetric demixing of the binary mixture, generating a spatial chemical concentration gradient which is responsible for the particle's self-diffusiophoretic motion. We study this effect as a function of the functionalization of the gold cap, the particle size and the illumination intensity: the functionalization determines what component of the binary mixture is preferentially adsorbed at the cap and the swimming direction (towards or away from the cap); the particle size determines the rotational diffusion and, therefore, the random reorientation of the particle; and the intensity tunes the strength of the heating and, therefore, of the motion. Finally, we harness this dependence of the swimming strength on the illumination intensity to investigate the behavior of a micro-swimmer in a spatial light gradient, where its swimming properties are space-dependent.

  7. Exercise and physical activity in older adults with knee pain: a mixed methods study

    PubMed Central

    Nicholls, Elaine E.; Young, Julie; Hay, Elaine M.; Foster, Nadine E.

    2015-01-01

    Objectives. To describe and explore current exercise and physical activity behaviour in older adults with knee pain in the UK. Methods. A survey was mailed to 2234 adults ≥50 years of age registered with one general practice within the UK to determine the presence and severity of knee pain and levels of physical activity. Semi-structured interviews were conducted with 22 questionnaire responders with knee pain. Results. The questionnaire response rate was 59% (n = 1276) and 611 respondents reported knee pain. Only ∼40% of individuals with knee pain were sufficiently active to meet physical activity recommendations. Interviews revealed individual differences in the type and setting of physical activity completed and some self-monitored their symptoms in response to physical activity in order to guide future behaviour. Conclusion. Innovative interventions that can be adapted to suit individual needs and preferences are required to help older adults with knee pain become more physically active. PMID:25187640

  8. Self-similarity in active colloid motion

    NASA Astrophysics Data System (ADS)

    Constant, Colin; Sukhov, Sergey; Dogariu, Aristide

    The self-similarity of displacements among randomly evolving systems has been used to describe the foraging patterns of animals and predict the growth of financial systems. At micron scales, the motion of colloidal particles can be analyzed by sampling their spatial displacement in time. For self-similar systems in equilibrium, the mean squared displacement increases linearly in time. However, external forces can take the system out of equilibrium, creating active colloidal systems, and making this evolution more complex. A moment scaling spectrum of the distribution of particle displacements quantifies the degree of self-similarity in the colloid motion. We will demonstrate that, by varying the temporal and spatial characteristics of the external forces, one can control the degree of self-similarity in active colloid motion.

  9. Active Flexion in Weight Bearing Better Correlates with Functional Outcomes of Total Knee Arthroplasty than Passive Flexion

    PubMed Central

    Song, Young Dong; Jain, Nimash; Kang, Yeon Gwi; Kim, Tae Yune

    2016-01-01

    Purpose Correlations between maximum flexion and functional outcomes in total knee arthroplasty (TKA) patients are reportedly weak. We investigated whether there are differences between passive maximum flexion in nonweight bearing and other types of maximum flexion and whether the type of maximum flexion correlates with functional outcomes. Materials and Methods A total of 210 patients (359 knees) underwent preoperative evaluation and postoperative follow-up evaluations (6, 12, and 24 months) for the assessment of clinical outcomes including maximum knee flexion. Maximum flexion was measured under five conditions: passive nonweight bearing, passive weight bearing, active nonweight bearing, and active weight bearing with or without arm support. Data were analyzed for relationships between passive maximum flexion in nonweight bearing by Pearson correlation analyses, and a variance comparison between measurement techniques via paired t test. Results We observed substantial differences between passive maximum flexion in nonweight bearing and the other four maximum flexion types. At all time points, passive maximum flexion in nonweight bearing correlated poorly with active maximum flexion in weight bearing with or without arm support. Active maximum flexion in weight bearing better correlated with functional outcomes than the other maximum flexion types. Conclusions Our study suggests active maximum flexion in weight bearing should be reported together with passive maximum flexion in nonweight bearing in research on the knee motion arc after TKA. PMID:27274468

  10. Muscle Activation Profiles and Co-Activation of Quadriceps and Hamstring Muscles around Knee Joint in Indian Primary Osteoarthritis Knee Patients.

    PubMed

    Sharma, Sanjeev Kumar; Yadav, Shiv Lal; Singh, U; Wadhwa, Sanjay

    2017-05-01

    Osteoarthritis (OA) of knee is a common joint disease. It is associated with reduced knee joint stability due to impaired quadriceps strength, pain, and an altered joint structure. There is altered muscle activation in knee OA patients, which interferes with normal load distribution around the knee and facilitates disease progression. Our primary aim was to determine activation patterns of the muscles i.e., quadriceps and hamstrings in knee OA patients during walking. We also studied co-activation of muscles around knee joint in primary OA knee patients including directed medial and lateral co-contractions. This observational study was done at Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India. Fourty-four patients with medial compartment primary knee OA were included in study after satisfying inclusion and exclusion criteria. All the patients were assessed for mean, peak and integrated Root Mean Square (RMS), EMG values, muscle activation patterns and co-activation of muscles around knee joint by surface Electromyography (EMG) analysis of Vastus Medialis Obliques (VMO), Vastus Lateralis (VL), Semitendinosus (SMT) and Biceps Femoris (BF) muscles during gait cycle. The EMG waveform for each muscle was amplitude normalized and time normalized to 100% of gait cycle and plotted on graph. Quantitative variables were assessed for normal distribution and accordingly mean±SD or median (range), as appropriate, was computed. For primary OA knee, mean age 61±5 years, mean weight 63.7±10.1 kg, mean height 153.9±7.2 cm, and mean Body Mass Index (BMI) 26.8±3.0 kg/m(2) was found. The muscle activity of hamstrings (SMT muscle and BF) was increased during midstance, late stance and early swing phase of gait cycle as compared to quadriceps (VMO and VL) muscle activity respectively, suggesting co-contraction of opposing muscles around knee joint. Patients with knee OA walk with increased hamstring muscle activity (during

  11. Comparison of the long-term effectiveness of progressive neuromuscular facilitation and continuous passive motion therapies after total knee arthroplasty

    PubMed Central

    Alaca, Nuray; Atalay, Ayçe; Güven, Zeynep

    2015-01-01

    [Purpose] The aim of this longitudinal study was to examine the long term functional effectiveness of proprioceptive neuromuscular facilitation (PNF) after total knee arthroplasty. [Subjects and Methods] We included 30 patients and they were randomly assigned to two groups. In addition to the standard rehabilitation program the PNF group received proprioceptive neuromuscular facilitation therapy and the CPM group received continuous passive motion therapy. The outcome measures included range of motion using a goniometer, pain scores using a numeric pain rating scale, days to reach functional benchmarks, the Beck depression scale and isokinetic torque and isometric strength measurements. [Results] There were no significant differences between the two groups in terms of baseline demographic data, clinical findings and length of stay. Days to reach range of motion benchmarks were similar in the two groups. Pain at the 8th week was slightly higher in the PNF group. With the exception of walking with a walker, days to reach functional benchmarks were statistically significantly fewer in patients of the PNF group despite similar isokinetic measurements. Administration of PNF resulted in earlier functional gains in patients after total knee arthroplasty. These functional accomplishments were more pronounced in the PNF group despite it having isokinetic torque measurements similar to those of the CPM group. [Conclusion] PNF techniques can positively affect functional outcomes over the long term. PMID:26696702

  12. Comparison of the long-term effectiveness of progressive neuromuscular facilitation and continuous passive motion therapies after total knee arthroplasty.

    PubMed

    Alaca, Nuray; Atalay, Ayçe; Güven, Zeynep

    2015-11-01

    [Purpose] The aim of this longitudinal study was to examine the long term functional effectiveness of proprioceptive neuromuscular facilitation (PNF) after total knee arthroplasty. [Subjects and Methods] We included 30 patients and they were randomly assigned to two groups. In addition to the standard rehabilitation program the PNF group received proprioceptive neuromuscular facilitation therapy and the CPM group received continuous passive motion therapy. The outcome measures included range of motion using a goniometer, pain scores using a numeric pain rating scale, days to reach functional benchmarks, the Beck depression scale and isokinetic torque and isometric strength measurements. [Results] There were no significant differences between the two groups in terms of baseline demographic data, clinical findings and length of stay. Days to reach range of motion benchmarks were similar in the two groups. Pain at the 8th week was slightly higher in the PNF group. With the exception of walking with a walker, days to reach functional benchmarks were statistically significantly fewer in patients of the PNF group despite similar isokinetic measurements. Administration of PNF resulted in earlier functional gains in patients after total knee arthroplasty. These functional accomplishments were more pronounced in the PNF group despite it having isokinetic torque measurements similar to those of the CPM group. [Conclusion] PNF techniques can positively affect functional outcomes over the long term.

  13. Obesity effect on male active joint range of motion.

    PubMed

    Park, Woojin; Ramachandran, Jaiganesh; Weisman, Paul; Jung, Eui S

    2010-01-01

    Despite the prevalence of obesity, how obesity affects human physical capabilities is not well documented. As an effort toward addressing this, the current study investigated the obesity effect on joint range of motion (RoM) based on data collected from 20 obese and 20 non-obese males. In total, 30 inter-segmental motions occurring at the shoulder, elbow, knee and ankle joints and lumbar and cervical spine areas were examined. The obesity effect was found to be non-uniform across the joint motions. Obesity significantly reduced RoM for nine of the 30 motions: shoulder extensions and adductions, lumbar spine extension and lateral flexions and knee flexions. The largest significant RoM reduction was 38.9% for the left shoulder adduction. The smallest was 11.1% for the right knee flexion. The obesity-associated RoM reductions appear to be mainly due to the mechanical interposition and obstruction of inter-segmental motions caused by excess fat in the obese body. STATEMENT OF RELEVANCE: Currently, obesity is prevalent worldwide and its prevalence is expected to increase continually in the near future. This study empirically characterised the obesity effects on joint RoM to provide better understanding of the physical capabilities of the obese. The study findings will facilitate designing man-artefact systems that accommodate obese individuals.

  14. Marker-free motion correction in weight-bearing cone-beam CT of the knee joint

    PubMed Central

    Berger, M.; Müller, K.; Aichert, A.; Unberath, M.; Thies, J.; Choi, J.-H.; Fahrig, R.; Maier, A.

    2016-01-01

    Purpose: To allow for a purely image-based motion estimation and compensation in weight-bearing cone-beam computed tomography of the knee joint. Methods: Weight-bearing imaging of the knee joint in a standing position poses additional requirements for the image reconstruction algorithm. In contrast to supine scans, patient motion needs to be estimated and compensated. The authors propose a method that is based on 2D/3D registration of left and right femur and tibia segmented from a prior, motion-free reconstruction acquired in supine position. Each segmented bone is first roughly aligned to the motion-corrupted reconstruction of a scan in standing or squatting position. Subsequently, a rigid 2D/3D registration is performed for each bone to each of K projection images, estimating 6 × 4 × K motion parameters. The motion of individual bones is combined into global motion fields using thin-plate-spline extrapolation. These can be incorporated into a motion-compensated reconstruction in the backprojection step. The authors performed visual and quantitative comparisons between a state-of-the-art marker-based (MB) method and two variants of the proposed method using gradient correlation (GC) and normalized gradient information (NGI) as similarity measure for the 2D/3D registration. Results: The authors evaluated their method on four acquisitions under different squatting positions of the same patient. All methods showed substantial improvement in image quality compared to the uncorrected reconstructions. Compared to NGI and MB, the GC method showed increased streaking artifacts due to misregistrations in lateral projection images. NGI and MB showed comparable image quality at the bone regions. Because the markers are attached to the skin, the MB method performed better at the surface of the legs where the authors observed slight streaking of the NGI and GC methods. For a quantitative evaluation, the authors computed the universal quality index (UQI) for all bone regions

  15. Validation of a new computational 6-DOF knee simulator during dynamic activities.

    PubMed

    Fitzpatrick, Clare K; Maag, Chase; Clary, Chadd W; Metcalfe, Amber; Langhorn, Jason; Rullkoetter, Paul J

    2016-10-03

    A new six-degree-of-freedom (6-DOF) joint simulator has recently been developed which facilitates testing of implants under more realistic loading conditions than has been possible previously. However, typical wear testing can be very time-consuming, taking weeks or months to complete. A validated computational model is an ideal complement to these types of long-running tests. In this study, a computational counterpart to the new 6-DOF joint simulator was developed and validated. Total knee replacement components were evaluated in both physical and computational simulations, and joint mechanics were compared between the experiment and the model. Kinematic comparisons were carried out for two total knee replacement designs, under loading conditions representative of three different activities of daily living: deep knee bend, gait, and stepdown. The model accurately reproduced the motions obtained in the physical simulator, and appropriately differentiated between activities and between implant designs. Root-mean-square differences in anterior-posterior translations and internal-external rotations were less than 1.7mm and 1.4°, respectively, for both implant designs and all three dynamic activities. Contact area, and peak and average contact pressure predicted by the model matched experimental measurements with a root-mean-square accuracy of 20mm(2), 9MPa, and 1MPa, respectively. The computational model of the 6-DOF joint simulator will be a key tool in efficient evaluation of implant mechanics under loading conditions representative of the in vivo environment. These simulations may be used directly in comparison of devices, or may aid in facilitating optimal usage of the physical simulator through determining which activities and/or loading conditions best address specific clinical or design issues, for example, development of worst-case loading profiles for wear testing.

  16. The Hip and Knee Book: developing an active management booklet for hip and knee osteoarthritis

    PubMed Central

    Williams, Nefyn H; Amoakwa, Elvis; Burton, Kim; Hendry, Maggie; Lewis, Ruth; Jones, Jeremy; Bennett, Paul; Neal, Richard D; Andrew, Glynne; Wilkinson, Clare

    2010-01-01

    Background The pain and disability of hip and knee osteoarthritis can be improved by exercise, but the best method of encouraging this is not known. Aim To develop an evidence-based booklet for patients with hip or knee osteoarthritis, offering information and advice on maintaining activity. Design of study Systematic review of reviews and guidelines, then focus groups. Setting Four general practices in North East Wales. Method Evidence-based messages were developed from a systematic review, synthesised into patient-centred messages, and then incorporated into a narrative. A draft booklet was examined by three focus groups to improve the phrasing of its messages and discuss its usefulness. The final draft was examined in a fourth focus group. Results Six evidence-based guidelines and 54 systematic reviews were identified. The focus groups found the draft booklet to be informative and easy to read. They reported a lack of clarity about the cause of osteoarthritis and were surprised that the pain could improve. The value of exercise and weight loss beliefs was accepted and reinforced, but there was a perceived contradiction about heavy physical work being causative, while moderate exercise was beneficial. There was a fear of dependency on analgesia and misinterpretation of the message on hyaluranon injections. The information on joint replacement empowered patients to discuss referral with their GP. The text was revised to accommodate these issues. Conclusion The booklet was readable, credible, and useful to end-users. A randomised controlled trial is planned, to test whether the booklet influences beliefs about osteoarthritis and exercise. PMID:20132695

  17. Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study.

    PubMed

    An, Chang-Man; Won, Jong-Im

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effects of ankle joint mobilization with movement on knee strength, ankle range of motion, and gait velocity, compared with weight-bearing exercise in stroke patients. [Subjects and Methods] Thirty subjects with chronic stroke were divided into three groups: MWM (n = 12), WBE (n = 8), and control (n = 10). All groups attended physical therapy sessions 3 times a week for 5 weeks. Subjects in the MWM group performed mobilization with movement exercises, whilst participants in the WBE group performed weight-bearing exercises. Knee peak torque, ankle range of motion, and spatiotemporal gait parameters were evaluated before and after the interventions. [Results] Knee extensor peak torque increased significantly in both MWM and WBE groups. However, only the MWM group showed significant improvement in passive and active ankle range of motion and gait velocity, among the three groups. [Conclusion] Ankle joint mobilization with movement intervention is more effective than simple weight-bearing intervention in improving gait speed in stroke patients with limited ankle motion.

  18. Effects of Low-Impact Dance on Blood Biochemistry, Bone Mineral Density, the Joint Range of Motion of Lower Extremities, Knee Extension Torque, and Fall in Females.

    PubMed

    Wu, Hui Ying; Tu, Jui Hung; Hsu, Chin Hsing; Tsao, Te Hung

    2016-01-01

    The effect of low-impact dance on blood metabolites, the joint range of motion (ROM) of the lower extremities, knee extension torque, bone mass density (BMD), the number of falls, and the confidence to perform daily activities (Modified Falls Efficacy Scale [MFES]) was examined in older sedentary women (age: 59 ± 4 years) before and after a 16-week intervention. Results showed that the average score for the MFES, some parameters of blood chemistry, and joint ROM were significantly improved after low-impact intervention. In addition to improvements in blood lipids and body fat percentages, the increases shown in the parameters regarding the lower extremities may contribute to confidence in performing common daily activities in older women, although the number of falls did not significantly differ between the two groups during the 16-week period.

  19. Agonist and antagonist muscle activation during maximal and submaximal isokinetic fatigue tests of the knee extensors.

    PubMed

    Hassani, A; Patikas, D; Bassa, E; Hatzikotoulas, K; Kellis, E; Kotzamanidis, C

    2006-12-01

    The purpose of this study was to examine the differences in electromyographic activity of agonist and antagonist knee musculature between a maximal and a submaximal isokinetic fatigue protocol. Fourteen healthy males (age: 24.3+/-2.5 years) performed 25 maximal (MIFP) and 60 submaximal (SIFP) isokinetic concentric efforts of the knee extensors at 60 degrees s(-1), across a 90 degrees range of motion. The two protocols were performed a week apart. The EMG activity of vastus medialis (VM), vastus lateralis (VL) and biceps femoris (BF) were recorded using surface electrodes. The peak torque (PT) and average EMG (aEMG) were expressed as percentages of pre-fatigue maximal value. One-way analysis of variance indicated a significant (p<0.05) decline of PT during the maximal (45.7%) and submaximal (46.8%) protocols. During the maximal test, the VM and VL aEMG initially increased and then decreased. In contrast, VM and VL aEMG continuously increased during submaximal testing (p<0.05). The antagonist (BF) aEMG remained constant during maximal test but it increased significantly and then declined during the submaximal testing. The above results indicate that agonist and antagonist activity depends on the intensity of the selected isokinetic fatigue test.

  20. A prosthetic knee using magnetorhelogical fluid damper for above-knee amputees

    NASA Astrophysics Data System (ADS)

    Park, Jinhyuk; Choi, Seung-Bok

    2015-04-01

    A prosthetic knee for above-knee (AK) amputees is categorized into two types; namely a passive and an active type. The passive prosthetic knee is generally made by elastic materials such as carbon fiber reinforced composite material, titanium and etc. The passive prosthetic knee easy to walk. But, it has disadvantages such that a knee joint motion is not similar to ordinary people. On the other hand, the active prosthetic knee can control the knee joint angle effectively because of mechanical actuator and microprocessor. The actuator should generate large damping force to support the weight of human body. But, generating the large torque using small actuator is difficult. To solve this problem, a semi-active type prosthetic knee has been researched. This paper proposes a semi-active prosthetic knee using a flow mode magneto-rheological (MR) damper for AK amputees. The proposed semi-active type prosthetic knee consists of the flow mode MR damper, hinge and prosthetic knee body. In order to support weight of human body, the required energy of MR damper is smaller than actuator of active prosthetic leg. And it can control the knee joint angle by inducing the magnetic field during the stance phase.

  1. The dog as a preclinical model to evaluate interface morphology and micro-motion in cemented total knee replacement.

    PubMed

    Mann, K A; Miller, M A; Khorasani, M; Townsend, K L; Allen, M J

    2012-01-01

    This study investigated cemented fixation of the tibial component from a canine total knee replacement preclinical model. The objective was to determine the local morphology at the material interfaces (implant, cement, bone) and the local relative micro- motion due to functional loading following in vivo service. Five skeletally mature research dogs underwent unilateral total knee replacement using a cemented implant system with a polyethylene (PE) monobloc tibial component. Use of the implanted limb was assessed by pressure-sensitive walkway analysis. At 60 weeks post-surgery, the animals were euthanatized and the tibia sectioned en bloc in the sagittal plane to create medial and lateral specimens. High resolution imaging was used to quantify the morphology under the tray and along the keel. Specimens were loaded to 50% body weight and micro- motions at the PE-cement and cement-bone interfaces were quantified. There was significantly (p = 0.002) more cement-bone apposition and interdigitation along the central keel compared to the regions under the tray. Cavitary defects were associated with the perimeters of the implant (60 ± 25%). Interdigitation fraction was negatively correlated with cavitary defect fraction, cement crack fraction, and total micro-motion. Achieving good interdigitation of cement into subchondral bone beneath the tibial tray is associated with improved interface morphology and reduced micro-motion; features that could result in a reduced incidence of aseptic loosening. Multiple drill holes distributed over the cut tibial surface and adequate pressurization of the cement into the subchondral bone should improve fixation and reduce interface micromotion and cavitary defects.

  2. Intestinal motor activity, endoluminal motion and transit.

    PubMed

    de Iorio, F; Malagelada, C; Azpiroz, F; Maluenda, M; Violanti, C; Igual, L; Vitrià, J; Malagelada, J-R

    2009-12-01

    A programme for evaluation of intestinal motility has been recently developed based on endoluminal image analysis using computer vision methodology and machine learning techniques. Our aim was to determine the effect of intestinal muscle inhibition on wall motion, dynamics of luminal content and transit in the small bowel. Fourteen healthy subjects ingested the endoscopic capsule (Pillcam, Given Imaging) in fasting conditions. Seven of them received glucagon (4.8 microg kg(-1) bolus followed by a 9.6 microg kg(-1) h(-1) infusion during 1 h) and in the other seven, fasting activity was recorded, as controls. This dose of glucagon has previously shown to inhibit both tonic and phasic intestinal motor activity. Endoluminal image and displacement was analyzed by means of a computer vision programme specifically developed for the evaluation of muscular activity (contractile and non-contractile patterns), intestinal contents, endoluminal motion and transit. Thirty-minute periods before, during and after glucagon infusion were analyzed and compared with equivalent periods in controls. No differences were found in the parameters measured during the baseline (pretest) periods when comparing glucagon and control experiments. During glucagon infusion, there was a significant reduction in contractile activity (0.2 +/- 0.1 vs 4.2 +/- 0.9 luminal closures per min, P < 0.05; 0.4 +/- 0.1 vs 3.4 +/- 1.2% of images with radial wrinkles, P < 0.05) and a significant reduction of endoluminal motion (82 +/- 9 vs 21 +/- 10% of static images, P < 0.05). Endoluminal image analysis, by means of computer vision and machine learning techniques, can reliably detect reduced intestinal muscle activity and motion.

  3. Sports activity is maintained or increased following total knee arthroplasty.

    PubMed

    Hepperger, Caroline; Gföller, Peter; Abermann, E; Hoser, Christian; Ulmer, Hanno; Herbst, Elmar; Fink, Christian

    2017-03-24

    The purpose of this study was to investigate sports activities and functional abilities in patients following total knee arthroplasty (TKA). It was hypothesized that patients who had undergone TKA would return to a higher activity level as that experienced preoperatively. Two hundred patients were included in this prospective single-cohort study. All the patients completed subjective questionnaires (Tegner Activity Level, Oxford Knee Score, Visual Analog Scale for pain) prior to surgery as well as at 6, 12, and 24 months postoperatively. Additionally, sports behaviour was evaluated. Sports frequency was divided into four categories: more than 5 times a week, 2-3 times a week, occasionally, and no sports activities. Additionally, the patients were asked to state their three favourite summer and winter sports. All patient-reported outcome scores improved significantly over time (p ≤ 0.005). The Tegner Activity Level increased significantly from the preoperative state to 24 months postsurgery (p = 0.005). Six months after surgery, 43% of the patients returned to the same and 35% to a higher Tegner Activity Level than prior to surgery. Gender-related differences were observed for the Tegner Activity Level showing a higher activity level for the male than for the female patients. Overall, 24 months postsurgery 83% of the patients practiced sports in comparison with 79% prior to surgery. Following TKA, the patients were able to increase sports performance, while pain was reduced. Therefore, patients who want to continue their desired sports may safely consider TKA. II.

  4. Definition and evaluation of testing scenarios for knee wear simulation under conditions of highly demanding daily activities.

    PubMed

    Schwiesau, Jens; Schilling, Carolin; Kaddick, Christian; Utzschneider, Sandra; Jansson, Volkmar; Fritz, Bernhard; Blömer, Wilhelm; Grupp, Thomas M

    2013-05-01

    The objective of our study was the definition of testing scenarios for knee wear simulation under various highly demanding daily activities of patients after total knee arthroplasty. This was mainly based on a review of published data on knee kinematics and kinetics followed by the evaluation of the accuracy and precision of a new experimental setup. We combined tibio-femoral load and kinematic data reported in the literature to develop deep squatting loading profiles for simulator input. A servo-hydraulic knee wear simulator was customised with a capability of a maximum flexion of 120°, a tibio-femoral load of 5000N, an anterior-posterior (AP) shear force of ±1000N and an internal-external (IE) rotational torque of ±50Nm to simulate highly demanding patient activities. During the evaluation of the newly configurated simulator the ability of the test machine to apply the required load and torque profiles and the flexion kinematics in a precise manner was examined by nominal-actual profile comparisons monitored periodically during subsequent knee wear simulation. For the flexion kinematics under displacement control a delayed actuator response of approximately 0.05s was inevitable due to the inertia of masses in movement of the coupled knee wear stations 1-3 during all applied activities. The axial load and IE torque is applied in an effective manner without substantial deviations between nominal and actual load and torque profiles. During the first third of the motion cycle a marked deviation between nominal and actual AP shear load profiles has to be noticed but without any expected measurable effect on the latter wear simulation due to the fact that the load values are well within the peak magnitude of the nominal load amplitude. In conclusion the described testing method will be an important tool to have more realistic knee wear simulations based on load conditions of the knee joint during activities of daily living. Copyright © 2012 IPEM. Published by

  5. Proper Motion Of Emerging Active Regions

    NASA Astrophysics Data System (ADS)

    Tian, Lirong

    2009-05-01

    Observational and modeling results indicate that typically the leading magnetic field of bipolar active regions is often spatially more compact, while more dispersed and fragmented in following polarity. Tian & Alexander (2009, ApJ, 695) studied 15 emerging active regions and find that magnetic helicity flux injected into the corona by the leading polarity is generally several times larger than that injected by the following polarity. They argue that the asymmetry of the magnetic helicity should be responsible for the asymmetry of the magnetic morphology. This argument is supported by two resent model results that magnetic flux tubes with higher degree of twist (and therefor greater magnetic tension) have higher rates of emergence (Murray & Hood 2008, A&A, 479; Cheung et al. 2008, ApJ, 687). These results are consistent because the proper motion (related to the emergence) of the leading polarity was found to be faster than that of the following polarity (van Driel-Gesztelyi & Petrovay 1990, Solar Phys., 126). In this paper, we will reinvestigate the proper motion of leading and following polarities of the emerging active regions, and study possible relationship between the proper motion and magnetic helicity.

  6. Reproducibility of an optical measurement system for the clinical evaluation of active knee rotation in weight-bearing, healthy subjects.

    PubMed

    Testa, R; Chouteau, J; Viste, A; Cheze, L; Fessy, M-H; Moyen, B

    2012-04-01

    A knee is typically evaluated passively by a clinician during an office visit, without using dedicated measurement tools. When the knee is evaluated with the patient standing and actively participating in the movement, the results will differ than when the knee is passively moved through its range-of-motion by the surgeon. If a precise measurement system was available, it could provide additional information to the clinician during this evaluation. The goal of this study was to verify the reproducibility of a fast, flexible optical measurement system to measure rotational knee laxity during weight-bearing. Two passive reflective targets were placed on the legs of 11 subjects to monitor femur and tibia displacements in three dimensions. Subjects performed internal and external rotation movements with the knee extended or flexed 30°. During each movement, seven variables were measured: internal rotation, external rotation and overall laxity in extension and 30° flexion, along with neutral rotation value in 30° flexion. Measurement accuracy was also assessed and the right and left knees were compared. Reproducibility was assessed over two measurements sessions. The calculated intra-class correlation coefficient (ICC) for reproducibility was above 0.9 for five of the seven variables measured. The calculated ICC for the right/left comparison was above 0.75 for five of the seven variables measured. These results confirmed that the proposed system provides reproducible measurements. Our right/left comparison results were consistent with the published literature. This system is fast, reproducible and flexible, which makes it suitable for assessing various weight-bearing movements during clinical evaluations. Level III, experimental study. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  7. Does bracing influence brain activity during knee movement: an fMRI study.

    PubMed

    Thijs, Youri; Vingerhoets, Guy; Pattyn, Els; Rombaut, Lies; Witvrouw, Erik

    2010-08-01

    Studies have shown that proprioceptive inputs during active and passive arm movements are processed in the primary and secondary somatosensory cortex and supplementary motor area of the brain. At which level of the central nervous system proprioceptive signals coming from the knee are regulated remains to be elucidated. In order to investigate whether there is a detectable difference in brain activity when various proprioceptive inputs are exerted at the knee, functional magnetic resonance imaging (fMRI) was used. fMRI in 13 healthy, right leg-dominant female volunteers compared brain activation during flexion-extension movements of the right knee under three different conditions: with application of a tight knee brace, with application of a moderate tight knee sleeve, and without application of a brace or sleeve. Brain activation was detected in the primary sensorimotor cortex (left and right paracentral lobule) and in the left superior parietal lobule of the brain. There was a significantly higher level of brain activation with the application of the brace and sleeve, respectively, compared to the condition without a brace or sleeve. A significantly higher cortical activation was also seen when comparing the braced condition with the condition when a sleeve was applied. The results suggest that peripheral proprioceptive input to the knee joint by means of a brace or sleeve seems to influence brain activity during knee movement. The results of this study also show that the intensity of brain activation during knee movement can be influenced by the intensity of proprioceptive stimulation at the joint.

  8. Weight-bearing condyle motion of the knee before and after cruciate-retaining TKA: In-vivo surgical transepicondylar axis and geometric center axis analyses.

    PubMed

    Dimitriou, Dimitris; Tsai, Tsung-Yuan; Park, Kwan Kyu; Hosseini, Ali; Kwon, Young-Min; Rubash, Harry E; Li, Guoan

    2016-06-14

    An equal knee joint height during flexion and extension is of critical importance in optimizing soft-tissue balancing following total knee arthroplasty (TKA). However, there is a paucity of data regarding the in-vivo knee joint height behavior. This study evaluated in-vivo heights and anterior-posterior (AP) translations of the medial and lateral femoral condyles before and after a cruciate-retaining (CR)-TKA using two flexion axes: surgical transepicondylar axis (sTEA) and geometric center axis (GCA). Eleven osteoarthritis (OA) knee patients were studied during a weight-bearing single leg lunge, using a validated dual fluoroscopic imaging system (DFIS) based tracking technique. Eight healthy subjects were recruited as controls. The results demonstrated that following TKA, the medial and lateral femoral condyle heights were not equal at mid-flexion (15-45°, medial condyle lower then lateral by 2.4mm at least, p<0.01), although the knees were well-balanced at 0° and 90°. While the femoral condyle heights increased from the pre-operative values (>2mm increase on average, p<0.05), they were similar to the intact knees except that the medial sTEA was lower than the intact medial condyle between 0° and 90°. At deep flexion (>90°), both condyles were significantly higher (>2mm, p<0.01) than the healthy knees. Anterior femoral translation of the TKA knee was more pronounce at mid-flexion, whereas limited posterior translation was found at deep flexion. These data suggest that a well-balanced knee intra-operatively might not necessarily result in mid-flexion and deep flexion balance during functional weight-bearing motion, implying mid-flexion instability and deep flexion tightness of the knee.

  9. Tibial Eminence Involvement With Tibial Plateau Fracture Predicts Slower Recovery and Worse Postoperative Range of Knee Motion.

    PubMed

    Konda, Sanjit R; Driesman, Adam; Manoli, Arthur; Davidovitch, Roy I; Egol, Kenneth A

    2017-07-01

    To examine 1-year functional and clinical outcomes in patients with tibial plateau fractures with tibial eminence involvement. Retrospective analysis of prospectively collected data. Academic Medical Center. All patients who presented with a tibial plateau fracture (Orthopaedic Trauma Association (OTA) 41-B and 41-C). Patients were divided into fractures with a tibial eminence component (+TE) and those without (-TE) cohorts. All patients underwent similar surgical approaches and fixation techniques for fractures. No tibial eminence fractures received fixation specifically. Short musculoskeletal functional assessment (SMFA), pain (Visual Analogue Scale), and knee range-of-motion (ROM) were evaluated at 3, 6, and 12 months postoperatively and compared between cohorts. Two hundred ninety-three patients were included for review. Patients with OTA 41-C fractures were more likely to have an associated TE compared with 41-B fractures (63% vs. 28%, P < 0.01). At 3 months postoperatively, the +TE cohort was noted to have worse knee ROM (75.16 ± 51 vs. 86.82 ± 53 degree, P = 0.06). At 6 months, total SMFA and knee ROM was significantly worse in the +TE cohort (29 ± 17 vs. 21 ± 18, P ≤ 0.01; 115.6 ± 20 vs. 124.1 ± 15, P = 0.01). By 12 months postoperatively, only knee ROM remained significantly worse in the +TE cohort (118.7 ± 15 vs. 126.9 ± 13, P < 0.01). Multivariate analysis revealed that tibial eminence involvement was a significant predictor of ROM at 6 and 12 months and SFMA at 6 months. Body mass index was found to be a significant predictor of ROM and age was a significant predictor of total SMFA at all time points. Knee ROM remains worse throughout the postoperative period in the +TE cohort. Functional outcome improves less rapidly in the +TE cohort but achieves similar results by 1 year. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  10. The mechanics of activated semitendinosus are not representative of the pathological knee joint condition of children with cerebral palsy.

    PubMed

    Ateş, Filiz; Temelli, Yener; Yucesoy, Can A

    2016-06-01

    Characteristic cerebral palsy effects in the knee include a restricted joint range of motion and forcefully kept joint in a flexed position. To show whether the mechanics of activated spastic semitendinosus muscle are contributing to these effects, we tested the hypothesis that the muscle's joint range of force exertion is narrow and force production capacity in flexed positions is high. The isometric semitendinosus forces of children with cerebral palsy (n=7, mean (SD)=7years (8months), GMFCS levels III-IV, 12 limbs tested) were measured intra-operatively as a function of knee angle, from flexion (120°) to full extension (0°). Peak force measured in the most flexed position was considered as the benchmark. However, peak force (mean (SD)=112.4N (54.3N)) was measured either at intermediate or even full knee extension (three limbs) indicating no narrow joint range of force exertion. Lack of high force production capacity in flexed knee positions (e.g., at 120° negligible or below 22% of the peak force) was shown except for one limb. Therefore, our hypothesis was rejected for a vast majority of the limbs. These findings and those reported for spastic gracilis agree, indicating that the patients' pathological joint condition must rely on a more complex mechanism than the mechanics of individual spastic muscles. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. [Comparison of analgesic activity of intraarticular lornoxicam, bupivacaine and saline after knee arthroscopy].

    PubMed

    Eren, Meltem; Koltka, Kemalettin; Köknel Talu, Gül; Aşik, Mehmet; Ozyalçin, Süleyman

    2008-10-01

    Postoperative pain is an important parameter in discharge and rehabilitation in daycase arthroscopic knee surgery. This study compared the efficacy of intraarticular application of lornoxicam, bupivacaine and placebo on postoperative pain after arthroscopic knee surgery. With the approval of the local ethics committee and informed consent of the patients, 90 patients (ASA score I-II), aged between 18-65 years undergoing arthroscopic meniscectomy were included in this randomized, blinded, prospective study and were divided into three groups (30 patients each): 8 mg lornoxicam was applied to Group L (GL), 50 mg bupivacaine to Group B (GB) and normal saline to Group S (GS) in 20 mL volume intraarticularly. Postoperative analgesia was maintained by intravenous tramadol-HCl 50 mg/h at the first 4 h and then paracetamol 500 mg plus codeine 7.5 mg preparation as needed. The numeric rating scale (NRS) values were evaluated at rest and at active-passive motion at 4, 12, 24 and 48 h, total analgesic consumption were recorded. There were statistically significant differences between GS and GL and GS and GB in term of tramadol consumption (p < 0.05 and p < 0.05). The analgesiconsumption of GL patients at the end of 48 h were lower than GB and GS (p < 0.001 and p < 0.05). The NRS values of GL were always lower than the other groups with statistical significance at certain times. We concluded that intraarticular lornoxicam provided better pain control than bupivacaine and saline in arthroscopic knee surgery.

  12. Console video games, postural activity, and motion sickness during passive restraint.

    PubMed

    Chang, Chih-Hui; Pan, Wu-Wen; Chen, Fu-Chen; Stoffregen, Thomas A

    2013-08-01

    We examined the influence of passive restraint on postural activity and motion sickness in individuals who actively controlled a potentially nauseogenic visual motion stimulus (a driving video game). Twenty-four adults (20.09 ± 1.56 years; 167.80 ± 7.94 cm; 59.02 ± 9.18 kg) were recruited as participants. Using elastic bands, standing participants were passively restrained at the head, shoulders, hips, and knees. During restraint, participants played (i.e., controlled) a driving video game (a motorcycle race), for 50 min. During game play, we recorded the movement of the head and torso, using a magnetic tracking system. Following game play, participants answered a forced choice, yes/no question about whether they were motion sick, and were assigned to sick and well groups on this basis. In addition, before and after game play, participants completed the Simulator Sickness Questionnaire, which provided numerical ratings of the severity of individual symptoms. Five of 24 participants (20.83 %) reported motion sickness. Participants moved despite being passively restrained. Both the magnitude and the temporal dynamics of movement differed between the sick and well groups. The results show that passive restraint of the body can reduce motion sickness when the nauseogenic visual stimulus is under participants' active control and confirm that motion sickness is preceded by distinct patterns of postural activity even during passive restraint.

  13. Influence of restricted vision and knee joint range of motion on gait properties during level walking and stair ascent and descent.

    PubMed

    Demura, Tomohiro; Demura, Shin-ich

    2011-01-01

    Because elderly individuals experience marked declines in various physical functions (e.g., vision, joint function) simultaneously, it is difficult to clarify the individual effects of these functional declines on walking. However, by imposing vision and joint function restrictions on young men, the effects of these functional declines on walking can be clarified. The authors aimed to determine the effect of restricted vision and range of motion (ROM) of the knee joint on gait properties while walking and ascending or descending stairs. Fifteen healthy young adults performed level walking and stair ascent and descent during control, vision restriction, and knee joint ROM restriction conditions. During level walking, walking speed and step width decreased, and double support time increased significantly with vision and knee joint ROM restrictions. Stance time, step width, and walking angle increased only with knee joint ROM restriction. Stance time, swing time, and double support time were significantly longer in level walking, stair descent, and stair ascent, in that order. The effects of vision and knee joint ROM restrictions were significantly larger than the control conditions. In conclusion, vision and knee joint ROM restrictions affect gait during level walking and stair ascent and descent. This effect is marked in stair ascent with knee joint ROM restriction.

  14. Endoplasmic reticulum stress activation during total knee arthroplasty

    PubMed Central

    Hocker, Austin D; Boileau, Ryan M; Lantz, Brick A; Jewett, Brian A; Gilbert, Jeffrey S; Dreyer, Hans C

    2013-01-01

    Total knee arthroplasty (TKA) is the most common remediation for knee pain from osteoarthritis (OA) and is performed 650,000 annually in the U.S. A tourniquet is commonly used during TKA which causes ischemia and reperfusion (I/R) to the lower limb but the effects of I/R on muscle are not fully understood. Previous reports suggest upregulation of cell stress and catabolism and downregulation of markers of cap-dependent translation during and after TKA. I/R has also been shown to cause endoplasmic reticulum (ER) stress and induce the unfolded protein response (UPR). We hypothesized that the UPR would be activated in response to ER stress during TKA. We obtained muscle biopsies from the vastus lateralis at baseline, before TKA; at maximal ischemia, prior to tourniquet deflation; and during reperfusion in the operating room. Phosphorylation of 4E-BP1 and AKT decreased during ischemia (−28%, P < 0.05; −20%, P < 0.05, respectively) along with an increase in eIF2α phosphorylation (64%, P < 0.05) suggesting decreased translation initiation. Cleaved ATF6 protein increased in ischemia (39%, P = 0.056) but returned to baseline during reperfusion. CASP3 activation increased during reperfusion compared to baseline (23%, P < 0.05). XBP1 splicing assays revealed an increase in spliced transcript during ischemia (31%, P < 0.05) which diminished during reperfusion. These results suggest that in response to I/R during TKA all three branches of the ER stress response are activated. PMID:24159375

  15. Alpine Skiing With total knee ArthroPlasty (ASWAP): physical activity, knee function, pain, exertion, and well-being.

    PubMed

    Würth, S; Finkenzeller, T; Pötzelsberger, B; Müller, E; Amesberger, G

    2015-08-01

    This study focused on the psychological and quality of life aspects of resuming alpine skiing practice after total knee arthroplasty (TKA) in elderly skilled skiers. Two data pools were used in order to analyze psychological states: (a) at the beginning, at the end, and 8 weeks after a 12-week skiing intervention; and (b) concerning diurnal variations of states (i.e., skiing days compared with everyday life during intervention and retention phase). In particular, effects of skiing on amount of physical activity and perceived exertion, perceived pain and knee function, and subjective well-being were analyzed using a control group design. Results reveal that the skiing intervention substantially increases the amount of physical activity by the intervention group (122.30 ± 32.38 min/day), compared with the control group (75.14 ± 21.27 min/day) [F (2, 32) = 8.22, P < 0.01, η(2)  = 0.34)]. Additionally, the analyses of psychological states demonstrated that skiing goes along with enhanced well-being and no significant impact on perceived pain, exertion or knee function. In sum, alpine skiing can be recommended for older persons with TKA with respect to well-being, perceived pain and knee function, and perceived exertion.

  16. To use or not to use continuous passive motion post-total knee arthroplasty presenting functional assessment results in early recovery.

    PubMed

    Maniar, Rajesh N; Baviskar, Jayesh V; Singhi, Tushar; Rathi, Suyog S

    2012-02-01

    Continuous passive motion (CPM), though of doubtful value, is yet routinely practiced post-total knee arthroplasty (TKA). We prospectively distributed 84 patients with TKA to 1 of the 3 standard rehabilitation regimes: no-CPM, 1-day-CPM, and 3-day-CPM. We recorded a unique "Timed up and go" test besides pain, Western Ontario and McMaster Universities (WOMAC), short form-12 (SF-12), range of motion, knee and calf swelling, and wound healing parameters. Our standardized and elaborate measurements preoperatively and on postoperative days 3, 5, 14, 42, and 90 showed no statistically significant difference among the 3 groups in each parameter. We concluded that CPM gives no benefit in immediate functional recovery post-TKA, and in fact, the postoperative knee swelling persisted longer. We have since then discontinued its use in our patients without any untoward effect.

  17. 3D CT to 2D low dose single-plane fluoroscopy registration algorithm for in-vivo knee motion analysis.

    PubMed

    Akter, Masuma; Lambert, Andrew J; Pickering, Mark R; Scarvell, Jennie M; Smith, Paul N

    2014-01-01

    A limitation to accurate automatic tracking of knee motion is the noise and blurring present in low dose X-ray fluoroscopy images. For more accurate tracking, this noise should be reduced while preserving anatomical structures such as bone. Noise in low dose X-ray images is generated from different sources, however quantum noise is by far the most dominant. In this paper we present an accurate multi-modal image registration algorithm which successfully registers 3D CT to 2D single plane low dose noisy and blurred fluoroscopy images that are captured for healthy knees. The proposed algorithm uses a new registration framework including a filtering method to reduce the noise and blurring effect in fluoroscopy images. Our experimental results show that the extra pre-filtering step included in the proposed approach maintains higher accuracy and repeatability for in vivo knee joint motion analysis.

  18. Effect of knee angle on quadriceps strength and activation after anterior cruciate ligament reconstruction

    PubMed Central

    Theuerkauf, Paul

    2015-01-01

    Quadriceps strength and activation deficits after anterior cruciate ligament (ACL) injury or surgery are typically evaluated at joint positions that are biomechanically advantageous to the quadriceps muscle. However, the effect of knee joint position and the associated changes in muscle length on strength and activation is currently unknown in this population. Here, we examined the effect of knee angle on quadriceps strength, activation, and electrically evoked torque in individuals with ACL reconstruction. Furthermore, we evaluated whether knee angle mediated the relationship between quadriceps weakness and functional performance after ACL reconstruction. Knee strength and activation were tested bilaterally at 90° and 45° of knee flexion in 11 subjects with ACL reconstruction using an interpolated triplet technique. The magnitude of electrically evoked torque at rest was used to quantify peripheral muscle contractile property changes, and the single-leg hop for distance test was used to evaluate functional performance. The results indicated that although quadriceps strength deficits were similar between knee angles, voluntary activation deficits were significantly higher in the reconstructed leg at 45° of knee flexion. On the contrary, the side-to-side evoked torque at rest ratio [i.e., (reconstructed/nonreconstructed) × 100] was significantly lower at 90° than at 45° of knee flexion. The association between quadriceps strength and functional performance was stronger at 45° of knee flexion. The results provide novel evidence that quadriceps activation is selectively affected at 45° of knee flexion and emphasize the importance of assessing quadriceps strength and activation at this position when feasible because it better captures activation deficits. PMID:25997949

  19. Superior results with continuous passive motion compared to active motion after periosteal transplantation. A retrospective study of human patella cartilage defect treatment.

    PubMed

    Alfredson, H; Lorentzon, R

    1999-01-01

    Fifty-seven consecutive patients (33 men and 24 women), with a mean age of 32 years (range 16-53 years), who suffered from an isolated full-thickness cartilage defect of the patella and disabling knee pain of long duration, were treated by autologous periosteal transplantation to the cartilage defect. The first 38 consecutive patients (group A) were postoperatively treated with continuous passive motion (CPM), and the next 19 consecutive patients (group B) were treated with active motion for the first 5 days postoperatively. In both groups, the initial regimens were followed by active motion, slowly progressive strength training, and slowly progressive weight bearing. In group A, after a mean follow-up of 51 months (range 33-92 months), 29 patients (76%) were graded as excellent or good, 7 patients (19%) were graded as fair, and 2 patients (5%) were graded as poor. In group B, after a mean follow-up of 21 months (range 14-28 months), 10 patients (53%) were graded as excellent or good, 6 patients (32%) were graded as fair, and 3 patients (15%) were graded as poor. Altogether, nine of the fair or poor cases (50%) were diagnosed with chondromalacia of the patella. Our results, after performing autologous periosteal transplantation in patients with full-thickness cartilage defects of the patella and disabling knee pain, are good if CPM is used postoperatively. The clinical results using active motion postoperatively are not acceptable, especially not in patients with chondromalacia of the patella.

  20. Preventing Knee Injuries

    MedlinePlus

    ... as a result of a twisting or pivoting motion. This injury may cause susceptibility to repeat injuries and knee instability, and therefore often requires surgery. Occasionally, a twisting or hyperextension force to the knee may result in a tibial ...

  1. Comparison of a Vibrating Foam Roller and a Non-vibrating Foam Roller Intervention on Knee Range of Motion and Pressure Pain Threshold: A Randomized Controlled Trial.

    PubMed

    Cheatham, Scott W; Stull, Kyle R; Kolber, Morey J

    2017-08-08

    The use of foam rollers to provide soft-tissue massage has become a common intervention among health and fitness professionals. Recently, manufacturers have merged the science of vibration therapy and foam rolling with the development of vibrating foam rollers. To date, no peer reviewed investigations have been published on this technology. The purpose of this study was to compare the effects of a vibrating roller and non-vibrating roller intervention on prone knee flexion passive range of motion (ROM) and pressure pain thresholds (PPT) of the quadriceps musculature. Forty-five recreationally active adults were randomly allocated to one of three groups: vibrating roller, non-vibrating roller, and control. Each roll intervention lasted a total of 2 minutes. The control group did not roll. Dependent variables included prone knee flexion ROM and PPT measures. Statistical analysis included parametric and non-parametric tests to measure changes among groups. The vibrating roller demonstrated the greatest increase in PPT (180kPa, p< 0.001), followed by the non-vibrating roller (112kPa, p< 0.001), and control (61kPa, p<0.001). For knee ROM, the vibrating roller demonstrated the greatest increase in ROM (7 degrees, p< 0.001), followed by the non-vibrating roller (5 degrees, p< 0.001), and control (2 degrees, p<0.001). Between groups, there was significant difference in PPT between the vibrating and non-vibrating roller (p=.03) and vibrating roller and control (p<.001). There was also a significant difference between the non-vibrating roller and control (p<.001). For knee ROM, there was no significant difference between the vibrating and non-vibrating roller (p=.31). A significant difference was found between the vibrating roller and control group (p<.001) and non-vibrating roller and control (p<.001). The results suggest that a vibrating roller may increase an individual's tolerance to pain greater than a non-vibrating roller. This investigation should be considered

  2. The association of body-mass index and depressed mood with knee pain and activity limitations in knee osteoarthritis: results from the Amsterdam osteoarthritis cohort

    PubMed Central

    2013-01-01

    Background Body-mass index (BMI) and depressed mood are both positively associated with pain and activity limitations in knee osteoarthritis (OA), and are interrelated. The aims of the present study were: 1) to assess whether BMI and depressed mood are independently associated with knee pain and activity limitations; and 2) to compare the relative contributions of BMI and depressed mood to knee pain and activity limitations. Methods A cross-sectional study in 294 patients with clinical knee OA. Regression analyses were performed with knee pain or activity limitations (self-reported and performance-based) as dependent variables, and BMI and depressed mood as independent variables. All analyses were adjusted for age, gender, marital status, education level, radiographic OA and comorbidity. Dominance analyses were performed to examine the relative contributions of BMI and depressed mood to knee pain and activity limitations. Results BMI and depressed mood were positively and independently associated with knee pain and activity limitations. BMI and depressed mood explained small parts (3.0% and 2.3%, respectively) of variance in knee pain. BMI explained a substantial part of variance in both self-reported (9.8%) and performance-based (20.4%) activity limitations, while depressed mood explained a small part of variance (3.1% in self-reported and 2.6% in performance-based activity limitations). Conclusions In patients with knee OA both BMI and depressed mood seem to be independently associated with knee pain and activity limitations. The contribution of BMI to activity limitations is most substantial, thereby offering a relevant target for interventions. PMID:24131757

  3. Analysis of muscle activation patterns during transitions into and out of high knee flexion postures.

    PubMed

    Tennant, Liana M; Maly, Monica R; Callaghan, Jack P; Acker, Stacey M

    2014-10-01

    Increased risk of medial tibiofemoral osteoarthritis (OA) is linked to occupations that require frequent transitions into and out of postures which require high knee flexion (>90°). Muscle forces are major contributors to joint loading, and an association between compressive forces due to muscle activations and the degeneration of joint cartilage has been suggested. The purpose of this study was to evaluate muscle activation patterns of muscles crossing the knee during transitions into and out of full-flexion kneeling and squatting, sitting in a low chair, and gait. Both net and co-activation were greater when transitioning out of high flexion postures, with maximum activation occurring at knee angles greater than 100°. Compared to gait, co-activation levels during high flexion transitions were up to approximately 3 times greater. Co-activation was significantly greater in the lateral muscle group compared to the medial group during transitions into and out of high flexion postures. These results suggest that compression due to activation of the medial musculature of the knee may not be the link between high knee flexion postures and increased medial knee OA observed in occupational settings. Further research on a larger subject group and workers with varying degrees of knee OA is necessary.

  4. Reliability and measurement precision of concentric-to-isometric and eccentric-to-isometric knee active joint position sense tests in uninjured physically active adults.

    PubMed

    Clark, Nicholas C; Akins, Jonathan S; Heebner, Nicholas R; Sell, Timothy C; Abt, John P; Lovalekar, Mita; Lephart, Scott M

    2016-03-01

    Proprioception is important because it is used by the central nervous system to mediate muscle control of joint stability, posture, and movement. Knee active joint position sense (AJPS) is one representation of knee proprioception. The purpose of this study was to establish the intra-tester, inter-session, test-retest reliability of concentric-to-isometric (seated knee extension; prone knee flexion) and eccentric-to-isometric (seated knee flexion; prone knee extension) knee AJPS tests in uninjured adults. Descriptive. University laboratory. Six males, six females (age 26.2 ± 5.7 years; height 171.1 ± 9.6 cm; mass 71.1 ± 16.6 kg). Mean absolute error (AE; °); intraclass correlation coefficient (ICC) (2,1); standard error of measurement (SEM; °). Mean AE ranged from 3.18° to 5.97° across tests. The ICCs and SEMs were: seated knee extension 0.13, 1.3°; prone knee flexion 0.51, 1.2°; seated knee flexion 0.31, 1.7°; prone knee extension 0.87, 1.4°. The prone knee flexion and prone knee extension tests demonstrated moderate to good reliability. Prone knee flexion and prone knee extension AJPS tests may be useful in cross-sectional studies estimating how proprioception contributes to knee functional joint stability or prospective studies estimating the role of proprioception in the onset of knee injury. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Contributions of biarticular myogenic components to the limitation of the range of motion after immobilization of rat knee joint

    PubMed Central

    2014-01-01

    Background Muscle atrophy caused by immobilization in the shortened position is characterized by a decrease in the size or cross-sectional area (CSA) of myofibers and decreased muscle length. Few studies have addressed the relationship between limitation of the range of motion (ROM) and the changes in CSA specifically in biarticular muscles after atrophy because of immobilization. We aimed to determine the contribution of 2 distinct muscle groups, the biarticular muscles of the post thigh (PT) and those of the post leg (PL), to the limitation of ROM as well as changes in the myofiber CSAs after joint immobilization surgery. Methods Male Wistar rats (n = 40) were randomly divided into experimental and control groups. In the experimental group, the left knee was surgically immobilized by external fixation for 1, 2, 4, 8, or 16 weeks (n = 5 each) and sham surgery was performed on the right knee. The rats in the control groups (n = 3 per time point) did not undergo surgery. After the indicated immobilization periods, myotomy of the PT or PL biarticular muscles was performed and the ROM was measured. The hamstrings and gastrocnemius muscles from the animals operated for 1 or 16 weeks were subjected to morphological analysis. Results In immobilized knees, the relative contribution of the PT biarticular myogenic components to the total restriction reached 80% throughout the first 4 weeks and decreased thereafter. The relative contribution of the PL biarticular myogenic components remained <20% throughout the immobilization period. The ratio of the myofiber CSA of the immobilized to that of the sham-operated knees was significantly lower at 16 weeks after surgery than at 1 week after surgery only in the hamstrings. Conclusions The relative contribution of the PT and PL components to myogenic contracture did not significantly change during the experimental period. However, the ratio of hamstrings CSAs to the sham side was larger than the ratio of medial

  6. RAPID KNEE-EXTENSIONS TO INCREASE QUADRICEPS MUSCLE ACTIVITY IN PATIENTS WITH TOTAL KNEE ARTHROPLASTY: A RANDOMIZED CROSS-OVER STUDY

    PubMed Central

    Wilquin, Lousia; Jakobsen, Thomas Linding; Holsgaard-Larsen, Anders; Bandholm, Thomas

    2017-01-01

    Background Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase agonist muscle activity, especially if the exercise is conducted using rapid muscle contractions. Purpose The purpose of this study was to examine if patients with total knee arthroplasty could perform rapid knee-extensions using a 10 RM load four to eight weeks after surgery, and the degree to which rapid knee-extensions were associated with greater voluntary quadriceps muscle activity during an experimental strength training session, compared to that elicited using slow knee-extensions. Study Design A randomized cross-over study. Methods Twenty-four patients (age 66.5) 4-8 weeks post total knee arthroplasty randomly performed one set of five rapid, and one set of five slow knee-extensions with the operated leg, using a load of their 10 repetition maximum, while surface electromyography recordings were obtained from the vastus medialis and lateralis of the quadriceps muscle. Results Data from 23 of the 24 included patients were analyzed. Muscle activity was significantly higher during rapid knee-extensions (120.2% [10th-90th percentile: 98.3-149.1]) compared to slow knee-extensions (106.0% [88.8-140.8]) for the vastus lateralis (p<0.01), but not for the vastus medialis (120.8% [90.4-134.0]) and (121.8% [93.0-133.0]) (p = 0.17), respectively. Slow and rapid knee-extensions were performed at a median angular velocity of 19.7 degrees/sec (13.7-24.4) and 51.4 degrees/sec (28.9-63.1), respectively Conclusion Four to eight weeks after their total knee arthroplasty, the patients in the present study were able to conduct rapid knee-extensions according to the experimental protocol with an approximately doubled angular velocity compared to slow knee-extensions. This was associated with

  7. Knee joint functional range of movement prior to and following total knee arthroplasty measured using flexible electrogoniometry.

    PubMed

    Myles, Christine M; Rowe, Philip J; Walker, Colin R C; Nutton, Richard W

    2002-08-01

    The functional ranges of movement of the knee were investigated in a group of patients with knee osteoarthritis (n = 42, mean age 70 years) before, 4 months and at 18-24 months after total knee arthroplasty and then compared with age matched normal subjects (n = 20, mean age 67 years). Flexible electrogoniometry was used to record the maximum flexion-extension angle, the minimum flexion-extension angle and flexion-extension excursions of both knees during eleven functional activities along with the active and passive knee joint range of motion measured using a manual goniometer. Over the eleven functional activities the patients pre-operatively exhibited 28% less knee joint excursion than normal age matched subjects. By 18-24 months following total knee arthroplasty only 2% of this deficit was recovered. Statistically this recovery was only significant in level walking, slope ascent and slope descent. A greater range of movement was measured in a non-weight bearing position than was used in weight bearing functional activity. It is concluded that total knee arthroplasty gives rise to little improvement in knee motion during functional activities and that functional range of movement of the knee remains limited when compared to normal knee function for a minimum of 18 months following operation.

  8. The influence of energy storage and return foot stiffness on walking mechanics and muscle activity in below-knee amputees.

    PubMed

    Fey, Nicholas P; Klute, Glenn K; Neptune, Richard R

    2011-12-01

    Below-knee amputees commonly experience asymmetrical gait patterns and develop comorbidities in their intact and residual legs. Carbon fiber prosthetic feet have been developed to minimize these asymmetries by utilizing elastic energy storage and return to provide body support, forward propulsion and leg swing initiation. However, how prosthetic foot stiffness influences walking characteristics is not well-understood. The purpose of this study was to identify the influence of foot stiffness on kinematics, kinetics, muscle activity, prosthetic energy storage and return, and mechanical efficiency during amputee walking. A comprehensive biomechanical analysis was performed on 12 unilateral below-knee amputees. Subjects walked overground at 1.2 m/s with three prosthetic feet of varying keel and heel stiffness levels, which were created using additive manufacturing. As stiffness decreased, peak residual and intact leg ankle angles and residual leg knee flexion angle increased. The residual and intact leg braking ground reaction forces and knee extensor moments, residual leg vastus and gluteus medius activity, and intact leg vastus and rectus femoris activity also increased. The second vertical ground reaction force peak and hamstring activity in the residual leg and first vertical ground reaction force peak in the intact leg decreased. In addition, prosthetic energy storage and return increased and mechanical efficiency decreased as stiffness decreased. Decreasing foot stiffness can increase prosthesis range of motion, mid-stance energy storage and late-stance energy return, but the net contributions to forward propulsion and swing initiation may be limited as additional muscle activity to provide body support becomes necessary. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Testosterone reduces knee passive range of motion and expression of relaxin receptor isoforms via 5α-dihydrotestosterone and androgen receptor binding.

    PubMed

    Dehghan, Firouzeh; Muniandy, Sekaran; Yusof, Ashril; Salleh, Naguib

    2014-03-17

    Ovarian steroids such as estrogen and progesterone have been reported to influence knee laxity. The effect of testosterone, however, remains unknown. This study investigated the effect of testosterone on the knee range of motion (ROM) and the molecular mechanisms that might involve changes in the expression of relaxin receptor isoforms, Rxfp1 and Rxfp2 in the patella tendon and lateral collateral ligament of the female rat knee. Ovariectomized adult female Wistar rats received three days treatment with peanut oil (control), testosterone (125 and 250 μg/kg) and testosterone (125 and 250 μg/kg) plus flutamide, an androgen receptor blocker or finasteride, a 5α-reductase inhibitor. Duplicate groups received similar treatment however in the presence of relaxin (25 ng/kg). A day after the last drug injection, knee passive ROM was measured by using a digital miniature goniometer. Both tendon and ligament were harvested and then analysed for protein and mRNA expression for Rxfp1 and Rxfp2 respectively. Knee passive ROM, Rxfp1 and Rxfp2 expression were significantly reduced following treatment with testosterone. Flutamide or finasteride administration antagonized the testosterone effect. Concomitant administration of testosterone and relaxin did not result in a significant change in knee ROM as compared to testosterone only treatment; however this was significantly increased following flutamide or finasteride addition. Testosterone effect on knee passive ROM is likely mediated via dihydro-testosterone (DHT), and involves downregulation of Rxfp1 and Rxfp2 expression, which may provide the mechanism underlying testosterone-induced decrease in female knee laxity.

  10. Testosterone Reduces Knee Passive Range of Motion and Expression of Relaxin Receptor Isoforms via 5α-Dihydrotestosterone and Androgen Receptor Binding

    PubMed Central

    Dehghan, Firouzeh; Muniandy, Sekaran; Yusof, Ashril; Salleh, Naguib

    2014-01-01

    Ovarian steroids such as estrogen and progesterone have been reported to influence knee laxity. The effect of testosterone, however, remains unknown. This study investigated the effect of testosterone on the knee range of motion (ROM) and the molecular mechanisms that might involve changes in the expression of relaxin receptor isoforms, Rxfp1 and Rxfp2 in the patella tendon and lateral collateral ligament of the female rat knee. Ovariectomized adult female Wistar rats received three days treatment with peanut oil (control), testosterone (125 and 250 μg/kg) and testosterone (125 and 250 μg/kg) plus flutamide, an androgen receptor blocker or finasteride, a 5α-reductase inhibitor. Duplicate groups received similar treatment however in the presence of relaxin (25 ng/kg). A day after the last drug injection, knee passive ROM was measured by using a digital miniature goniometer. Both tendon and ligament were harvested and then analysed for protein and mRNA expression for Rxfp1 and Rxfp2 respectively. Knee passive ROM, Rxfp1 and Rxfp2 expression were significantly reduced following treatment with testosterone. Flutamide or finasteride administration antagonized the testosterone effect. Concomitant administration of testosterone and relaxin did not result in a significant change in knee ROM as compared to testosterone only treatment; however this was significantly increased following flutamide or finasteride addition. Testosterone effect on knee passive ROM is likely mediated via dihydro-testosterone (DHT), and involves downregulation of Rxfp1 and Rxfp2 expression, which may provide the mechanism underlying testosterone-induced decrease in female knee laxity. PMID:24642882

  11. From Cannibalism to Active Motion of Groups

    NASA Astrophysics Data System (ADS)

    Romanczuk, Pawel; Schimansky-Geier, Lutz

    2008-03-01

    The detailed mechanisms leading to collective dynamics in groups of animals and insect are still poorly understood. A recent study by Simpson et. al. suggests cannibalism as a driving mechanism for coordinated migration of mormon crickets [1]. Based on this result we propose a simple generic model of brownian particles interacting by asymmetric, non-conservative collisions accounting for cannibalistic behavior and the corresponding avoidance strategy. We discuss our model in one and two dimensions and show that a certain type of collisions drives the system out of equilibrium and leads to coordinated active motion of groups.[1] Stephen J. Simpson, Gregory A. Sword, Patrick D. Lorch and Iain D. Couzin: Cannibal crickets on a forced march for protein and salt, PNAS, 103:4152-4156, 2006

  12. VARIABILITY IN ANTAGONIST MUSCLE ACTIVITY AND PEAK TORQUE DURING ISOMETRIC KNEE STRENGTH TESTING

    PubMed Central

    Krishnan, Chandramouli; Williams, Glenn N.

    2009-01-01

    BACKGROUND & OBJECTIVE: Strength testing is common in the treatment of people with knee pathology and in research related to knee health. Variability in the magnitude of antagonist muscle activity and peak torque measurements during isometric knee strength testing is not well defined and has potential implications of strength test validity and reliability. The aim of this study was to determine the magnitude and variability (side-to-side, session-to-session) of antagonist muscle activity and peak torque during isometric knee strength testing and to compare and contrast the results of males and females. METHODS: Electromyograms and torque data were collected from 30 active young people (15 males, 15 females) during isometric strength testing of the knee extensors and flexors at two sessions that took place approximately one week apart. The magnitude of antagonist muscle activity and peak torque during isometric knee strength testing was calculated and the variability in these parameters assessed. RESULTS: Significant side-to-side differences were observed in the magnitude of antagonist muscle activity when the leg with higher antagonist activity was contrasted with the leg with lower antagonist activity (P < 0.001). Significant side-to-side differences were also observed when peak torque measurements were contrasted in a similar manner (P < 0.001). No significant differences were observed in peak torque and antagonist activity measurements between sessions. Significantly higher vastus medialis antagonist activity was observed in females (P < 0.001). CONCLUSIONS: Our findings suggest that significant variability in antagonist muscle activity and peak torque is present during maximal isometric knee strength testing. This variability may reduce the accuracy of knee strength tests, especially when side-to-side comparisons are made as is typical in clinical settings. The results of this study may be helpful when interpreting strength test results and setting criteria for

  13. In vivo kinematics of early-stage osteoarthritic knees during pivot and squat activities.

    PubMed

    Matsuki, Keisuke; Matsuki, Kei O; Kenmoku, Tomonori; Yamaguchi, Satoshi; Sasho, Takahisa; Banks, Scott A

    2017-08-04

    Kinematic changes have been shown to accompany severe knee osteoarthritis, but no studies have analyzed early-stage osteoarthritic knee kinematics in the transverse plane during functional activities. The purpose of this study was to analyze kinematics of early-stage osteoarthritic knees using model registration techniques. Fifteen early-stage osteoarthritic knees from eight females with a mean age of 52 years old (range, 43-57years old) were involved in this study. A radiologist confirmed with plain radiographs that knees had Kellgren-Lawrence grade-1 or -2 arthritic changes. Fluoroscopic images of squat and pivot activities were recorded for each subject. Three-dimensional surface models of the distal femur and proximal tibia were created from CT images, and anatomic coordinate systems were embedded in each model. The three-dimensional position and orientation of the femur and the tibia were determined using model-image registration techniques, and tibial anteroposterior translation and internal/external rotation relative to the femur were calculated. The contact points of the medial and lateral femoral condyle were also computed. Compared to healthy knees, osteoarthritic knees showed lateral contact points that were significantly shifted anteriorly in both pivot (P<0.001) and squat (P=0.001) activities and greater tibial external rotation in pivot activity (P=0.007). The medial contact point location was similar to healthy knees, but the amount of anteroposterior translation was smaller (P<0.001). These kinematic changes might change stress distributions in the medial compartment during weight-bearing activities. The changes in kinematics possibly have some influence on initiation or progression of knee osteoarthritis. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Associations of isokinetic and isotonic knee strength with knee function and activity level after anterior cruciate ligament reconstruction: a prospective cohort study.

    PubMed

    Pua, Yong-Hao; Ho, Jia-Ying; Chan, Suelyn Ai-Sim; Khoo, Shin-Jiun; Chong, Hwei-Chi

    2017-07-21

    Although isokinetic dynamometry often serves as a reference to assess the concurrent validity of weight-machine isotonic strength testing, it is unknown whether isokinetic knee strength is associated with knee function and activity level more strongly than isotonic knee strength in patients with an anterior cruciate ligament reconstruction (ACLR). This study aimed to compare the associations of isokinetic and isotonic knee strength with knee function and work-and-sports activity levels in patients with ACLR. One-hundred and six patients with a unilateral ACLR participated. At three months post-ACLR, isokinetic quadriceps and hamstrings strength was measured using an isokinetic dynamometer whilst isotonic strength was measured using weight machines. At six months post-ACLR, patients performed the single-leg hop-for-distance test. Self reported knee function and work-and-sports activity levels were assessed by the Lysholm Knee Score and Tegner Activity Score, respectively. In multivariable analyses, isotonic and isokinetic quadriceps strength limb symmetry indices (LSIs) were significantly associated with all outcomes (P≤0.03) and had comparable predictive performance. Isotonic and isokinetic hamstrings strength LSIs were significantly associated with Lysholm scores (P≤0.03) and isotonic hamstrings strength was additionally significantly associated with hop-for-distance LSI (P=0.01). Weight machine-derived isotonic quadriceps strength was independently and consistently associated with knee function and work-and-sport activity level post-ACLR. Isokinetic knee strength was not more strongly associated than isotonic knee strength with the various outcomes. These findings have logistic and economic implications because the isokinetic dynamometer system is relatively expensive and its operation requires more logistic effort and technical skills. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Water on the Knee

    MedlinePlus

    ... your knee joint. Some people call this condition "water on the knee." A swollen knee may be ... Choose low-impact exercise. Certain activities, such as water aerobics and swimming, don't place continuous weight- ...

  16. Position controlled Knee Rehabilitation Orthotic Device for Patients after Total Knee Replacement Arthroplasty

    NASA Astrophysics Data System (ADS)

    Wannaphan, Patsiri; Chanthasopeephan, Teeranoot

    2016-11-01

    Knee rehabilitation after total knee replacement arthroplasty is essential for patients during their post-surgery recovery period. This study is about designing one degree of freedom knee rehabilitation equipment to assist patients for their post-surgery exercise. The equipment is designed to be used in sitting position with flexion/extension of knee in sagittal plane. The range of knee joint motion is starting from 0 to 90 degrees angle for knee rehabilitation motion. The feature includes adjustable link for different human proportions and the torque feedback control at knee joint during rehabilitation and the control of flexion/extension speed. The motion of the rehabilitation equipment was set to move at low speed (18 degrees/sec) for knee rehabilitation. The rehabilitation link without additional load took one second to move from vertical hanging up to 90° while the corresponding torque increased from 0 Nm to 2 Nm at 90°. When extra load is added, the link took 1.5 seconds to move to 90° The torque is then increased from 0 Nm to 4 Nm. After a period of time, the speed of the motion can be varied. User can adjust the motion to 40 degrees/sec during recovery activity of the knee and users can increase the level of exercise or motion up to 60 degrees/sec to strengthen the muscles during throughout their rehabilitation program depends on each patient. Torque control is included to prevent injury. Patients can use the equipment for home exercise to help reduce the number of hospital visit while the patients can receive an appropriate therapy for their knee recovery program.

  17. Using Kinesthetic Activities to Teach Ptolemaic and Copernican Retrograde Motion

    ERIC Educational Resources Information Center

    Richards, Ted

    2012-01-01

    This paper describes a method for teaching planetary retrograde motion, and the Ptolemaic and Copernican accounts of retrograde motion, by means of a series kinesthetic learning activities (KLAs). In the KLAs described, the students literally walk through the motions of the planets in both systems. A retrospective statistical analysis shows that…

  18. Using Kinesthetic Activities to Teach Ptolemaic and Copernican Retrograde Motion

    ERIC Educational Resources Information Center

    Richards, Ted

    2012-01-01

    This paper describes a method for teaching planetary retrograde motion, and the Ptolemaic and Copernican accounts of retrograde motion, by means of a series kinesthetic learning activities (KLAs). In the KLAs described, the students literally walk through the motions of the planets in both systems. A retrospective statistical analysis shows that…

  19. Knee stabilization in patients with medial compartment knee osteoarthritis

    PubMed Central

    Lewek, Michael D.; Ramsey, Dan K.; Snyder-Mackler, Lynn; Rudolph, Katherine S.

    2005-01-01

    OBJECTIVE Individuals with medial knee osteoarthritis (MKOA) experience knee laxity and instability. Muscle stabilization strategies may influence the long term integrity of the joint. In this study we determined how individuals with medial knee OA respond to a rapid valgus knee movement to investigate the relationship between muscle stabilization strategies and knee instability. METHODS Twenty one subjects with MKOA and genu varum, and 19 control subjects were tested. Subjects stood with the test limb on a moveable platform that translated laterally to rapidly stress the knee’s medial periarticular structures and create a potentially destabilizing feeling at the knee joint. Knee motion and muscle responses were recorded. Subjects rated their knee instability with a self-report questionnaire about knee instability during daily activities. RESULTS Prior to plate movement the OA subjects demonstrated more medial muscle co-contraction (p=0.014). Following plate movement the OA subjects shifted less weight off the test limb (p = 0.013) and had more medial co-contraction (p=0.037). Those without instability had higher VMMH co-contraction than those who reported more instability (p=0.038). Knee stability correlated positively with VMMH co-contraction prior to plate movement (r = 0.459; p = 0.042). CONCLUSION This study demonstrates that individuals with MKOA attempt to stabilize the knee with greater medial muscle co-contraction in response to laxity that appears on only the medial side of the joint. This strategy presumably contributes to higher joint compression and could exacerbate joint destruction and needs to be altered to slow or stop the progression of the OA disease process. PMID:16142714

  20. Exercise and physical activity in older adults with knee pain: a mixed methods study.

    PubMed

    Holden, Melanie A; Nicholls, Elaine E; Young, Julie; Hay, Elaine M; Foster, Nadine E

    2015-03-01

    To describe and explore current exercise and physical activity behaviour in older adults with knee pain in the UK. A survey was mailed to 2234 adults ≥50 years of age registered with one general practice within the UK to determine the presence and severity of knee pain and levels of physical activity. Semi-structured interviews were conducted with 22 questionnaire responders with knee pain. The questionnaire response rate was 59% (n = 1276) and 611 respondents reported knee pain. Only ∼40% of individuals with knee pain were sufficiently active to meet physical activity recommendations. Interviews revealed individual differences in the type and setting of physical activity completed and some self-monitored their symptoms in response to physical activity in order to guide future behaviour. Innovative interventions that can be adapted to suit individual needs and preferences are required to help older adults with knee pain become more physically active. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology.

  1. [CPM--Continuous Passive Motion: treatment of injured or operated knee-joints using passive movement. A meta-analysis of current literature].

    PubMed

    Kirschner, P

    2004-04-01

    There is still a controversial discussion in literature about the use of motor driven splints in knee surgery--as the principle of continuous passive motion, CPM. For this reason it seemed useful for an evaluation to look through the papers which were published since 1990. It was obvious, that negative results were published often before this year, but this papers are still quoted standard works. In medical data bases subito-doc.de, medscape.com, medica.de and zbmed.de 230 papers were found by search CPM, continuous passive motion and arthromot. Coincidentally there was a search for authors who were already quoted in other papers. 36 papers concerning CPM after knee surgery were utilized. The role of CPM regarding the range of motion, swelling, duration of hospital stay, use of analgesics, costs, postoperative manipulations, wound healing and thrombo embolic complications was evaluated. Although the results of this partial retrospective, partial prospective, sometimes randomized or double blinded studies are in contradiction, there can only be found a trend to better results. New clinical studies for evidence based guidelines in the handling of continuous passive motion after knee surgery are necessary.

  2. Biotribology of a mobile bearing posterior stabilised knee design--effect of motion restraint on wear, tibio-femoral kinematics and particles.

    PubMed

    Grupp, Thomas M; Schroeder, Christian; Kyun Kim, Tae; Miehlke, Rolf K; Fritz, Bernhard; Jansson, Volkmar; Utzschneider, Sandra

    2014-07-18

    The objective of our study was to evaluate the impact of a biphaseal anterior-posterior (AP) and internal-external (IE) motion restraint system on the wear behaviour, tibio-femoral kinematics and particle release of a mobile bearing posterior stabilised knee design in comparison to the widely used linear restraint. in vitro wear simulation was performed using a posterior stabilised total knee replacement with a mobile rotating platform gliding surface design to compare the standard ISO 14243-1:2002 (E) protocol with a linear AP and IE motion restraint and the new ISO 14243-1:2009 (E) protocol with a biphaseal AP and IE motion restraint. For the mobile gliding surfaces, an increase in wear rate by more than a magnitude was measured applying the biphaseal protocol (8.5±1.6 mg/million cycles) in a direct comparison to the linear protocol (0.33±0.07 mg/million cycles), with statistically significant difference. The amplitudes of AP displacement were 3.22±0.47 mm for the biphaseal test, compared to 1.97±0.22 mm in the linear test and the amplitudes of the IE rotation angle had mean values of 7.32°±0.91° under the biphaseal setup, compared to 1.97°±0.14° under linear motion restraint test conditions. From our observations, we conclude that the changes in AP translation and IE rotation motion restraints from ISO linear to ISO biphaseal test conditions highly impact the knee joint kinematics and wear behaviour of a mobile bearing posterior stabilised knee design.

  3. Does the Q − H index show a stronger relationship than the H:Q ratio in regard to knee pain during daily activities in patients with knee osteoarthritis?

    PubMed Central

    Fujita, Remi; Matsui, Yasumoto; Harada, Atsushi; Takemura, Marie; Kondo, Izumi; Nemoto, Tetsuya; Sakai, Tadahiro; Hiraiwa, Hideki; Ota, Susumu

    2016-01-01

    [Purpose] The purpose of this study was to elucidate the relationship between knee muscle strength and knee pain in activities of daily living, based on consideration of the difference between extension and flexion strength (Q − H) and the hamstring:quadriceps (H:Q) ratio in patients with knee osteoarthritis. [Subjects and Methods] The participants were 78 females with knee osteoarthritis, and a total of 133 knees that had not been treated surgically were the targets of this research. The legs were divided according to dominance. Isometric knee extension and flexion muscle strength and knee pain during activities of daily living were measured. The H:Q ratio (flexion/extension muscle strength) and the difference between extension and flexion strength, (extension muscle strength/weight) minus (flexion muscle strength/weight), that is, Q − H, were calculated. The correlation between these indices and the knee pain score during activities of daily living was investigated. [Results] Greater knee pain during activities of daily living was related to lower knee extension muscle strength and Q − H in both the dominant and nondominant legs. Knee flexion muscle strength and the H:Q ratio were not significantly correlated with knee pain during any activities of daily living. [Conclusion] Knee extension muscle strength and Q − H were found to be significantly correlated with knee pain during activities of daily living, whereas the H:Q ratio was not. PMID:28174444

  4. In vivo kinematics of knee replacement during daily living activities: Condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses.

    PubMed

    Belvedere, Claudio; Leardini, Alberto; Catani, Fabio; Pianigiani, Silvia; Innocenti, Bernardo

    2017-07-01

    In total knee replacement, the investigation on the exact contact patterns at the post-cam in implanted patients from real in vivo data during daily living activities is fundamental for validating implant design concepts and assessing relevant performances. This study is aimed at verifying the restoration of natural tibio-femoral condylar kinematics by investigating the post-cam engagement at different motor tasks. An innovative validated technique, combining three-dimensional fluoroscopic and finite element analyses, was applied to measure joint kinematics during daily living activities in 15 patients implanted with guided motion posterior-stabilized total knee replacement. Motion results showed physiological antero-posterior translations of the tibio-femoral condyles for every motor task. However, high variability was observed in the position of the calculated pivot point among different patients and different motor tasks, as well as in the range of post-cam engagement. Physiological tibio-femoral joint rotations and contacts at the condyles were found restored in the present knee replacement. Articular contact patterns experienced at the post-cam were found compatible with this original prosthesis design. The present study reports replaced knee kinematics also in terms of articular surface contacts, both at the condyles and, for the first time, at the post-cam. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1396-1403, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  5. Contribution of micro-motion to backside wear in a fixed bearing total knee arthroplasty.

    PubMed

    Levine, Rayna A C; Lewicki, Kathleen A; Currier, John H; Mayor, Michael B; Van Citters, Douglas W

    2016-11-01

    This study seeks to identify important factors related to backside wear of tibial inserts in vivo and determine an appropriate wear model for backside wear. An IRB approved database was queried for tibial inserts of a single design from one manufacturer that exhibited evidence of rotatory motion on the backside of the polyethylene. These devices were measured for volumetric wear using a previously established protocol. Features including the change in locking lip width and measurement of micro-motion marks were used to describe the motion pattern. Volumetric wear and implant characteristics were compared using linear regressions by modeling wear theories suggested by Archard and Wang to determine the most appropriate model for backside wear. The Wang model showed that duration, adjusted sliding distance, and cross-shear index accounted for approximately 58% of the volumetric wear variation while adjusted sliding distance and duration in vivo accounted for approximately 35% of the volumetric wear variation in the Archard model. Patient weight (p = 0.750), patient BMI (p = 0.680), and backside area (p = 0.784) of the tibial insert were all found to be non-significant in the Wang model. Similarly, patient weight (p = 0.233), patient BMI (p = 0.162), and backside area (p = 0.796) were found to be non-significant in the Archard model. Multidirectional micro-motion appears to contribute significantly to the wear of these components, supporting the Wang theory of cross-shear for polyethylene wear. Cross-shear of polymers on an unpolished titanium tray can lead to an increase in wear debris in the body. Care should be taken when designing locking mechanisms and tray designs. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1933-1940, 2016.

  6. The Immediate Effect of Lateral Wedge Insoles, With and Without a Subtalar Strap, on the Lateral Trunk Lean Motion in Patients With Knee Osteoarthritis

    PubMed Central

    Esfandiari, Elham; Kamyab, Mojtaba; Yazdi, Hamid Reza; Foroughi, Nasim; Sanjari, Mohammad Ali

    2013-01-01

    Background: Orthotic interventions for knee osteoarthritis (OA) aim to reduce mechanical loading on the medial compartment of the knee and may lessen the lateral trunk lean as the most important compensatory gait strategy. The lateral wedge insole is a known orthotic intervention for knee OA. However, the question whether the addition of a subtalar strap to the wedge improves its effect has not been addressed in the literature. Objective: To compare the effects of lateral wedge insoles, with and without a subtalar strap, on the lateral trunk lean in patients with knee OA. Methods: Twenty-three patients aged over 40 years, with grade I or II OA of the medial compartment of one knee, based on the American College of Rheumatology criteria, were included in this study. The patients were diagnosed with OA based on a clinical examination, and the diagnosis was confirmed with radiographs. A 3-dimensional motion measurement system was used to collect the gait data for 3 different conditions: (1) with no insole, (2) with a lateral wedge insole, and (3) with a lateral wedge insole and a subtalar strap. The immediate effect of the 3 test conditions on the lateral trunk lean was compared during a gait cycle a stance phase and at the point of midstance. Results: Based on the laboratory coordinate system, the 3 conditions had no significant effect on the lateral trunk lean during a gait cycle and a stance phase and at the point of midstance in patients with knee OA. Conclusion: The results of this study demonstrated that the lateral wedge insoles, with and without a subtalar strap, had no immediate effect on the lateral trunk lean in patients with knee OA. However, the long-term effect of lateral wedge insoles on the lateral trunk lean in these patients requires further investigation. PMID:24600533

  7. Activation of quadriceps femoris including vastus intermedius during fatiguing dynamic knee extensions.

    PubMed

    Akima, Hiroshi; Saito, Akira

    2013-11-01

    Fatigue-related muscle activity in the superficial quadriceps femoris (QF) muscles has been widely examined; however, there is no information on the activity of the deep vastus intermedius (VI) muscle during fatiguing dynamic knee extensions. The purpose of this study was to investigate neuromuscular activation patterns of the QF synergists, including the VI, during fatiguing dynamic knee extensions at two submaximal loads. Nine healthy men performed dynamic knee extensions with loads of 50 and 70 % of one-repetition maximum (1RM) until failure. Muscle activation of the VI, vastus lateralis, vastus medialis (VM) and rectus femoris was recorded using surface electrodes. Root mean square (RMS) amplitude was calculated during the concentric (CON) and eccentric (ECC) phases of each repetition, and normalized to the RMS amplitude during the CON and ECC phases of the 1RM. Each CON and ECC phase was further divided into three subphases according to knee joint angle. The normalized RMS amplitude of the four individual QF muscles during the CON phase linearly increased with fatigue with contractions at both 50 and 70 % 1RM. The highest RMS amplitude was found in VI at flexed knee joint angles until fatigue. This activation pattern was more prominent at 70 % 1RM than 50 % 1RM. The RMS amplitude of VM at extended knee joint angles was selectively higher at 70 % 1RM than 50 % 1RM. These results suggest that the contribution of the four individual QF muscles to fatiguing dynamic knee extensions differs according to knee joint angle and intensity of load.

  8. Design, construction and evaluation of an electromechanical stance-control knee-ankle-foot orthosis.

    PubMed

    Yakimovich, Terris; Kofman, Jonathan; Lemaire, Edward

    2005-01-01

    A new electromechanical Stance-Control Knee-Ankle-Foot Orthosis (SCKAFO) was designed to provide improved gait for people with knee-extensor weakness. This SCKAFO inhibits knee flexion at any knee angle while allowing knee extension during weight bearing. During swing or other non-weight bearing activities, the SCKAFO allows free knee motion. A prototype joint was mechanically tested to determine the moment at failure, loading behaviour, and device safety. Quantitative kinematic gait analysis of three able-bodied subjects and three knee-ankle-foot-orthosis (KAFO) users showed that the new SCKAFO had a desired minimal effect on able-bodied walking gait. The SCKAFO permitted a mean increase in sagittal knee motion (488%) during swing for the three KAFO users and a reduction in pelvic obliquity and hip abduction angle abnormalities during terminal stance and swing for two KAFO users.

  9. Design, construction and evaluation of an electromechanical stance-control knee-ankle-foot orthosis.

    PubMed

    Yakimovich, Terris; Kofman, Jonathan; Lemaire, Edward

    2005-01-01

    A new electromechanical Stance-Control Knee-Ankle-Foot Orthosis (SCKAFO) was designed to provide improved gait for people with knee-extensor weakness. This SCKAFO inhibits knee flexion at any knee angle while allowing knee extension during weight bearing. During swing or other non-weight bearing activities, the SCKAFO allows free knee motion. A prototype joint was mechanically tested to determine the moment at failure, loading behaviour, and device safety. Quantitative kinematic gait analysis of three able-bodied subjects and three knee-anklefoot-orthosis (AFO) users showed that the new SCKAFO had a desired minimal effect on able-bodied walking gait. The SCKAFO permitted a mean increase in sagittal knee motion (488%) during swing for the three KAFO users and a reduction in pelvic obliquity and hip abduction angle abnormalities during terminal stance and swing for two KAFO users.

  10. The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis.

    PubMed

    O'Connell, Megan; Farrokhi, Shawn; Fitzgerald, G Kelley

    2016-01-01

    The association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis. Sixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n=18), mild pain (n=27), or moderate/severe pain (n=22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified. The moderate/severe pain group demonstrated worse global pain (P<0.01) and physical function scores (P<0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P=0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P=0.009), which was associated with higher weight acceptance peak knee adduction moments (P=0.003) and worse global pain (P=0.003) and physical function scores (P=0.006). Greater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Abdominal muscle activity according to knee joint angle during sit-to-stand

    PubMed Central

    Eom, Juri; Rhee, Min-Hyung; Kim, Laurentius Jongsoon

    2016-01-01

    [Purpose] This study assessed the activity of the abdominal muscles according to the angle of the knee joints during sit-to-stand. [Subjects and Methods] Thirty healthy adult males participated in this study. Subjects initiated sit-to-stand at knee joint angles of 60°, 90°, or 120°. An electromyography system was used to measure the maximum voluntary isometric contraction of the rectus abdominis, external oblique, and internal oblique and transverse abdominis muscles. [Results] Percent contraction differed significantly among the three knee joint angles, most notably for the internal oblique and transverse abdominis muscles. [Conclusion] Wider knee joint angles more effectively activate the abdominal muscles, especially those in the deep abdomen, than do narrower angles. PMID:27390431

  12. Astym® Therapy for the Management of Recalcitrant Knee Joint Stiffness after Total Knee Arthroplasty.

    PubMed

    Bhave, Anil; Corcoran, James; Cherian, Jeffery J; Mont, Michael A

    2016-01-01

    Knee stiffness is a common complication after total knee arthroplasty (TKA). Despite studies published on the surgical management of reduced range of motion (ROM) after TKA, there is limited evidence on the nonoperative management of joint and soft tissue imbalances possibly contributing to reduced knee ROM. This report assesses changes in ROM, pain, function, and patellar tendon length after Astym® joint mobilization use. A 38-year-old male professional skier had a right TKA 3 months before presentation with 2 subsequent manipulations under anesthesia secondary to persistent knee stiffness. He had patellar baja on radiograph, a reduced arc of ROM, reduced patellar mobility and muscular extensibility, and pain to palpation along the patellar tendon. He had 12 visits of physical therapy with the use of Astym®, patellar mobilization, and tibio-femoral mobilizations with movement. The patient also used a customized knee device at home for prolonged knee extension stretching. The patient was treated for 12 visits, along with home use of customized bracing for knee extension. Significant improvements were seen in pain, function, and ROM. He returned to work full-time, ambulated prolonged distances, and negotiated stairs pain-free. He also demonstrated resolution of patellar baja radiographically. Conservative management of recalcitrant knee joint stiffness after primary TKA can be effective in restoring knee mobility and reducing pain and activity limitation. A multimodal approach using Astym® treatment, customized knee bracing, and targeted joint mobilization can be effective in resolving knee joint stiffness.

  13. Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls.

    PubMed

    Fältström, Anne; Hägglund, Martin; Kvist, Joanna

    2017-02-01

    Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)-reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams. Cross-sectional study; Level of evidence, 3. This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses. The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players' matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended

  14. Active functional stiffness of the knee joint during activities of daily living: a parameter for improved design of prosthetic limbs.

    PubMed

    Bayram, Hande Argunsah; Chien, Chih-Hao; Davis, Brian L

    2014-12-01

    Exploring knee joint physiological functional stiffness is crucial for improving the design of prosthetic legs that aim to mimic normal gait. This study hypothesizes that knee joint stiffness varies among different activities of daily living, additionally while the knee performs natural movements; the magnitude of the stiffness indicates the degree of energy storage element sufficiency in terms of harvesting/returning energy. This study examined sagittal plane knee moment vs. knee flexion angle curves from 12 able-bodied subjects during activities of daily living. Slopes of these curves were assessed to find the calculated stiffness during the peak energy return and harvest phases so that the activities, which can be performed when the prosthetic knee is supplemented by a spring, were identified. For the energy return and harvest phases, the stiffness varied between 0.006 and 0.046 Nm/kg deg. and 0 and 0.052 Nm/kg deg. respectively. The optimum energy return phase stiffness was 0.024 (SD 0.013) Nm/kg deg. and energy harvest phase stiffness was 0.011 (SD 0.018) Nm/kg deg. Knee joint stiffness varied significantly during activities of daily living, which indicated that a storage unit with a constant stiffness would not be sufficient in providing energy regenerative gait during all activities. However, by controlling the amount and timing of spring compression and release, an energy-regenerative prosthetic knee device could be developed during most of the activities. This study was directed to the development of a complete data set, which determined the torque-angle properties of the healthy knee joint. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis.

    PubMed

    Everts, Peter A M; Devilee, Roger J J; Oosterbos, Cornelis J M; Mahoney, Christine Brown; Schattenkerk, Maarten Eeftinck; Knape, Johannes T A; van Zundert, André

    2007-07-01

    In this study we describe the potential role of autologous platelet gel and fibrin sealant in unilateral total knee arthroplasty to improve the postoperative range of motion and to reduce the incidence of arthrofibrosis. Total knee arthroplasty is often associated with a considerable amount of post-operative blood loss. Persistent limited motion directly after surgery may ultimately result in arthrofibrosis. To counteract these effects we investigated whether the use of autologous derived platelet gel and fibrin sealant would reduce postoperative blood loss, decrease the impaired range of motion and the incidence of arthrofibrosis. All patients were consecutively operated and assigned to the study or control groups. Study group patients (n = 85) were treated with the application of autologous platelet gel and fibrin sealant at the end of surgery. Eighty patients were operated without the use of platelet gel and fibrin sealant, and served as the control group. The postoperative hemoglobin decrease, range of motion and length of hospitalization were recorded. During a 5-month postoperative period patients were followed to observe the incidence of arthrofibrosis. In patients in the treatment group the hemoglobin concentration in blood decreased significantly less when compared to the control group. They also showed a superior postoperative range of motion when compared to those of the control group (P < 0.001). The incidence of arthrofibrosis and subsequent forced manipulation was significantly less (P < 0.001) in patients managed with platelet gel and fibrin sealant. We conclude that peri-operatively applied platelet gel and fibrin sealant may improve the range of motion after total knee arthroplasty, decreases the length of stay and may reduce the incidence of arthrofibrosis.

  16. Increased knee muscle strength is associated with decreased activity limitations in established knee osteoarthritis: Two-year follow-up study in the Amsterdam osteoarthritis cohort.

    PubMed

    Sanchez-Ramirez, Diana C; van der Leeden, Marike; van der Esch, Martin; Roorda, Leo D; Verschueren, Sabine; van Dieën, Jaap; Lems, Willem F; Dekker, Joost

    2015-08-18

    To examine the association between changes in knee muscle strength (extensor and flexor muscles separately, and mean values) and changes in activity limitations in patients with established knee osteoarthritis at 2 years. Data from 186 patients with knee osteoarthritis, part of the Amsterdam Osteoarthritis cohort, were gathered at baseline and at 2-year follow-up. Strength of the knee extensor and flexor muscles were assessed using an isokinetic dynamometer. Activity limitations were assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) - Physical Function subscale, the Get Up and Go test (GUG), and the 12-steps stairs test. Univariate and multivariate linear regression analyses were used to assess the association between changes in muscle strength and changes in activity limitations, adjusting for relevant confounders and baseline activity limitations. There was an overall 16% increase in mean knee muscle strength (p < 0.001), 19% increase in knee extensor muscle strength (p < 0.001), and 17% increase in knee flexor muscle strength (p < 0.001) at 2 years. Increased mean knee muscle strength and knee flexor muscle strength were associated with better self-reported physical function (WOMAC) (b = -5.7, p = 0.03 and b = -6.2, p = 0.05), decreased time on the GUG (b = -1.2, p = 0.003 and b = -1.4, p = 0.05) and decreased time on the stairs test (b = -4.4, p < 0.001 and b = -6.6, p < 0.001). Increased extensor muscle strength was associated only with decreased time on the stairs test (b = -2.7, p < 0.001). Increased knee muscle strength, mainly in the knee flexors, was associated with decreased activity limitations in patients with knee osteoarthritis at 2 years. Thus, differences in muscle strength may partially explain the between-patients variability in activity limitations.

  17. In vivo kinematics of a robot-assisted uni- and multi-compartmental knee arthroplasty.

    PubMed

    Watanabe, Toshifumi; Abbasi, Ali Z; Conditt, Michael A; Christopher, Jennifer; Kreuzer, Stefan; Otto, Jason K; Banks, Scott A

    2014-07-01

    There is great interest in providing reliable and durable treatments for one- and two-compartment arthritic degeneration of the cruciate-ligament intact knee. One approach is to resurface only the diseased compartments with discrete unicompartmental components, retaining the undamaged compartment(s). However, placing multiple small implants into the knee presents a greater surgical challenge than total knee arthroplasty, so it is not certain that the natural knee mechanics can be maintained or restored. The goal of this study was to determine whether near-normal knee kinematics can be obtained with a robot-assisted multi-compartmental knee arthroplasty. Thirteen patients with 15 multi-compartmental knee arthroplasties using haptic robotic-assisted bone preparation were involved in this study. Nine subjects received a medial unicompartmental knee arthroplasty (UKA), three subjects received a medial UKA and patellofemoral (PF) arthroplasty, and three subjects received medial and lateral bi-unicondylar arthroplasty. Knee motions were recorded using video-fluoroscopy an average of 13 months (6-29 months) after surgery during stair and kneeling activities. The three-dimensional position and orientation of the implant components were determined using model-image registration techniques. Knee kinematics during maximum flexion kneeling showed femoral external rotation and posterior lateral condylar translation. All knees showed femoral external rotation and posterior condylar translation with flexion during the step activity. Knees with medial UKA and PF arthroplasty showed the most femoral external rotation and posterior translation, and knees with bicondylar UKA showed the least. Knees with accurately placed uni- or bi-compartmental arthroplasty exhibited stable knee kinematics consistent with intact and functioning cruciate ligaments. The patterns of tibiofemoral motion were more similar to natural knees than commonly has been observed in knees with total knee

  18. Ten-year results of physical activity after high tibial osteotomy in patients with knee osteoarthritis.

    PubMed

    W-Dahl, Annette; Toksvig-Larsen, Sören; Lindstrand, Anders

    2017-03-01

    The purpose was to describe physical activity with respect to leisure and working activity in patients operated on by high tibial osteotomy using the hemicallotasis technique for knee osteoarthritis (OA), preoperatively and 10 years postoperatively. Seventy-nine patients, median age 55 (range 35-66), operated on by high tibial osteotomy using the hemicallotasis technique for knee OA 2001-2003 were included. Questionnaires for evaluation of physical and working activity, satisfaction as well as the Knee injury and Osteoarthritis Outcome Score (KOOS) were filled in preoperatively and 2 and 10 years postoperatively. Conversion to knee arthroplasty was obtained through the Swedish Knee Arthroplasty Register. Changes between two postoperative measurements were assessed by Wilcoxon's rank test. Twenty-five patients were converted to a total knee arthroplasty, and nine patients were lost to follow-up during the 10 years, resulted in 45 patients available for follow-up. Preoperatively, 33/45 patients were physically active mainly in heavy yard/household work, and 43/45 patients were working active. Ten years after the HCO, 23/45 patients were still active with golf, dancing, hiking, etc., and 23/45 were retired. At 10 years postoperatively compared to 2 years postoperatively, the patients experienced more problems with pain (89 compared to 69, p = <0.0001). Of 45 patients, 36 were satisfied with the high tibial osteotomy surgery in general 10 years postoperatively, while 13/45 were satisfied with their sport and recreational function. The 10-year results indicate that high tibial osteotomy using the hemicallotasis technique for knee OA is an option for selected patients that improves the level of physical activity, with mild deterioration over time, and gives the majority of the patients the possibility to be working active until retirement. Level IV.

  19. Can the Functional Movement Screen™ be used to capture changes in spine and knee motion control following 12 weeks of training?

    PubMed

    Frost, David M; Beach, Tyson A C; Campbell, Troy L; Callaghan, Jack P; McGill, Stuart M

    2017-01-01

    To examine whether objective measures of spine and frontal plane knee motion exhibited during Functional Movement Screen™ (FMS) task performance changed following a movement-guided fitness (MOV) and conventional fitness (FIT) exercise intervention. Secondary analysis of a randomized controlled experiment. Before and after 12 weeks of exercise, participants' kinematics were quantified while performing the FMS and a series of general whole-body movement tasks. Biomechanics laboratory. Fifty-two firefighters were assigned to MOV, FIT, or a control (CON) group. Peak lumbar spine flexion/extension, lateral bend and axial twist, and frontal plane knee motion. The post-training kinematic changes exhibited by trainees while performing the FMS tasks were similar in magnitude (effect size < 0.8) to those exhibited by CON. However, when performing the battery of general whole-body movement tasks, only MOV showed significant improvements in spine and frontal plane knee motion control (effect size > 0.5). Whether graded qualitatively, or quantitatively via kinematic analyses, the FMS may not be a viable tool to detect movement-based exercise adaptations. Amendments to the FMS tasks and/or scoring method are needed before it can be used for reasons beyond appraising the ability to move freely, symmetrically, and without pain. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Fiducial marker-based correction for involuntary motion in weight-bearing C-arm CT scanning of knees. Part I. Numerical model-based optimization

    PubMed Central

    Choi, Jang-Hwan; Fahrig, Rebecca; Keil, Andreas; Besier, Thor F.; Pal, Saikat; McWalter, Emily J.; Beaupré, Gary S.; Maier, Andreas

    2013-01-01

    Purpose: Human subjects in standing positions are apt to show much more involuntary motion than in supine positions. The authors aimed to simulate a complicated realistic lower body movement using the four-dimensional (4D) digital extended cardiac-torso (XCAT) phantom. The authors also investigated fiducial marker-based motion compensation methods in two-dimensional (2D) and three-dimensional (3D) space. The level of involuntary movement-induced artifacts and image quality improvement were investigated after applying each method. Methods: An optical tracking system with eight cameras and seven retroreflective markers enabled us to track involuntary motion of the lower body of nine healthy subjects holding a squat position at 60° of flexion. The XCAT-based knee model was developed using the 4D XCAT phantom and the optical tracking data acquired at 120 Hz. The authors divided the lower body in the XCAT into six parts and applied unique affine transforms to each so that the motion (6 degrees of freedom) could be synchronized with the optical markers’ location at each time frame. The control points of the XCAT were tessellated into triangles and 248 projection images were created based on intersections of each ray and monochromatic absorption. The tracking data sets with the largest motion (Subject 2) and the smallest motion (Subject 5) among the nine data sets were used to animate the XCAT knee model. The authors defined eight skin control points well distributed around the knees as pseudo-fiducial markers which functioned as a reference in motion correction. Motion compensation was done in the following ways: (1) simple projection shifting in 2D, (2) deformable projection warping in 2D, and (3) rigid body warping in 3D. Graphics hardware accelerated filtered backprojection was implemented and combined with the three correction methods in order to speed up the simulation process. Correction fidelity was evaluated as a function of number of markers used (4–12) and

  1. Possibilities and limitations of novel in-vitro knee simulator.

    PubMed

    Verstraete, Matthias A; Victor, Jan

    2015-09-18

    The ex-vivo evaluation of knee kinematics remains vital to understand the impact of surgical treatments such as total knee arthroplasty (TKA). To that extent, knee simulators have been developed. However, these simulators have mainly focused on the simulation of a squatting motion. The relevance of this motion pattern for patients' activities of daily living is however questionable as squatting is difficult for elderly patients. Walking, stairs and cycling are more relevant motion patterns. This paper presents the design and control of a simulator that allows to independently control the applied kinematic and kinetic boundary conditions to simulate these daily life activities. Thereby, the knee is left with five degrees of freedom; only the knee flexion is actively controlled. From a kinetic point of view, the quadriceps and hamstring muscles are loaded. Optionally, a varus/valgus moment can be applied, facilitating a dynamic evaluation of the knee's stability. The simulator is based on three control loops, whose synchronization appears satisfactory. The input for these control loops can be determined from either musculoskeletal simulations or in accordance to literature data for traditional knee simulators. This opens the door towards an improved understanding of the knee biomechanics and comparison between different applied motion and force patterns.

  2. People can understand descriptions of motion without activating visual motion brain regions

    PubMed Central

    Dravida, Swethasri; Saxe, Rebecca; Bedny, Marina

    2013-01-01

    What is the relationship between our perceptual and linguistic neural representations of the same event? We approached this question by asking whether visual perception of motion and understanding linguistic depictions of motion rely on the same neural architecture. The same group of participants took part in two language tasks and one visual task. In task 1, participants made semantic similarity judgments with high motion (e.g., “to bounce”) and low motion (e.g., “to look”) words. In task 2, participants made plausibility judgments for passages describing movement (“A centaur hurled a spear … ”) or cognitive events (“A gentleman loved cheese …”). Task 3 was a visual motion localizer in which participants viewed animations of point-light walkers, randomly moving dots, and stationary dots changing in luminance. Based on the visual motion localizer we identified classic visual motion areas of the temporal (MT/MST and STS) and parietal cortex (inferior and superior parietal lobules). We find that these visual cortical areas are largely distinct from neural responses to linguistic depictions of motion. Motion words did not activate any part of the visual motion system. Motion passages produced a small response in the right superior parietal lobule, but none of the temporal motion regions. These results suggest that (1) as compared to words, rich language stimuli such as passages are more likely to evoke mental imagery and more likely to affect perceptual circuits and (2) effects of language on the visual system are more likely in secondary perceptual areas as compared to early sensory areas. We conclude that language and visual perception constitute distinct but interacting systems. PMID:24009592

  3. Using Kinesthetic Activities to Teach Ptolemaic and Copernican Retrograde Motion

    NASA Astrophysics Data System (ADS)

    Richards, Ted

    2012-06-01

    This paper describes a method for teaching planetary retrograde motion, and the Ptolemaic and Copernican accounts of retrograde motion, by means of a series kinesthetic learning activities (KLAs). In the KLAs described, the students literally walk through the motions of the planets in both systems. A retrospective statistical analysis shows that students who participated in these activities performed better on examination questions pertaining to retrograde motion than students who did not. Potential explanations for this result, including the breaking of classroom routine, the effect of body movement on conceptual memory, and egocentric spatial proprioception, are considered.

  4. Instabilities, motion and deformation of active fluid droplets

    NASA Astrophysics Data System (ADS)

    Whitfield, Carl A.; Hawkins, Rhoda J.

    2016-12-01

    We consider two minimal models of active fluid droplets that exhibit complex dynamics including steady motion, deformation, rotation and oscillating motion. First we consider a droplet with a concentration of active contractile matter adsorbed to its boundary. We analytically predict activity driven instabilities in the concentration profile, and compare them to the dynamics we find from simulations. Secondly, we consider a droplet of active polar fluid of constant concentration. In this system we predict, motion and deformation of the droplets in certain activity ranges due to instabilities in the polarisation field. Both these systems show spontaneous transitions to motility and deformation which resemble dynamics of the cell cytoskeleton in animal cells.

  5. Effect of Knee Position on Quadriceps Muscle Force Steadiness and Activation Strategies

    PubMed Central

    Krishnan, Chandramouli; Allen, Eric J.; Williams, Glenn N.

    2010-01-01

    Introduction This study investigated the effect of knee position on quadriceps force steadiness and activation strategies. Methods Quadriceps force steadiness was evaluated in twenty-two volunteers at two knee positions by testing their ability to regulate submaximal force. Muscle activation strategies were studied in both time and frequency domains using surface electromyography. Results Quadriceps force fluctuations and the associated agonist and antagonist activity were significantly higher at 90° than at 30° of flexion (P < 0.05). The quadriceps median frequency recorded at 30° was significantly higher than at 90° of flexion (P < 0.05). Regression analyses revealed that force steadiness was related to quadriceps activation and median frequency (P < 0.001), but not to hamstring coactivation (P > 0.05). Discussion The results indicate that knee position significantly affects quadriceps force steadiness and activation strategies. This finding may have important implications for designing a force control testing protocol and interpreting test results. PMID:21404288

  6. Design and control of a prosthetic leg for above-knee amputees operated in semi-active and active modes

    NASA Astrophysics Data System (ADS)

    Park, Jinhyuk; Yoon, Gun-Ha; Kang, Je-Won; Choi, Seung-Bok

    2016-08-01

    This paper proposes a new prosthesis operated in two different modes; the semi-active and active modes. The semi-active mode is achieved from a flow mode magneto-rheological (MR) damper, while the active mode is obtained from an electronically commutated (EC) motor. The knee joint part of the above knee prosthesis is equipped with the MR damper and EC motor. The MR damper generates reaction force by controlling the field-dependent yield stress of the MR fluid, while the EC motor actively controls the knee joint angle during gait cycle. In this work, the MR damper is designed as a two-end type flow mode mechanism without air chamber for compact size. On other hand, in order to predict desired knee joint angle to be controlled by EC motor, a polynomial prediction function using a statistical method is used. A nonlinear proportional-derivative controller integrated with the computed torque method is then designed and applied to both MR damper and EC motor to control the knee joint angle. It is demonstrated that the desired knee joint angle is well achieved in different walking velocities on the ground ground.

  7. Motion and Muscle Activity Are Affected by Instability Location During a Squat Exercise.

    PubMed

    Nairn, Brian C; Sutherland, Chad A; Drake, Janessa D M

    2017-03-01

    Nairn, BC, Sutherland, CA, and Drake, JDM. Motion and muscle activity are affected by instability location during a squat exercise. J Strength Cond Res 31(3): 677-685, 2017-Squat exercise training using instability devices has become increasingly popular for a multitude of reasons. Many devices generate instability at the feet and provide a bottom-up perturbation; however, the effect of a top-down instability device during a squat remains unclear. To induce instability at the upper body, a water-filled cylinder called the Attitube was used. This study analyzed the effects of instability location (top-down, bottom-up, and no instability) during a squat exercise in terms of kinematics and muscle activation. Ten male participants were instrumented with 75 reflective markers to track kinematics of the ankle, knee, hip, trunk, and the Bar/Attitube, and electromyography was recorded from 12 muscles bilaterally. Squats were performed with an Olympic bar on a stable surface, an Olympic bar on a BOSU ball (BALL, bottom-up), and the Attitube on solid ground (TUBE, top-down). The TUBE showed up to 1.5 times reduction in erector spinae activation and up to 1.5 times less trunk flexion while being performed at a slower velocity. There was also higher abdominal activation in the TUBE, with up to 2.8 times greater oblique activation compared with the stable condition. The BALL increased ankle eversion and knee flexion with higher muscle activation in gastrocnemius, biceps femoris, and quadriceps. Overall, changing the location of instability during a squat changed the motion and muscle activation patterns of the trunk and lower extremities. This provides information for future research into rehabilitation, learning proper squat technique, and for specific training scenarios.

  8. Agonist muscle activity and antagonist muscle co-activity levels during standardized isotonic and isokinetic knee extensions.

    PubMed

    Remaud, Anthony; Cornu, Christophe; Guével, Arnaud

    2009-06-01

    This study aimed to analyze the effects of the contraction mode (isotonic vs. isokinetic concentric conditions), the joint angle and the investigated muscle on agonist muscle activity and antagonist muscle co-activity during standardized knee extensions. Twelve healthy adult subjects performed three sets of isotonic knee extensions at 40% of their maximal voluntary isometric torque followed by three sets of maximal isokinetic knee extensions on an isokinetic dynamometer. For each set, the mean angular velocity and the total external amount of work performed were standardized during the two contraction modes. Surface electromyographic activity of vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), semitendinosus (ST) and biceps femoris (BF) muscles was recorded. Root mean square values were then calculated for each 10 degrees between 85 degrees and 45 degrees of knee extension (0 degrees =horizontal position). Results show that agonist muscle activity and antagonist muscle co-activity levels are significantly greater in isotonic mode compared to isokinetic mode. Quadriceps activity and hamstrings co-activity are significantly lower at knee extended position in both contraction modes. Considering agonist muscles, VL reveals a specific pattern of activity compared to VM and RF; whereas considering hamstring muscles, BF shows a significantly higher co-activity than ST in both contraction modes. Results of this study confirmed our hypothesis that higher quadriceps activity is required during isotonic movements compared to isokinetic movements leading to a higher hamstrings co-activity.

  9. Relationship Between Physical Activity and Health-Related Utility Among Knee Osteoarthritis Patients

    PubMed Central

    Manheim, Larry M.; Dunlop, Dorothy; Song, Jing; Semanik, Pamela; Lee, Jungwha; Chang, Rowland W.

    2012-01-01

    Objective To estimate the relationship between physical activity and health-related utility for people with knee OA and implications for designing cost effective interventions. Methods Use GEE regression analysis to estimate partial association of accelerometer-measured physical activity levels with health-related utility after controlling for demographics, health status, knee OA severity level, pain and functioning. Results Moving from lowest to middle tertile of physical activity levels is associated with .071 (p<.01) increase in health-related utility after controlling for demographics and .036 (p<.05) increase in utility after controlling for demographics, health status, knee OA severity level, weight, pain, and functional impairments. Conclusion Intervention programs that move individuals out of the lowest tertile of physical activity have the potential to be cost effective. PMID:22328141

  10. Effects of therapeutic exercise and hydrotherapy on pain severity and knee range of motion in patients with hemophilia: a randomized controlled trial.

    PubMed

    Mazloum, Vahid; Rahnama, Nader; Khayambashi, Khalil

    2014-01-01

    Pain and limited range of motion (ROM) are the crucial subsequent results of joint hemorrhages in individuals with bleeding disorders and hemophilia. Exercise interventions are particularly recommended in treatment of such patients. The purpose of this study was to detect the influences of conventional exercise therapy and hydrotherapy on the knee joint complications in patients with hemophilia. A total of 40 patients engaging hemophilia A were randomized into one of three groups: Therapeutic exercise (N = 13), hydrotherapy (N = 14) or control (N = 13). While the first two groups followed their specific programs for 4 weeks, routine life-style was maintained by subjects in the control group in this period. To evaluate the pain level and knee ROM the visual analog scale and standard goniometer were utilized, respectively. The outcome was measured at baseline and after completing the prescribed protocols. Data analysis was performed using one-way analysis of variance and Scheffe statistical tests (P < 0.05). Both experimental groups experienced more significant decreasing in pain level (P < 0.001) and knee flexion and extension ROM (P < 0.001) in comparison to the control group. Although the pain was significantly (P < 0.01) more alleviated in participants treated through hydrotherapy in comparison to exercise therapy, the difference in ROM improvement was not statistically significant (P > 0.05). Using hydrotherapy in addition to usual rehabilitation training can result in beneficial effect in terms of pain and knee joint ROM. However, it appears that hydrotherapy is more effective in reducing pain.

  11. Changes in the activity of trunk and hip extensor muscles during bridge exercises with variations in unilateral knee joint angle.

    PubMed

    Kim, Juseung; Park, Minchul

    2016-09-01

    [Purpose] This study compared abdominal and hip extensor muscle activity during a bridge exercise with various knee joint angles. [Subjects and Methods] Twenty-two healthy male subjects performed a bridge exercise in which the knee joint angle was altered. While subjects performed the bridge exercise, external oblique, internal oblique, gluteus maximus, and semitendinosus muscle activity was measured using electromyography. [Results] The bilateral external and internal oblique muscle activity was significantly higher at 0° knee flexion compared to 120°, 90°, and 60°. The bilateral gluteus maximus muscle activity was significantly different at 0° of knee flexion compared to 120°, 90°, and 60°. The ipsilateral semitendinosus muscle activity was significantly increased at 90° and 60° of knee flexion compared to 120°, and significantly decreased at 0° knee flexion compared with 120°, 90°, and 60°. The contralateral semitendinosus muscle activity was significantly higher at 60° of knee flexion than at 120°, and significantly higher at 0° of knee flexion than at 120°, 90°, and 60°. [Conclusion] Bridge exercises performed with knee flexion less than 90° may be used to train the ipsilateral semitendinosus. Furthermore, bridge exercise performed with one leg may be used to train abdominal and hip extensor muscles.

  12. Changes in the activity of trunk and hip extensor muscles during bridge exercises with variations in unilateral knee joint angle

    PubMed Central

    Kim, Juseung; Park, Minchul

    2016-01-01

    [Purpose] This study compared abdominal and hip extensor muscle activity during a bridge exercise with various knee joint angles. [Subjects and Methods] Twenty-two healthy male subjects performed a bridge exercise in which the knee joint angle was altered. While subjects performed the bridge exercise, external oblique, internal oblique, gluteus maximus, and semitendinosus muscle activity was measured using electromyography. [Results] The bilateral external and internal oblique muscle activity was significantly higher at 0° knee flexion compared to 120°, 90°, and 60°. The bilateral gluteus maximus muscle activity was significantly different at 0° of knee flexion compared to 120°, 90°, and 60°. The ipsilateral semitendinosus muscle activity was significantly increased at 90° and 60° of knee flexion compared to 120°, and significantly decreased at 0° knee flexion compared with 120°, 90°, and 60°. The contralateral semitendinosus muscle activity was significantly higher at 60° of knee flexion than at 120°, and significantly higher at 0° of knee flexion than at 120°, 90°, and 60°. [Conclusion] Bridge exercises performed with knee flexion less than 90° may be used to train the ipsilateral semitendinosus. Furthermore, bridge exercise performed with one leg may be used to train abdominal and hip extensor muscles. PMID:27799688

  13. Development and validation of the computer-administered animated activity questionnaire to measure physical functioning of patients with hip or knee osteoarthritis.

    PubMed

    Terwee, Caroline B; Coopmans, Charlotte; Peter, Wilfred F; Roorda, Leo D; Poolman, Rudolf W; Scholtes, Vanessa A B; Harlaar, Jaap; de Vet, Henrica C W

    2014-02-01

    Physical functioning of patients with hip or knee osteoarthritis is measured by self-report questionnaires and performance-based tests. However, performance-based tests often are not feasible. The aim of this study was to develop a computer-administered questionnaire (ie, the Animated Activity Questionnaire [AAQ]) to measure physical functioning in patients with hip or knee OA. By showing animations of activities, the influence of the patient's own reference frame is minimized. The AAQ measures the same aspects of physical functioning as performance-based tests do. This was a development and preliminary validation (cross-sectional) study. A pilot version of the AAQ was developed using motion capture to analyze the movement of a person performing 7 daily activities. Different animations of the same activity were made with 2 to 5 levels of difficulty. For each activity, participants were asked to choose one animation that best corresponds to their own way of performing the activity. A preliminary validation study was performed to compare the AAQ with validated self-report questionnaires (Knee Injury and Osteoarthritis Outcome Score, Hip Disability and Osteoarthritis Outcome Score, and questionnaires on walking, stair climbing, and rising and sitting down) and performance-based tests (walking, Timed "Up & Go" Test, Timed Stair Test) in 33 patients with hip or knee osteoarthritis. As expected, the AAQ showed a correlation above .70 (.79, 95% confidence interval=.61-.89) with the total score of the performance-based tests. On the subscore level, the results were partly as expected. Fifty-eight percent of the participants preferred the AAQ over self-report questionnaires and performance-based tests. The findings need to be replicated in larger samples of patients because the sample size of the study was rather small. The AAQ might be a good alternative for measuring physical functioning of patients with hip or knee osteoarthritis. The AAQ can easily be adapted for use in

  14. Mechanical correction of dynamometer moment for the effects of segment motion during isometric knee-extension tests.

    PubMed

    Tsaopoulos, Dimitrios E; Baltzopoulos, Vasilios; Richards, Paula J; Maganaris, Constantinos N

    2011-07-01

    The purpose of this study was to determine the effect of dynamometer and joint axis misalignment on measured isometric knee-extension moments using inverse dynamics based on the actual joint kinematic information derived from the real-time X-ray video and to compare the errors when the moments were calculated using measurements from external anatomical surface markers or obtained from the isokinetic dynamometer. Six healthy males participated in this study. They performed isometric contractions at 90° and 20° of knee flexion, gradually increasing to maximum effort. For the calculation of the actual knee-joint moment and the joint moment relative to the knee-joint center, determined using the external marker, two free body diagrams were used of the Cybex arm and the lower leg segment system. In the first free body diagram, the mean center of the circular profiles of the femoral epicondyles was used as the knee-joint center, whereas in the second diagram, the joint center was assumed to coincide with the external marker. Then, the calculated knee-joint moments were compared with those measured by the dynamometer. The results indicate that 1) the actual knee-joint moment was different from the dynamometer recorded moment (difference ranged between 1.9% and 4.3%) and the moment calculated using the skin marker (difference ranged between 2.5% and 3%), and 2) during isometric knee extension, the internal knee angle changed significantly from rest to the maximum contraction state by about 19°. Therefore, these differences cannot be neglected if the moment-knee-joint angle relationship or the muscle mechanical properties, such as length-tension relationship, need to be determined.

  15. Mechanical correction of dynamometer moment for the effects of segment motion during isometric knee-extension tests

    PubMed Central

    Baltzopoulos, Vasilios; Richards, Paula J.; Maganaris, Constantinos N.

    2011-01-01

    The purpose of this study was to determine the effect of dynamometer and joint axis misalignment on measured isometric knee-extension moments using inverse dynamics based on the actual joint kinematic information derived from the real-time X-ray video and to compare the errors when the moments were calculated using measurements from external anatomical surface markers or obtained from the isokinetic dynamometer. Six healthy males participated in this study. They performed isometric contractions at 90° and 20° of knee flexion, gradually increasing to maximum effort. For the calculation of the actual knee-joint moment and the joint moment relative to the knee-joint center, determined using the external marker, two free body diagrams were used of the Cybex arm and the lower leg segment system. In the first free body diagram, the mean center of the circular profiles of the femoral epicondyles was used as the knee-joint center, whereas in the second diagram, the joint center was assumed to coincide with the external marker. Then, the calculated knee-joint moments were compared with those measured by the dynamometer. The results indicate that 1) the actual knee-joint moment was different from the dynamometer recorded moment (difference ranged between 1.9% and 4.3%) and the moment calculated using the skin marker (difference ranged between 2.5% and 3%), and 2) during isometric knee extension, the internal knee angle changed significantly from rest to the maximum contraction state by about 19°. Therefore, these differences cannot be neglected if the moment–knee-joint angle relationship or the muscle mechanical properties, such as length-tension relationship, need to be determined. PMID:21474701

  16. [Locomotive syndrome and frailty. Total knee arthroplasty supports active life of the elderly].

    PubMed

    Watanabe, Toshifumi; Sekiya, Ichiro; Muneta, Takeshi

    2012-04-01

    For a society with an aging population, it is important to extend healthy life expectancy. Knee arthroplasty is one of the most successful and beneficial treatments for osteoarthritic knees, helping the elderly improve their activities of daily life. Previous reports have proved health-related quality of life improves dramatically with this surgery. In particular, pain and physical functioning scores improve significantly. Although the preoperative physical activity of each patient does affect the postoperative activity level, sufficient improvements can be expected for this procedure on the elderly. These effective improvements make the number of knee arthroplasties increase year to year. The elderly have high risks of postoperative medical complications. However, long term results are comparable or superior to those in younger patients. In elderly patients, pre-existing conditions should be carefully controlled, and postoperative complications, including infection and thrombosis, should be treated prophylactically to promote safety and postoperative recovery.

  17. Single- vs. double-bundle anterior cruciate ligament reconstruction: a new aspect of knee assessment during activities involving dynamic knee rotation.

    PubMed

    Czamara, Andrzej; Królikowska, Aleksandra; Szuba, Łukasz; Widuchowski, Wojciech; Kentel, Maciej

    2015-02-01

    Few studies have compared single-bundle (SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) in the knee joint during activities involving change-of-direction maneuvers and knee rotation. This study examined whether the type of ACLR contributes to postphysiotherapy outcomes, with an emphasis on knee function assessment during activities involving dynamic knee rotation. Fifteen male patients after SB ACLR and 15 male patients after DB ACLR took part in the same physiotherapy program. Twenty-four weeks after ACLR, both groups underwent anterior laxity measurement, pivot shift tests, range of movement and joint circumference measurements, subjective assessment of pain and stability levels in the knee joint, peak torque measurement of the muscles rotating the tibia toward the femur, and a run test with maximal speed and change-of-direction maneuvers. Comparative analysis did not show any differences between the results of anterior tibial translation, pivot shift test, range of movement and joint circumference, and subjective assessment of pain and knee joint stability levels. No differences were noted between the groups in peak torque values obtained from the muscles responsible for internal and external tibial rotation or results of the run test. The data obtained from this study can be used by research teams to monitor and compare the effectiveness of various study protocols involving surgical and physiotherapy treatment. The data are especially useful when combined with the clinical assessment of patients who would like to return to sport.

  18. Effect of implant design on knee flexion.

    PubMed

    Dennis, Douglas A; Heekin, R David; Clark, Charles R; Murphy, Jeffrey A; O'Dell, Tammy L; Dwyer, Kimberly A

    2013-03-01

    From March 2006 to August 2008, 93 subjects (186 knees) underwent simultaneous bilateral total knee arthroplasty performed by eight surgeons at North American centers. This randomized study was conducted to determine whether non-weight-bearing passive flexion was superior for knees receiving a posterior stabilized high flexion device compared to a posterior stabilized standard device in the contra-lateral knee. Weight-bearing single leg active flexion was one secondary endpoint. Follow-up compliance was 92.5%. Results show small, but significant superiority in the motion metrics for the high flexion device compared to the standard device 12 months after surgery, especially for a subgroup of patients with pre-operative flexion less than 120° in both knees. Thus, the ideal candidate for the high flexion device may be one with lesser pre-operative flexion.

  19. Rib motion modulates inspiratory intercostal activity in dogs.

    PubMed Central

    De Troyer, A

    1996-01-01

    1. A test was performed of the hypothesis that the motion of the ribs during inspiration modulates, via changes in spindle afferent activity, the activation of the inspiratory intercostal muscles. The electrical activity of the parasternal intercostal, external intercostal, and levator costae muscles in anaesthetized spontaneously breathing dogs was thus recorded during manipulation of the inspiratory displacement of the ribs over a wide range of rib motion. 2. In agreement with the hypothesis, the external intercostal and levator costae muscles lengthened and showed increased inspiratory activities when the normal inspiratory cranial motion of the lower rib was reduced or reversed into an inspiratory caudal motion. Conversely, the inspiratory activities decreased when the inspiratory cranial motion of the rib and the inspiratory shortening of the muscles was augmented. The inspiratory activity of the parasternal intercostal remained unchanged throughout. 3. However, when the two ribs making up the interspace were linked together so that the external intercostal muscle was constant in length, the relationship of muscle activity to rib motion was maintained. 4. In addition, when the upper rather than the lower rib of the interspace was manipulated, the relationship between the change in muscle length and inspiratory activity was reversed, so that activity decreased when the muscle was lengthened and increased when the muscle was shortened. The relationship of muscle activity to lower rib motion, however, was still maintained. 5. These observations thus indicate that rib motion triggers proprioceptive reflexes which, regardless of the changes in length of the individual muscles, make the external intercostal inspiratory activity exquisitely sensitive to the direction of rib displacement. PMID:8730601

  20. Prospective Randomized Trial of the Efficacy of Continuous Passive Motion Post Total Knee Arthroplasty: Experience of the Hospital for Special Surgery.

    PubMed

    Joshi, Rupali N; White, Peter B; Murray-Weir, Mary; Alexiades, Michael M; Sculco, Thomas P; Ranawat, Amar S

    2015-12-01

    Conflicting evidence has created substantial controversy regarding the use of continuous passive motion (CPM) in the in-patient setting post total knee arthroplasty (TKA). A total of 109 patients were randomly assigned to two groups, CPM or no CPM, applied after TKA. All patients received the same physical therapy protocol (3 sessions per day), with the only exception being the CPM. Both groups had a knee flexion of 115° at 6 weeks and 120° at 3 months, with no significant differences (P=0.69 and P=0.41, respectively). Length of stay was significantly less for the group who did not receive CPM. The use of CPM had no clinically relevant benefits with respect to AROM, clinical outcomes or discharge disposition and was associated with a cost of $235.50 per TKA.

  1. Effects of hand and knee positions on muscular activity during trunk extension exercise with the Roman chair.

    PubMed

    Park, Se-yeon; Yoo, Won-gyu

    2014-12-01

    This experimental study was performed to investigate the effects of hand and knee positions on muscular activity during back extension exercises with the Roman chair. Eighteen asymptomatic male amateur athletes performed four prone back extension exercises with two hand positions (crossed-arms and behind-the-head), and two knee positions (extended knee and 90° flexed knee). Surface electromyography (sEMG) was performed to collect data from the lower trapezius (LT), latissimus dorsi (LD), erector spinae in the T12 paraspinal region (ES-T12), erector spinae at the L3 level (ES-L3), gluteus maximus (GM), and biceps femoris (BF). Two-way repeated analysis of variance with two within-subject factors (two hand positions and two knee positions) was used to determine the significance of differences between the exercise conditions, and which hand and knee positions resulted in greater activation with exercise variation. The root mean square sEMG values were normalized using the maximum voluntary isometric contraction (MVIC) and represented as the % of the maximum EMG (%mEMG). There was no significant interaction between knee and hand positions in the %mEMG data. The results showed that the hand position affected the normalized activation of LT; the behind-the-head position resulted in significantly greater muscle activation than the crossed-arms hand position (P<0.05). The activations of the LD, ES-T10, ES-L4, and GM were greater in the 90° flexed-knee position compared to the extended-knee position (P<0.05). Although back extension exercise using the Roman chair has been shown to effectively activate the extensor musculature, our results indicated that changing the knee and hand positions could activate specific muscles differently. To achieve greater activation of trunk extensor muscle during extension exercise with the Roman chair, the flexed-knee position is a useful means of increasing resistance.

  2. COMPARISON OF VIDEO-GUIDED, LIVE INSTRUCTED, AND SELF-GUIDED FOAM ROLL INTERVENTIONS ON KNEE JOINT RANGE OF MOTION AND PRESSURE PAIN THRESHOLD: A RANDOMIZED CONTROLLED TRIAL.

    PubMed

    Cheatham, Scott W; Kolber, Morey J; Cain, Matt

    2017-04-01

    The use of foam rollers to provide tissue massage is a commonly used intervention by rehabilitation professionals for their patients and clients. Currently, there is no consensus on the optimal foam rolling treatment approach. Of particular interest are the effects of different instructional methods of foam rolling, as individuals ultimately perform these interventions independently outside of formal care. Finding the optimal instructional method may help improve the individual's understanding of the technique, allowing for a safe and effective intervention. The purpose of this study was to compare the effects of video-guided, live instructed, and self-guided foam roll interventions on knee flexion Range of Motion (ROM) and pressure pain thresholds. Forty-five healthy adults were recruited and randomly allocated to one of three intervention groups: video-guided, live-instructed, and self-guided. Each foam roll intervention lasted a total of 2 minutes. Dependent variables included knee flexion ROM and pressure pain threshold of the left quadriceps. Statistical analysis included subject demographic calculations and appropriate parametric and non-parametric tests to measure changes within and between intervention groups. Each intervention group showed significant gains in knee flexion ROM (p ≤ 0.003) and pressure pain thresholds (p < 0.001). An approximate 5 degree increase of knee flexion and a 150 kPa increase in pressure pain threshold was observed at the posttest measure for all groups. There was no significant difference (p=0.25) found between intervention groups. All three foam roll interventions showed short-term increases in knee flexion ROM and pressure pain thresholds. The two instructional methods (video and live instruction) and the self-guided method produced similar outcomes and can be used interchangeably. Individuals can benefit from various types of instruction and in cases of limited resources video may offer an alternative or adjunct to

  3. Reduced biceps femoris myoelectrical activity influences eccentric knee flexor weakness after repeat sprint running.

    PubMed

    Timmins, R G; Opar, D A; Williams, M D; Schache, A G; Dear, N M; Shield, A J

    2014-08-01

    The aim of this study was to determine whether declines in knee flexor strength following overground repeat sprints were related to changes in hamstrings myoelectrical activity. Seventeen recreationally active men completed maximal isokinetic concentric and eccentric knee flexor strength assessments at 180°/s before and after repeat sprint running. Myoelectrical activity of the biceps femoris (BF) and medial hamstrings (MHs) was measured during all isokinetic contractions. Repeated measures mixed model [fixed factors = time (pre- and post-repeat sprint) and leg (dominant and nondominant), random factor = participants] design was fitted with the restricted maximal likelihood method. Repeat sprint running resulted in significant declines in eccentric, and concentric, knee flexor strength (eccentric = 26 ± 4 Nm, 15% P < 0.001; concentric 11 ± 2 Nm, 10% P < 0.001). Eccentric BF myoelectrical activity was significantly reduced (10%; P = 0.035). Concentric BF and all MH myoelectrical activity were not altered. The declines in maximal eccentric torque were associated with the change in eccentric BF myoelectrical activity (P = 0.013). Following repeat sprint running, there were preferential declines in the myoelectrical activity of the BF, which explained declines in eccentric knee flexor strength.

  4. Multiplanar Knee Laxity and Perceived Function During Activities of Daily Living and Sport

    PubMed Central

    Taylor, Jeffrey B.; Wang, Hsin-Min; Schmitz, Randy J.; Rhea, Christopher K.; Ross, Scott E.; Shultz, Sandra J.

    2015-01-01

    Context Greater knee-joint laxity may lead to a higher risk of knee injury, yet it is unknown whether results of self-reported outcome measures are associated with distinct knee-laxity profiles. Objective To identify the extent to which multiplanar knee laxity is associated with patient-reported outcomes of knee function in healthy individuals during activities of daily living and sport. Design Descriptive laboratory study. Setting University research laboratory. Patients or Other Participants Forty healthy individuals (20 men, 20 women; age = 18–31 years). Main Outcome Measure(s) All participants were given the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) and Sports Activities Scale (KOS-SAS) and subsequently measured for knee laxity in the sagittal, frontal, and transverse planes. Separate backward stepwise regression analyses were performed to determine the extent to which multiplanar knee-laxity values predicted KOS-ADL and KOS-SAS scores within each sex. Results Women had higher magnitudes of anterior, posterior (POSTLAX), varus (VARLAX), valgus (VALLAX), and internal-rotation laxity than men and trended toward greater external rotation (ERLAX) laxity. Greater POSTLAX, less VALLAX, and greater VARLAX was associated with lower KOS-ADL scores (KOS-ADL = −4.8 [POSTLAX], + 3.3 [VALLAX] − 2.2 [VARLAX] + 100.4, R2 = 0.74, P < .001) and greater POSTLAX and less VALLAX was associated with lower KOS-SAS scores (KOS-SAS = −8.2 [POSTLAX], + 3.6 [VALLAX] + 96.4, R2 = 0.67, P < .001) in women. In men, greater POSTLAX and less ERLAX was associated with lower KOS-SAS scores (KOS-ADL = −4.7 [POSTLAX], + 0.9 [ERLAX] + 96.4, R2 = 0.49, P < .001). Conclusions The combination of POSTLAX with less relative VALLAX (women) or less relative ERLAX (men) was a strong predictor of KOS scores, suggesting that a self-reported outcome measure may be beneficial as part of a preparticipation screening battery to identify those with perceived functional deficits

  5. Muscle activity response to external moment during single-leg drop landing in young basketball players: the importance of biceps femoris in reducing internal rotation of knee during landing.

    PubMed

    Fujii, Meguru; Sato, Haruhiko; Takahira, Naonobu

    2012-01-01

    Internal tibial rotation with the knee close to full extension combined with valgus collapse during drop landing generally results in non-contact anterior cruciate ligament (ACL) injury. The purpose of this study was to investigate the relationship between internal rotation of the knee and muscle activity from internal and external rotator muscles, and between the internal rotation of knee and externally applied loads on the knee during landing in collegiate basketball players. Our hypothesis was that the activity of biceps femoris muscle would be an important factor reducing internal knee rotation during landing. The subjects were 10 collegiate basketball students: 5 females and 5 males. The subjects performed a single-leg drop landing from a 25-cm height. Femoral and tibial kinematics were measured using a 3D optoelectronic tracking system during the drop landings, and then the knee angular motions were determined. Ground reaction forces and muscle activation patterns (lateral hamstring and medial hamstring) were simultaneously measured and computed. Results indicated that lower peak internal tibial rotation angle at the time of landing was associated with greater lateral hamstring activity (r = -0.623, p < 0.001). When gender was considered, the statistically significant correlation remained only in females. There was no association between the peak internal tibial rotation angle and the knee internal rotation moment. Control of muscle activity in the lateral to medial hamstring would be an important factor in generating sufficient force to inhibit excessive internal rotation during landing. Strengthening the biceps femoris might mitigate the higher incidence of non-contact ACL injury in female athletes. Key pointsLower activity of the external rotator muscle of the knee, which inhibits internal rotation of the knee, may be the reason why females tend to show a large internal rotation of the knee during drop landing.Externally applied internal rotation moment of

  6. Influence of advanced prosthetic knee joints on perceived performance and everyday life activity level of low-functional persons with a transfemoral amputation or knee disarticulation.

    PubMed

    Theeven, Patrick J; Hemmen, Bea; Geers, Richard P J; Smeets, Rob J E M; Brink, Peter R G; Seelen, Henk A M

    2012-05-01

    To assess the effects of two types of microprocessor-controlled prosthetic knee joints (MPKs) on perceived performance and everyday life activity level. Randomized cross-over trial. Thirty persons with a unilateral above-knee amputation or knee disarticulation classified as Medicare Functional Classification Level-2. Participants were measured in 3 conditions, i.e. using a mechanically controlled prosthesis, an MPK featuring a microprocessor-controlled stance and swing phase (MPKA), and an MPK featuring a microprocessor-controlled stance phase (MPKB). Subjects' perceived performance regarding prosthesis use was measured with the Prosthesis Evaluation Questionnaire. Subjects' activity level was quantified using accelerometry. As high within-group variability regarding subjects' functional performance was expected to impede detection of possible effects of an MPK, data were analysed for the total group and for 3 subgroups of participants. Participants' perception regarding ambulation, residual limb health, utility, and satisfaction with walking were significantly higher in the MPKA condition compared with the mechanical knee joint condition. Participants' activity level was similar in all knee joint conditions. Although Medicare Functional Classification Level-2 amputees report benefitting in terms of their performance from using an MPK, this is not reflected in their actual daily activity level after one week of using an MPK.

  7. Prevention and management of knee osteoarthritis and knee cartilage injury in sports.

    PubMed

    Takeda, Hideki; Nakagawa, Takumi; Nakamura, Kozo; Engebretsen, Lars

    2011-04-01

    Articular cartilage defects in the knee of young or active individuals remain a problem in orthopaedic practice. These defects have limited ability to heal and may progress to osteoarthritis. The prevalence of knee osteoarthritis among athletes is higher than in the non-athletic population. The clinical symptoms of osteoarthritis are joint pain, limitation of range of motion and joint stiffness. The diagnosis of osteoarthritis is confirmed by the symptoms and the radiological findings (narrowing joint space, osteophyte formation and subchondral sclerosis). There is no strong correlation between symptoms and radiographic findings. The aetiology of knee osteoarthritis is multifactorial. Excessive musculoskeletal loading (at work or in sports), high body mass index, previous knee injury, female gender and muscle weakness are well-known risk factors. The high-level athlete with a major knee injury has a high incidence of knee osteoarthritis. Cartilage injuries are frequently observed in young and middle-aged active athletes. Often this injury precedes osteoarthritis. Reducing risk factors can decrease the prevalence of knee osteoarthritis. The prevention of knee injury, especially anterior cruciate ligament and meniscus injury in sports, is important to avoid progression of knee osteoarthritis.

  8. Modelling knee flexion effects on joint power absorption and adduction moment.

    PubMed

    Nagano, Hanatsu; Tatsumi, Ichiroh; Sarashina, Eri; Sparrow, W A; Begg, Rezaul K

    2015-12-01

    Knee osteoarthritis is commonly associated with ageing and long-term walking. In this study the effects of flexing motions on knee kinetics during stance were simulated. Extended knees do not facilitate efficient loading. It was therefore, hypothesised that knee flexion would promote power absorption and negative work, while possibly reducing knee adduction moment. Three-dimensional (3D) position and ground reaction forces were collected from the right lower limb stance phase of one healthy young male subject. 3D position was sampled at 100 Hz using three Optotrak Certus (Northern Digital Inc.) motion analysis camera units, set up around an eight metre walkway. Force plates (AMTI) recorded ground reaction forces for inverse dynamics calculations. The Visual 3D (C-motion) 'Landmark' function was used to change knee joint positions to simulate three knee flexion angles during static standing. Effects of the flexion angles on joint kinetics during the stance phase were then modelled. The static modelling showed that each 2.7° increment in knee flexion angle produced 2.74°-2.76° increments in knee flexion during stance. Increased peak extension moment was 6.61 Nm per 2.7° of increased knee flexion. Knee flexion enhanced peak power absorption and negative work, while decreasing adduction moment. Excessive knee extension impairs quadriceps' power absorption and reduces eccentric muscle activity, potentially leading to knee osteoarthritis. A more flexed knee is accompanied by reduced adduction moment. Research is required to determine the optimum knee flexion to prevent further damage to knee-joint structures affected by osteoarthritis. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength.

    PubMed

    Peeler, Jason; Christian, Mathew; Cooper, Juliette; Leiter, Jeffrey; MacDonald, Peter

    2015-11-01

    To determine the effect of a 12-week lower body positive pressure (LBPP)-supported low-load treadmill walking program on knee joint pain, function, and thigh muscle strength in overweight patients with knee osteoarthritis (OA). Prospective, observational, repeated measures investigation. Community-based, multidisciplinary sports medicine clinic. Thirty-one patients aged between 55 and 75 years, with a body mass index ≥25 kg/m and mild-to-moderate knee OA. Twelve-week LBPP-supported low-load treadmill walking regimen. Acute knee joint pain (visual analog scale) during full weight bearing treadmill walking, chronic knee pain, and joint function [Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire] during normal activities of daily living, and thigh muscle strength (isokinetic testing). Appropriate methods of statistical analysis were used to compare data from baseline and follow-up evaluation. Participants reported significant improvements in knee joint pain and function and demonstrated significant increases in thigh muscle strength about the degenerative knee. Participants also experienced significant reductions in acute knee pain during full weight bearing treadmill walking and required dramatically less LBPP support to walk pain free on the treadmill. Data suggest that an LBPP-supported low-load exercise regimen can be used to significantly diminish knee pain, enhance joint function, and increase thigh muscle strength, while safely promoting pain-free walking exercise in overweight patients with knee OA. These findings have important implications for the development of nonoperative treatment strategies that can be used in the management of joint symptoms associated with progressive knee OA in at-risk patient populations. This research suggests that LBPP-supported low-load walking is a safe user-friendly mode of exercise that can be successfully used in the management of day-to-day joint symptoms associated with knee OA, helping to improve the

  10. Role of gastrocnemius activation in knee joint biomechanics: gastrocnemius acts as an ACL antagonist.

    PubMed

    Adouni, M; Shirazi-Adl, A; Marouane, H

    2016-01-01

    Gastrocnemius is a premier muscle crossing the knee, but its role in knee biomechanics and on the anterior cruciate ligament (ACL) remains less clear when compared to hamstrings and quadriceps. The effect of changes in gastrocnemius force at late stance when it peaks on the knee joint response and ACL force was initially investigated using a lower extremity musculoskeletal model driven by gait kinematics-kinetics. The tibiofemoral joint under isolated isometric contraction of gastrocnemius was subsequently analyzed at different force levels and flexion angles (0°-90°). Changes in gastrocnemius force at late stance markedly influenced hamstrings forces. Gastrocnemius acted as ACL antagonist by substantially increasing its force. Simulations under isolated contraction of gastrocnemius confirmed this role at all flexion angles, in particular, at extreme knee flexion angles (0° and 90°). Constraint on varus/valgus rotations substantially decreased this effect. Although hamstrings and gastrocnemius are both knee joint flexors, they play opposite roles in respectively protecting or loading ACL. Although the quadriceps is also recognized as antagonist of ACL, at larger joint flexion and in contrast to quadriceps, activity in gastrocnemius substantially increased ACL forces (anteromedial bundle). The fact that gastrocnemius is an antagonist of ACL should help in effective prevention and management of ACL injuries.

  11. Abdominal muscle activation changes if the purpose is to control pelvis motion or thorax motion.

    PubMed

    Vera-Garcia, Francisco J; Moreside, Janice M; McGill, Stuart M

    2011-12-01

    The aim of this study was to compare trunk muscular recruitment and lumbar spine kinematics when motion was constrained to either the thorax or the pelvis. Nine healthy women performed four upright standing planar movements (rotations, anterior-posterior translations, medial-lateral translations, and horizontal circles) while constraining pelvis motion and moving the thorax or moving the pelvis while minimizing thorax motion, and four isometric trunk exercises (conventional curl-up, reverse curl-up, cross curl-up, and reverse cross curl-up). Surface EMG (upper and lower rectus abdominis, lateral and medial aspects of external oblique, internal oblique, and latissimus dorsi) and 3D lumbar displacements were recorded. Pelvis movements produced higher EMG amplitudes of the oblique abdominals than thorax motions in most trials, and larger lumbar displacements in the medial-lateral translations and horizontal circles. Conversely, thorax movements produced larger rotational lumbar displacement than pelvis motions during rotations and higher EMG amplitudes for latissimus dorsi during rotations and anterior-posterior translations and for lower rectus abdominis during the crossed curl-ups. Thus, different neuromuscular compartments appear when the objective changes from pelvis to thorax motion. This would suggest that both movement patterns should be considered when planning spine stabilization programs, to optimize exercises for the movement and muscle activations desired. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. The influence of a powered knee-ankle-foot orthosis on walking in poliomyelitis subjects: A pilot study.

    PubMed

    Arazpour, Mokhtar; Moradi, Alireza; Samadian, Mohammad; Bahramizadeh, Mahmood; Joghtaei, Mahmoud; Ahmadi Bani, Monireh; Hutchins, Stephen W; Mardani, Mohammad A

    2016-06-01

    Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee-ankle-foot orthosis. A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine differences of the powered knee-ankle-foot orthosis compared to a locked knee-ankle-foot orthosis in kinematic data and temporospatial parameters during ambulation. Quasi-experimental design. Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee-ankle-foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system. Walking with the powered knee-ankle-foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee-ankle-foot orthosis. Cadence was not significantly different between the two test conditions (p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis. The new powered orthosis permitted improved knee joint kinematic for knee-ankle-foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee-ankle-foot orthosis. This orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities. © The International Society for Prosthetics and Orthotics 2015.

  13. Knee Instability and Basic and Advanced Function Decline in Persons with Knee Osteoarthritis

    PubMed Central

    Sharma, Leena; Chmiel, Joan S.; Almagor, Orit; Moisio, Kirsten; Chang, Alison H.; Belisle, Laura; Zhang, Yunhui; Hayes, Karen W.

    2015-01-01

    Objective Manifestations of instability in knee OA include low overall knee confidence, low confidence that the knees will not buckle, buckling, and excessive motion during gait. Confidence and buckling may particularly influence activity choices, contributing to events leading to disability. Buckling is more likely to affect advanced than basic functional tasks. In this prospective, longitudinal study, we tested the hypotheses: overall knee confidence, buckling confidence, buckling, and frontal plane motion during gait are associated with advanced 2-year function outcome in persons with knee OA. Methods Persons with knee OA were queried about overall knee confidence (higher worse), buckling confidence, and knee buckling, and underwent quantitative gait analysis to quantify varus-valgus excursion and angular velocity. Physical function was assessed using the LLFDI Basic and Advanced Lower Extremity Domain scores. Logistic regression was used to evaluate the relationship between baseline instability measures and baseline-to-2-year function outcome, adjusting for potential confounders. Results 212 persons (mean age 64.6 years, 76.9% women) comprised the sample. Buckling was significantly associated with poor advanced (adjusted OR 2.08, 95% CI: 1.03–4.20) but not basic function outcome. Overall knee confidence was significantly associated with advanced outcome (adjusted OR 1.65, 95% CI: 1.01–2.70), while associations between buckling confidence and both outcomes approached significance. Neither varus-valgus excursion nor angular velocity during gait was associated with either outcome. Conclusion Knee buckling and confidence were each associated with poor 2-year advanced function outcome. Current treatment does not address these modifiable factors; interventions to address them may improve outcome in knee OA. PMID:25732594

  14. Changes in voluntary quadriceps activation predict changes in muscle strength and gait biomechanics following knee joint effusion.

    PubMed

    Pietrosimone, Brian; Lepley, Adam S; Murray, Amanda M; Thomas, Abbey C; Bahhur, Nael O; Schwartz, Todd A

    2014-09-01

    It has been hypothesized that arthrogenic muscle inhibition is responsible for altering physical function following knee injury. The association between the onset of arthrogenic muscle inhibition, measured using voluntary quadriceps activation, and changes in muscle strength and gait biomechanics are unknown. Outcomes were collected before and following a 60 ml experimental knee effusion in eighteen healthy participants. Voluntary quadriceps activation was the predictor variable, while the criterion variable included, maximal voluntary isometric strength, peak knee flexion angle, peak internal knee extension moment, and peak vertical ground reaction forces during the first half of stance phase upon stair descent. Percent change scores (Δ) were imputed into linear regression equations to determine associations between predictor and criterion variables. The variance in Δ voluntary quadriceps activation significantly predicted 87% the variance in the Δ strength (R(2)=0.87, P<0.001; Δ strength=-2.15+1.77Δ voluntary quadriceps activation) and 25% of the Δ vertical ground reaction force following effusion (R(2)=0.25, P=0.04; Δ vertical ground reaction force=-6.1+0.57 Δ voluntary quadriceps activation). After accounting for Δ knee flexion angle, Δ voluntary quadriceps activation predicted an additional 29% (Δ R(2)=0.29, P=0.007) of the variance in the Δ knee extension moment (R(2)=0.54, P=0.003, Δ knee extension moment=-10.79+0.74Δ knee flexion angle+1.64Δ voluntary quadriceps activation) following knee effusion. Immediate quadriceps activation deficits following joint effusion result in immediate alterations in muscle strength, knee extensor moment and vertical ground reaction force during gait. Published by Elsevier Ltd.

  15. Validation of the French version of two on high-activity knee questionnaires.

    PubMed

    Diesinger, Y; Jenny, J-Y

    2014-09-01

    Self-administered quality-of-life questionnaires are valuable evaluation tools in orthopedic surgery. The conventional questionnaires are limited by a substantial ceiling effect. We wished to validate a French translation of two English questionnaires for high-activity patients: the High-Activity Arthroplasty Score (HAAS) and the Activity Scale for Arthroplasty Patients (ASAP). One hundred patients operated on for knee replacement were selected. The answers to both questionnaires were analyzed and compared to the Oxford Knee Score (OKS) and to the scoring system of the American Knee Society (AKS). There is no correlation between the results of both high-activity questionnaires and of the two conventional scoring systems. All questions were easily understood. The mean scores of the HAAS and ASAP questionnaires were 8.2±3.0 and 30.7±9.6, respectively. The distributions were not considered normal. There was no floor effect, but there was a limited ceiling effect (0% and 14%, respectively). The internal coherence of both questionnaires was satisfactory. There was a significant correlation between the high-activity scores and the conventional scores. Both high-activity questionnaires in our French translation can potentially measure the overall function of a patient after knee replacement as accurately as the index English version. It is self-administered, easy to use, can collect patients' answers by postage mailing, and involves no ceiling effect. All these points should allow its routine use for evaluation after knee replacement. The HAAS evaluation seems to be superior to the ASAP evaluation. Case-control study, level III. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players.

    PubMed

    Markovic, Goran

    2015-10-01

    The aim of the present investigation was to evaluate the acute effects of foam rolling (FR) and a new form of instrument-assisted soft tissue mobilization (IASTM), Fascial Abrasion Technique ™ (FAT) on hip and knee range of motion in soccer players. Twenty male soccer players randomly allocated into FR and FAT group (n = 10 each). Passive knee flexion and straight leg raise tests were measured before, immediately after and 24 h after intervention (FR or FAT). The FR group applied a 2-min quadriceps and hamstrings rolling, while FAT group received a 2-min application of FAT to the quadriceps and hamstrings muscles. Both groups significantly improved knee and hip ROM (p < 0.05), with higher gains observed in FAT group (10-19% vs. 5-9%). At 24 h post-treatment, only FAT group preserved most of the gains in ROM (7-13%; p < 0.05). These results support the use of the newly developed IASMT, Fascial Abrasion Technique ™ and FR for increasing lower extremity ROM of athletes.

  17. Differences between actual and expected leisure activities after total knee arthroplasty for osteoarthritis.

    PubMed

    Jones, Dina L; Bhanegaonkar, Abhijeet J; Billings, Anthony A; Kriska, Andrea M; Irrgang, James J; Crossett, Lawrence S; Kwoh, C Kent

    2012-08-01

    This prospective cohort study determined the type, frequency, intensity, and duration of actual vs expected leisure activity among a cohort undergoing total knee arthroplasty. Data on actual and expected participation in 36 leisure activities were collected preoperatively and at 12 months in 90 patients with knee osteoarthritis. Despite high expectations, there were statistically and clinically significant differences between actual and expected activity at 12 months suggesting that expectations may not have been fulfilled. The differences were equivalent to walking 14 less miles per week than expected, which is more than the amount of activity recommended in national physical activity guidelines. Perhaps an educational intervention could be implemented to help patients establish appropriate and realistic leisure activity expectations before surgery.

  18. Image-based compensation for involuntary motion in weight-bearing C-arm cone-beam CT scanning of knees

    NASA Astrophysics Data System (ADS)

    Unberath, Mathias; Choi, Jang-Hwan; Berger, Martin; Maier, Andreas; Fahrig, Rebecca

    2015-03-01

    We previously introduced four fiducial marker-based strategies to compensate for involuntary knee-joint motion during weight-bearing C-arm CT scanning of the lower body. 2D methods showed significant reduction of motion- related artifacts, but 3D methods worked best. However, previous methods led to increased examination times and patient discomfort caused by the marker attachment process. Moreover, sub-optimal marker placement may lead to decreased marker detectability and therefore unstable motion estimates. In order to reduce overall patient discomfort, we developed a new image-based 2D projection shifting method. A C-arm cone-beam CT system was used to acquire projection images of five healthy volunteers at various flexion angles. Projection matrices for the horizontal scanning trajectory were calibrated using the Siemens standard PDS-2 phantom. The initial reconstruction was forward projected using maximum-intensity projections (MIP), yielding an estimate of a static scan. This estimate was then used to obtain the 2D projection shifts via registration. For the scan with the most motion, the proposed method reproduced the marker-based results with a mean error of 2.90 mm +/- 1.43 mm (compared to a mean error of 4.10 mm +/- 3.03 mm in the uncorrected case). Bone contour surrounding modeling clay layer was improved. The proposed method is a first step towards automatic image-based, marker-free motion-compensation.

  19. A pilot study of the effect of Kinesiology tape on knee proprioception after physical activity in healthy women.

    PubMed

    Hosp, Simona; Bottoni, Giuliamarta; Heinrich, Dieter; Kofler, Philipp; Hasler, Michael; Nachbauer, Werner

    2015-11-01

    Kinesiology tape has gained significant popularity in recent years and is widely used as an adjunct for treatment and prevention of musculoskeletal injuries. However, evidence regarding its influence on knee proprioception is scarce. The purpose of this study was to evaluate the effect of Kinesiology tape on knee proprioception after physical activity in healthy women. It was hypothesized that Kinesiology tape enhances knee proprioception. Longitudinal analysis, pretest-posttest design. Twelve young women with healthy knees were tested for knee proprioception without the use of Kinesiology tape and wearing Kinesiology tape at the knee. The joint position sense was measured at the start and after a 30-min uphill walking protocol on a treadmill. Outcome was the knee angle deviation. No significant difference of proprioceptive performance between the application with Kinesiology tape and without Kinesiology tape was found after uphill walking (p > 0.05). However, when the participants' results for knee angle deviation were graded into good (< 6.1°) and poor ( > 6.1°), Kinesiology tape significantly enhanced those with poor proprioceptive ability after uphill walking, compared to the untaped knee (p = 0.002). This study has shown that the application of Kinesiology tape did not improve knee proprioception in a group of healthy young women. However, it also has demonstrated that Kinesiology tape provided significant proprioceptive enhancement at the knee joint after uphill walking in healthy women with poor proprioceptive ability. This may support its use in sports medicine for preventing knee injuries. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  20. Why Patients Do Not Participate in Sports Activities After Total Knee Arthroplasty

    PubMed Central

    Chang, Moon Jong; Kang, Yeon Gwi; Chung, Byung June; Chang, Chong Bum; Kim, Tae Kyun

    2015-01-01

    Background It is important to identify the reasons or factors preventing patients from participating in sports activities after total knee arthroplasty (TKA) to improve patient satisfaction and general health that can be gained from regular sports activities. Purpose To determine the reasons for lack of participation in regular sports activities after TKA as perceived by patients and to identify specific factors involved. Study Design Case series; Level of evidence, 4. Methods A total of 369 patients with a follow-up longer than 1 year after TKA were included in this retrospective study. A postal survey regarding sports activities was conducted using a questionnaire gathering information such as sociodemographic data, activity levels, and sports activities after TKA. The reasons perceived by patients for not participating in sports activities were determined. Patients unable to participate in sports activities were compared with patients able to do so in terms of sociodemographic data and pre- and postoperative outcomes. Results Of the 369 patients, 88 (24%) replied that they could not participate in a sports activity. Among the perceived reasons, reasons not related to the replaced knee were more frequent than those related to the replaced knee (76% vs 24%). Symptoms related to the spine or other joints composed 25% of the total perceived reasons. The presence of medical comorbidities accounted for 16%, while symptoms in the nonreplaced knee represented 8% of the reasons. In terms of patient factors, multivariate logistic regression revealed that male sex, a floor-based (ie, non-Western) lifestyle with greater demands on knee flexion, and worse postoperative University of California at Los Angeles activity scale were associated with nonregular sports activity levels. Conclusion The perceived reasons and patient factors hindering regular sports activities after TKA were not restricted to problems with the replaced knee. Nonetheless, orthopaedic surgeons may have a

  1. Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function.

    PubMed

    Tengman, E; Brax Olofsson, L; Nilsson, K G; Tegner, Y; Lundgren, L; Häger, C K

    2014-12-01

    Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23 ± 2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR ), and 37 treated with physiotherapy alone (ACLPT ). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P < 0.001), while IPAQ score was similar. ACL-injured demonstrated inferior jump capacity in injured compared with noninjured leg (6-25%, P < 0.001-P = 0.010 in the different jumps), while noninjured leg had equal jump capacity as controls. ACL groups scored 33 ± 7 and 32 ± 7 of 68 on TSK. Lower scores on Lysholm and KOOS symptom were seen for persons with moderate-to-high OA than for no-or-low OA, while there were no differences for physical activity and jump capacity. Regardless of treatment, there are still negative knee-related effects of ACL injury more than 20 years later.

  2. Mediolateral force distribution at the knee joint shifts across activities and is driven by tibiofemoral alignment.

    PubMed

    Kutzner, I; Bender, A; Dymke, J; Duda, G; von Roth, P; Bergmann, G

    2017-06-01

    Tibiofemoral alignment is important to determine the rate of progression of osteoarthritis and implant survival after total knee arthroplasty (TKA). Normally, surgeons aim for neutral tibiofemoral alignment following TKA, but this has been questioned in recent years. The aim of this study was to evaluate whether varus or valgus alignment indeed leads to increased medial or lateral tibiofemoral forces during static and dynamic weight-bearing activities. Tibiofemoral contact forces and moments were measured in nine patients with instrumented knee implants. Medial force ratios were analysed during nine daily activities, including activities with single-limb support (e.g. walking) and double-limb support (e.g. knee bend). Hip-knee-ankle angles in the frontal plane were analysed using full-leg coronal radiographs. The medial force ratio strongly correlated with the tibiofemoral alignment in the static condition of one-legged stance (R² = 0.88) and dynamic single-limb loading (R² = 0.59) with varus malalignment leading to increased medial force ratios of up to 88%. In contrast, the correlation between leg alignment and magnitude of medial compartment force was much less pronounced. A lateral shift of force occurred during activities with double-limb support and higher knee flexion angles. The medial force ratio depends on both the tibiofemoral alignment and the nature of the activity involved. It cannot be generalised to a single value. Higher medial ratios during single-limb loading are associated with varus malalignment in TKA. The current trend towards a 'constitutional varus' after joint replacement, in terms of overall tibiofemoral alignment, should be considered carefully with respect to the increased medial force ratio. Cite this article: Bone Joint J 2017;99-B:779-87. ©2017 The British Editorial Society of Bone & Joint Surgery.

  3. Physical Function and Physical Activity in Obese Adults After Total Knee Arthroplasty.

    PubMed

    Smith, Webb A; Zucker-Levin, Audrey; Mihalko, William M; Williams, Michael; Loftin, Mark; Gurney, James G

    2017-04-01

    Obese patients are more likely to have osteoarthritis and total knee arthroplasty (TKA). This investigation sought to evaluate physical function, activity level, and quality of life (QOL). Obese participants near 1-year postsurgical follow-up appointment were recruited. Evaluation included QOL and activity questionnaire, medical histories, anthropometrics, strength, and aerobic capacity. Sixty participants completed assessments. Obese TKA patients have physical performance limitations and low physical activity levels 1 year after surgery and completion of postoperative rehabilitation.

  4. Effects of Therapeutic Exercise and Hydrotherapy on Pain Severity and Knee Range of Motion in Patients with Hemophilia: A Randomized Controlled Trial

    PubMed Central

    Mazloum, Vahid; Rahnama, Nader; Khayambashi, Khalil

    2014-01-01

    Background: Pain and limited range of motion (ROM) are the crucial subsequent results of joint hemorrhages in individuals with bleeding disorders and hemophilia. Exercise interventions are particularly recommended in treatment of such patients. The purpose of this study was to detect the influences of conventional exercise therapy and hydrotherapy on the knee joint complications in patients with hemophilia. Methods: A total of 40 patients engaging hemophilia A were randomized into one of three groups: Therapeutic exercise (N = 13), hydrotherapy (N = 14) or control (N = 13). While the first two groups followed their specific programs for 4 weeks, routine life-style was maintained by subjects in the control group in this period. To evaluate the pain level and knee ROM the visual analog scale and standard goniometer were utilized, respectively. The outcome was measured at baseline and after completing the prescribed protocols. Data analysis was performed using one-way analysis of variance and Scheffe statistical tests (P < 0.05). Results: Both experimental groups experienced more significant decreasing in pain level (P < 0.001) and knee flexion and extension ROM (P < 0.001) in comparison to the control group. Although the pain was significantly (P < 0.01) more alleviated in participants treated through hydrotherapy in comparison to exercise therapy, the difference in ROM improvement was not statistically significant (P > 0.05). Conclusions: Using hydrotherapy in addition to usual rehabilitation training can result in beneficial effect in terms of pain and knee joint ROM. However, it appears that hydrotherapy is more effective in reducing pain. PMID:24554996

  5. Prevalence of Knee Osteoarthritis in 100 Athletically Active Veteran Soccer Players Compared With a Matched Group of 100 Military Personnel.

    PubMed

    Paxinos, Odysseas; Karavasili, Alexandra; Delimpasis, Georgios; Stathi, Afroditi

    2016-06-01

    Although knee injuries in professional soccer (football) have been extensively studied, the prevalence of knee osteoarthritis (OA) in veteran players is not well documented. To investigate the prevalence of knee OA in retired professional soccer players in comparison with a group of athletically active military personnel. Cross-sectional study; Level of evidence, 3. A group of 100 veteran Greek soccer players aged 35 to 55 years (mean [±SD] age, 46.90 ± 5.9 years) were examined for knee OA and were administered the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A matched group of 100 athletically active military personnel served as a comparison group. The sonographic prevalence of OA was significantly higher in the veteran soccer group (52%) than in the military group (33%) (n = 200; P = .010). This difference remained significant even after excluding participants with a history of knee surgery (44.1% vs 25.3%, respectively) (n = 151; P = .010). Femoral cartilage thickness was similar between the 2 groups (P = .473), while altered knee alignment had no effect on the prevalence of OA (P = .740). With the exception of perceived pain being more prevalent in the military group, there were no other statistically significant differences between the 2 groups in KOOS values. Veteran soccer players had a higher sonographic prevalence of knee OA but better pain scores than a matched group of athletically active military personnel. © 2016 The Author(s).

  6. Effect of continuing repeated passive and active exercises on knee's position senses in patients with hemiplegia.

    PubMed

    Kwon, Oh Sung; Lee, Seung Won

    2013-01-01

    To determine the repeated passive movement (RPM) and repeated active movement (RAM) exercise on position sense of the knee joint in patients with hemiplegia. 45 hemiplegia patients were randomly allocated to either the control group(no exercise), RPM group, or RAM group, with 15 subjects in each group. The exercise was repeated 60 times on the angle 10 to 100 degrees of the knee joint with an angle speed of 120°/s, with three sets for 15 minutes. Evaluation was performed using Passive Angle Repositioning (PAR) and Active Angle Repositioning (AAR). Error of positioning sense showed a decrease in PAR and AAR in the RPM group (p < 0.01) and an increase in AAR was observed in the RAM group (p < 0.05). In comparison of knee joint position sense error value and rate of change among the three groups, the RPM group is decreased mostly in PAR and AAR (p < 0.01), and Error value (p < 0.05) and rate of change (p < 0.01) of the RAM group showed a greater increase in AAR than the control group. RAM exercise can support an increase in proprioception on the knee joint of hemiplegia; however, RAM exercise that causes fatigue can decrease proprioception.

  7. Dynamic Contact Mechanics on the Tibial Plateau of the Human Knee During Activities of Daily Living

    PubMed Central

    Gilbert, Susannah; Chen, Tony; Hutchinson, Ian D.; Choi, Dan; Voigt, Clifford; Warren, Russell F.; Maher, Suzanne A.

    2013-01-01

    Despite significant advances in scaffold design, manufacture, and development, it remains unclear what forces these scaffolds must withstand when implanted into the heavily loaded environment of the knee joint. The objective of this study was to fully quantify the dynamic contact mechanics across the tibial plateau of the human knee joint during gait and stair climbing. Our model consisted of a modified Stanmore knee simulator (to apply multi-directional dynamic forces), a two-camera motion capture system (to record joint kinematics), an electronic sensor (to record contact stresses on the tibial plateau), and a suite of post-processing algorithms. During gait, peak contact stresses on the medial plateau occurred in areas of cartilage-cartilage contact; while during stair climb, peak contact stresses were located in the posterior aspect of the plateau, under the meniscus. On the lateral plateau, during gait and in early stair-climb, peak contact stresses occurred under the meniscus, while in late stair-climb, peak contact stresses were experienced in the zone of cartilage-cartilage contact. At 45% of the gait cycle, and 20% and 48% of the stair-climb cycle, peak stresses were simultaneously experienced on both the medial and lateral compartment, suggesting that these phases of loading warrant particular consideration in any simulation intended to evaluate scaffold performance. Our study suggests that in order to design a scaffold capable of restoring ‘normal’ contact mechanics to the injured knees, the mechanics of the intended site of implantation should be taken into account in any pre-clinical testing regime. PMID:24296275

  8. Runner's Knee

    MedlinePlus

    ... Surgery? A Week of Healthy Breakfasts Shyness Runner's Knee KidsHealth > For Teens > Runner's Knee A A A ... told he had runner's knee. What Is Runner's Knee? Runner's knee is the term doctors use for ...

  9. TSG-6 Activity as a Novel Biomarker of Progression in Knee Osteoarthritis

    PubMed Central

    Wisniewski, Hans-Georg; Colón, Elisa; Liublinska, Viktoriia; Karia, Raj J.; Stabler, Thomas V.; Attur, Mukundan; Abramson, Steven B.; Band, Philip A.; Kraus, Virginia B.

    2014-01-01

    Objective To establish whether there is an association between TSG-6 activity and osteoarthritis (OA) progression. Design TSG-6 activity was determined in 132 synovial fluids from patients with OA of the knee, using a novel quantitative TSG-6 activity assay. The association between TSG-6 activities at baseline and four distinct disease progression states, determined at three-year follow-up, was analyzed using logistic regression. Results There was a statistically significant relationship between TSG-6 activity at baseline and all OA progression states over a three-year period. Patient knees with TSG-6 activities in the top 10th percentile, compared to the median activity, had an odds ratio (OR) of at least 7.86 (confidence interval (CI) [3.2, 20.5]) for total knee arthroplasty (TKA) within three years, and of at least 5.20 (CI [1.8, 13.9]) after adjustment for confounding factors. Receiver operating characteristic (ROC) analysis for knee arthroplasty yielded a cut-off point of 13.3 TSG-6 activity units/ml with the following parameters: area under the curve 0.90 (CI [0.804, 0.996]), sensitivity 0.91 (CI [0.59, 0.99]), specificity 0.82 (CI [0.74, 0.88]) and a negative predictive value (NPV) of 0.99 (CI [0.934, 0.994]). Conclusion The TSG-6 activity is a promising independent biomarker for OA progression. Given the high NPV, this assay may be particularly suitable for identifying patients at low risk of rapid disease progression and to assist in the timing of arthroplasty. PMID:24333293

  10. Does Total Knee Arthroplasty Affect Physical Activity Levels? Data from the Osteoarthritis Initiative.

    PubMed

    Kahn, Timothy L; Schwarzkopf, Ran

    2015-09-01

    Total knee arthroplasty (TKA) is associated with improved patient-reported pain levels, function, and quality of life; however, it is poorly understood whether there is increased physical activity following TKA. Using data from the Osteoarthritis Initiative (OAI), we compare physical activity, as measured using an accelerometer, and patient-reported outcome measures of 60 patients who had already received a TKA with 63 patients who eventually received a TKA during the OAI study. There was no significant difference in activity levels between the two groups as measured by the accelerometer. Total WOMAC, KOOS Quality of Life, KOOS Knee Pain, and KOOS Function scores improved in the post-TKA compared to the pre-TKA group. In both pre-TKA and post-TKA groups, physical activity guidelines were met in only 5% or less. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Knee rotation associated with dynamic knee valgus and toe direction.

    PubMed

    Ishida, Tomoya; Yamanaka, Masanori; Takeda, Naoki; Aoki, Yoshimitsu

    2014-03-01

    Dynamic knee valgus contributes to injuries of the anterior cruciate ligament (ACL). However, it is unclear how the knee rotates during dynamic knee valgus. Knee rotation significantly affects ACL strain. To understand knee rotation during dynamic knee valgus should help the clinician evaluate dynamic alignment. The purpose of this study was to determine how the knee rotates during dynamic knee valgus and whether the knee rotation is affected by toe direction (foot rotation). Sixteen females performed dynamic knee valgus in three toe directions (neutral, toe-out, and toe-in) while maintaining the knee flexion angle at 30°. The knee rotation angle was evaluated using a 7-camera motion analysis system. Knee rotation was compared between the start position and the dynamic knee valgus position, as well as among the three toe directions, using repeated measures ANOVA models. The knee significantly rotated externally in the dynamic knee valgus position compared with the start position in two toe directions (neutral and toe-out). A similar tendency was observed with the toe-in condition. Toe direction significantly affected the knee rotation angle. For toe-out and toe-in conditions, external and internal shifts of knee rotation compared with neutral were observed. The knee rotates externally during dynamic knee valgus, and the knee rotation is affected by toe direction. Because of knee abduction and external rotation, the ACL may impinge on the femoral condyle in the case of dynamic valgus, especially in the toe-out position. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Assessment of Knee Cartilage Stress Distribution and Deformation Using Motion Capture System and Wearable Sensors for Force Ratio Detection.

    PubMed

    Mijailovic, N; Vulovic, R; Milankovic, I; Radakovic, R; Filipovic, N; Peulic, A

    2015-01-01

    Knowledge about the knee cartilage deformation ratio as well as the knee cartilage stress distribution is of particular importance in clinical studies due to the fact that these represent some of the basic indicators of cartilage state and that they also provide information about joint cartilage wear so medical doctors can predict when it is necessary to perform surgery on a patient. In this research, we apply various kinds of sensors such as a system of infrared cameras and reflective markers, three-axis accelerometer, and force plate. The fluorescent marker and accelerometers are placed on the patient's hip, knee, and ankle, respectively. During a normal walk we are recording the space position of markers, acceleration, and ground reaction force by force plate. Measured data are included in the biomechanical model of the knee joint. Geometry for this model is defined from CT images. This model includes the impact of ground reaction forces, contact force between femur and tibia, patient body weight, ligaments, and muscle forces. The boundary conditions are created for the finite element method in order to noninvasively determine the cartilage stress distribution.

  13. Effects of active fatiguing movement versus passive repetitive movement on knee proprioception.

    PubMed

    Ju, Yan-Ying; Wang, Chia-Wei; Cheng, Hsin-Yi Kathy

    2010-08-01

    Proprioception can be affected by many factors such as age, gender, injury, disease, exercise, and fatigue. To date, the mechanisms or pathways by which fatigue influences proprioception have not been elucidated. Generally, it is accepted that local muscular effects occurred during fatigue state may negatively affect proprioception. Research has indicated that metabolic acidosis resulting from active muscle activities, along with tissue stretching and joint laxity resulting from repetitive joint movements, are likely related to proprioceptive deterioration. So far, little direct evidence or research supports these statements. The purpose of this study was to examine the effects of fatigue exercises (repetitive active movement) and repetitive passive movements on knee proprioception. A quasi-experimental design with repeated measure on proprioception following two forms of knee joint movement (repetitive active/passive movement in 120 degrees /s with 60 repetitions over a 10 degrees -100 degrees range) was conducted. Fifteen healthy volunteers underwent two forms of movement intervention in two consecutive days in a counter-balanced manner. Knee joint repositioning errors were measured before and after the movement intervention. Study results showed a statistically significant increase in absolute repositioning error following repetitive active movement, but a decrease following repetitive passive movement intervention. This study concluded that a repetitive passive movement protocol was capable of improving knee joint position sense. Meanwhile, the negative effect from the muscle receptors following the repetitive active movement overwhelmed the positive effect from the repetitive passive movement intervention. It supports the clinical utilization of repetitive passive movement to promote proprioception. This utilization can be implemented for proprioceptive training in sports activities, plus injury prevention and rehabilitation. Copyright (c) 2010 Elsevier Ltd

  14. Knee and Hip Joint Kinematics Predict Quadriceps and Hamstrings Neuromuscular Activation Patterns in Drop Jump Landings

    PubMed Central

    Malfait, Bart; Dingenen, Bart; Smeets, Annemie; Staes, Filip; Pataky, Todd; Robinson, Mark A.; Vanrenterghem, Jos; Verschueren, Sabine

    2016-01-01

    Purpose The purpose was to assess if variation in sagittal plane landing kinematics is associated with variation in neuromuscular activation patterns of the quadriceps-hamstrings muscle groups during drop vertical jumps (DVJ). Methods Fifty female athletes performed three DVJ. The relationship between peak knee and hip flexion angles and the amplitude of four EMG vectors was investigated with trajectory-level canonical correlation analyses over the entire time period of the landing phase. EMG vectors consisted of the {vastus medialis(VM),vastus lateralis(VL)}, {vastus medialis(VM),hamstring medialis(HM)}, {hamstring medialis(HM),hamstring lateralis(HL)} and the {vastus lateralis(VL),hamstring lateralis(HL)}. To estimate the contribution of each individual muscle, linear regressions were also conducted using one-dimensional statistical parametric mapping. Results The peak knee flexion angle was significantly positively associated with the amplitudes of the {VM,HM} and {HM,HL} during the preparatory and initial contact phase and with the {VL,HL} vector during the peak loading phase (p<0.05). Small peak knee flexion angles were significantly associated with higher HM amplitudes during the preparatory and initial contact phase (p<0.001). The amplitudes of the {VM,VL} and {VL,HL} were significantly positively associated with the peak hip flexion angle during the peak loading phase (p<0.05). Small peak hip flexion angles were significantly associated with higher VL amplitudes during the peak loading phase (p = 0.001). Higher external knee abduction and flexion moments were found in participants landing with less flexed knee and hip joints (p<0.001). Conclusion This study demonstrated clear associations between neuromuscular activation patterns and landing kinematics in the sagittal plane during specific parts of the landing. These findings have indicated that an erect landing pattern, characterized by less hip and knee flexion, was significantly associated with an

  15. Knee Dislocations

    PubMed Central

    Schenck, Robert C.; Richter, Dustin L.; Wascher, Daniel C.

    2014-01-01

    Background: Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking. Purpose: To present 2 cases with minimum 20-year follow-up and a review of the literature to illustrate some of the fundamental principles in the management of the dislocated knee. Study Design: Review and case reports. Methods: Two patients with knee dislocations who underwent multiligamentous knee reconstruction were reviewed, with a minimum 20-year follow-up. These patients were brought back for a clinical evaluation using both subjective and objective measures. Subjective measures include the following scales: Lysholm, Tegner activity, visual analog scale (VAS), Short Form–36 (SF-36), International Knee Documentation Committee (IKDC), and a psychosocial questionnaire. Objective measures included ligamentous examination, radiographic evaluation (including Telos stress radiographs), and physical therapy assessment of function and stability. Results: The mean follow-up was 22 years. One patient had a vascular injury requiring repair prior to ligament reconstruction. The average assessment scores were as follows: SF-36 physical health, 52; SF-36 mental health, 59; Lysholm, 92; IKDC, 86.5; VAS involved, 10.5 mm; and VAS uninvolved, 2.5 mm. Both patients had excellent stability and were functioning at high levels of activity for their age (eg, hiking, skydiving). Both patients had radiographic signs of arthritis, which lowered 1 subject’s IKDC score to “C.” Conclusion: Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results. By following fundamental principles in the management of a dislocated knee, patients can be given the opportunity to function at high levels. Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the

  16. Simulation of the active Brownian motion of a microswimmer

    NASA Astrophysics Data System (ADS)

    Volpe, Giorgio; Gigan, Sylvain; Volpe, Giovanni

    2014-07-01

    Unlike passive Brownian particles, active Brownian particles, also known as microswimmers, propel themselves with directed motion and thus drive themselves out of equilibrium. Understanding their motion can provide insight into out-of-equilibrium phenomena associated with biological examples such as bacteria, as well as with artificial microswimmers. We discuss how to mathematically model their motion using a set of stochastic differential equations and how to numerically simulate it using the corresponding set of finite difference equations both in homogenous and complex environments. In particular, we show how active Brownian particles do not follow the Maxwell-Boltzmann distribution—a clear signature of their out-of-equilibrium nature—and how, unlike passive Brownian particles, microswimmers can be funneled, trapped, and sorted.

  17. Effect of different postoperative limb positions on blood loss and range of motion in total knee arthroplasty: An updated meta-analysis of randomized controlled trials.

    PubMed

    Wu, Yuangang; Yang, Timin; Zeng, Yi; Si, Haibo; Li, Canfeng; Shen, Bin

    2017-01-01

    Postoperative limb positioning has been reported to be an efficient and simple way to reduce blood loss and improve range of motion following total knee arthroplasty (TKA). This meta-analysis was designed to compare the effectiveness of two different limb positions in primary TKA. A meta-analysis of the PubMed, CENTRAL, Web of Science, EMBASE and Google Search Engine electronic databases was performed. In this meta-analysis, two postoperative limb positions were considered: mild-flexion (flexion less than 60°) and high-flexion (flexion at 60° or more). The subgroups were analysed using RevMan 5.3. Nine RCTs were included with a total sample size of 913 patients. The mild- and high-flexion positions significantly reduced postoperative total blood loss (P = 0.04 and P = 0.01; respectively). Subgroup analysis indicated that knee flexion significantly reduced hidden blood loss when the knee was fixed in mild-flexion (P = 0.0004) and significantly reduced transfusion requirements (P = 0.03) and improved range of motion (ROM) (P < 0.00001) when the knee was fixed in high-flexion. However, the rates of wound-related infection, deep venous thrombosis (DVT) and pulmonary embolism (PE) did not significantly differ between the two flexion groups. This meta-analysis suggests that mild- and high-flexion positions have similar efficacy in reducing total blood loss. In addition, subgroup analysis indicates that the mild-flexion position is superior in decreasing hidden blood loss compared with high-flexion; the high-flexion position is superior to mild-flexion in reducing transfusion requirements and improving postoperative ROM. Thus, the use of the high-flexion position is a viable option to reduce blood loss in patients following primary TKA without increasing the risk of wound-related infection, DVT or PE. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Knee Conditioning Program

    MedlinePlus

    ... muscles help your knee joint absorb shock. Flexibility: Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Gently stretching after strengthening exercises can help reduce muscle soreness ...

  19. Image based weighted center of proximity versus directly measured knee contact location during simulated gait

    PubMed Central

    Wang, Hongsheng; Chen, Tony; Koff, Matthew F.; Hutchinson, Ian D.; Gilbert, Susannah; Choi, Dan; Warren, Russell F.; Rodeo, Scott A.; Maher, Suzanne A.

    2014-01-01

    To understand the mechanical consequences of knee injury requires a detailed analysis of the effect of that injury on joint contact mechanics during activities of daily living. Three-dimensional (3D) knee joint geometric models have been combined with knee joint kinematics to dynamically estimate the location of joint contact during physiological activities – using a weighted center of proximity (WCoP) method. However, the relationship between the estimated WCoP and the actual location of contact has not been defined. The objective of this study was to assess the relationship between knee joint contact location as estimated using the image-based WCoP method, and a directly measured weighted center of contact (WCoC) method during simulated walking. To achieve this goal, we created knee specific models of six human cadaveric knees from magnetic resonance imaging. All knees were then subjected to physiological loads on a knee simulator intended to mimic gait. Knee joint motion was captured using a motion capture system. Knee joint contact stresses were synchronously recorded using a thin electronic sensor throughout gait, and used to compute WCoC for the medial and lateral plateaus of each knee. WCoP was calculated by combining knee kinematics with the MRI-based knee specific model. Both metrics were compared throughout gait using linear regression. The anteroposterior (AP) location of WCoP was significantly correlated with that of WCoC on both tibial plateaus in all specimens (P < 0.01, 95% confidence interval of Person’s coefficient r > 0), but the correlation was not significant in the mediolateral (ML) direction for 4/6 knees (P > 0.05). Our study demonstrates that while the location of joint contact obtained from 3D knee joint contact model, using the WCoP method, is significantly correlated with the location of actual contact stresses in the AP direction, that relationship is less certain in the ML direction. PMID:24837219

  20. Muscle motion and EMG activity in vibration treatment.

    PubMed

    Fratini, Antonio; La Gatta, Antonio; Bifulco, Paolo; Romano, Maria; Cesarelli, Mario

    2009-11-01

    The aim of this study is to highlight the relationship between muscle motion, generated by whole body vibration, and the correspondent electromyographic (EMG) activity and to suggest a new method to customize the stimulation frequency. Simultaneous recordings of EMG and tri-axial accelerations of quadriceps rectus femoris from fifteen subjects undergoing vibration treatments were collected. Vibrations were delivered via a sinusoidal oscillating platform at different frequencies (10-45 Hz). Muscle motion was estimated by processing the accelerometer data. Large EMG motion artifacts were removed using sharp notch filters centred at the vibration frequency and its superior harmonics. EMG-RMS values were computed and analyzed before and after artifact suppression to assess muscular activity. Muscles acceleration amplitude increased with frequency. Muscle displacements revealed a mechanical resonant-like behaviour of the muscle. Resonance frequencies and dumping factors depended on subject. Moreover, RMS of artifact-free EMG was found well correlated (R(2)=0.82) to the actual muscle displacement, while the maximum of the EMG response was found related to the mechanical resonance frequency of muscle. Results showed that maximum muscular activity was found in correspondence to the mechanical resonance of the muscle itself. Assuming the hypothesis that muscle activation is proportional to muscle displacement, treatment optimization (i.e. to choose the best stimulation frequency) could be obtained by simply monitoring local acceleration (resonance), leading to a more effective muscle stimulation. Motion artifact produced an overestimation of muscle activity, therefore its removal was essential.

  1. Breast size impacts spine motion and postural muscle activation.

    PubMed

    Schinkel-Ivy, Alison; Drake, Janessa D M

    2016-11-21

    While it is generally accepted that large breast sizes in females contribute to back pain and poor posture, the effects of breast size on spinal motion and muscle activation characteristics are poorly understood. This study examined the relationship between breast size, spine motion, and trunk muscle activation. Fifteen university-aged females, free of back pain symptoms, were tested. Breast sizes were calculated, and three-dimensional spine motion and activation from five trunk muscles bilaterally were measured during standing and trunk flexion movements. Correlations between breast size and motion and muscle activation measures were assessed. Head and trunk angles were strongly, negatively correlated to breast size during upright standing; thoracic angles were moderately, positively correlated to breast size during thoracic flexion movements. Trunk muscles showed positive, moderate-strength relationships with breast size during upright standing and some trunk movements. These findings provide a preliminary indication that increasing breast sizes are associated with altered postures and increased muscle activation in a non-clinical population, and constitute a baseline for the study of females with a full range of breast sizes. Further research is required to confirm the generalizability of these findings to other sizes, in order to inform strategies for the prevention or reduction of back pain, as well as diagnosis, treatment, and rehabilitation techniques associated with breast size and back pain.

  2. Gait patterns during different walking conditions in older adults with and without knee osteoarthritis--results from the Baltimore Longitudinal Study of Aging.

    PubMed

    Ko, Seung-uk; Ling, Shari M; Schreiber, Catherine; Nesbitt, Mark; Ferrucci, Luigi

    2011-02-01

    Biomechanical analysis of lower extremity activities while walking at different speeds and in challenging conditions may help to identify specific gait patterns associated with knee osteoarthritis (knee-OA). We hypothesized that individuals with asymptomatic knee-OA have lower ankle activity, while individuals with symptomatic knee-OA have similar or higher ankle activity compared to individuals without knee-OA, and that such differences are enhanced during challenging gait tasks. We tested this hypothesis by examining gait characteristics in multiple gait tasks using data from 153 Baltimore Longitudinal Study of Aging (BLSA) participants (112 without knee-OA, 41 with knee-OA; 53-87 years, 52% women). All participants who could walk unassisted were evaluated in the BLSA gait lab while walking at self-selected speed (usual-walking), at maximum speed (fast-walking) and again at self-selected speed after 30-min of walking activities (usual-walking-after-30 min). Knee range of motion was lower for knee-OA participants in the fast-walking and usual-walking-after-30 min tasks (p<0.030). Ankle range of motion for symptomatic knee-OA was greater compared to asymptomatic knee-OA for all walking tasks (p<0.050). Symptomatic knee-OA had greater generative MWE of the ankle compared to asymptomatic knee-OA (p=0.034), while keeping similar absorptive MWE of the knee when compared to no-OA controls (p=0.151). Symptomatic knee-OA individuals seem to adapt an ankle kinematic gait pattern aimed at avoiding knee pain, by enhancing forward propulsion so to minimize knee joint load. Whether these conditions represent subsequent steps in the causal pathway from knee-OA to changes in gait is still not clear.

  3. Is high flexion following total knee arthroplasty safe?: evaluation of knee joint loads in the patients during maximal flexion.

    PubMed

    Nagura, Takeo; Otani, Toshiro; Suda, Yasunori; Matsumoto, Hideo; Toyama, Yoshiaki

    2005-08-01

    The purpose of this study was to indicate the mechanical loads and the flexion angle at the knee during rise from maximal flexion following total knee arthroplasty (TKA). Twenty three knees were evaluated using skin marker-based motion analysis system during four different activities of daily living. The average maximum flexion was 90 degrees (34 degrees less than passive flexion) and all subjects required support for their weight to rise from maximal flexion. The external moments and the external forces at the knee during the maximal flexion were smaller than those during the stair descending activity. The results indicate that capable flexion angle for the patients following TKA is approximately 90 degrees which has smaller mechanical loads at the knee than the stair descending activity.

  4. Fiducial marker-based correction for involuntary motion in weight-bearing C-arm CT scanning of knees. II. Experiment

    SciTech Connect

    Choi, Jang-Hwan; Maier, Andreas; Keil, Andreas; McWalter, Emily J.; Gold, Garry E.; Fahrig, Rebecca; Pal, Saikat; Beaupré, Gary S.

    2014-06-15

    Purpose: A C-arm CT system has been shown to be capable of scanning a single cadaver leg under loaded conditions by virtue of its highly flexible acquisition trajectories. In Part I of this study, using the 4D XCAT-based numerical simulation, the authors predicted that the involuntary motion in the lower body of subjects in weight-bearing positions would seriously degrade image quality and the authors suggested three motion compensation methods by which the reconstructions could be corrected to provide diagnostic image quality. Here, the authors demonstrate that a flat-panel angiography system is appropriate for scanning both legs of subjectsin vivo under weight-bearing conditions and further evaluate the three motion-correction algorithms using in vivo data. Methods: The geometry of a C-arm CT system for a horizontal scan trajectory was calibrated using the PDS-2 phantom. The authors acquired images of two healthy volunteers while lying supine on a table, standing, and squatting at several knee flexion angles. In order to identify the involuntary motion of the lower body, nine 1-mm-diameter tantalum fiducial markers were attached around the knee. The static mean marker position in 3D, a reference for motion compensation, was estimated by back-projecting detected markers in multiple projections using calibrated projection matrices and identifying the intersection points in 3D of the back-projected rays. Motion was corrected using three different methods (described in detail previously): (1) 2D projection shifting, (2) 2D deformable projection warping, and (3) 3D rigid body warping. For quantitative image quality analysis, SSIM indices for the three methods were compared using the supine data as a ground truth. Results: A 2D Euclidean distance-based metric of subjects’ motion ranged from 0.85 mm (±0.49 mm) to 3.82 mm (±2.91 mm) (corresponding to 2.76 to 12.41 pixels) resulting in severe motion artifacts in 3D reconstructions. Shifting in 2D, 2D warping, and 3D

  5. Fiducial marker-based correction for involuntary motion in weight-bearing C-arm CT scanning of knees. II. Experiment

    PubMed Central

    Choi, Jang-Hwan; Maier, Andreas; Keil, Andreas; Pal, Saikat; McWalter, Emily J.; Beaupré, Gary S.; Gold, Garry E.; Fahrig, Rebecca

    2014-01-01

    Purpose: A C-arm CT system has been shown to be capable of scanning a single cadaver leg under loaded conditions by virtue of its highly flexible acquisition trajectories. In Part I of this study, using the 4D XCAT-based numerical simulation, the authors predicted that the involuntary motion in the lower body of subjects in weight-bearing positions would seriously degrade image quality and the authors suggested three motion compensation methods by which the reconstructions could be corrected to provide diagnostic image quality. Here, the authors demonstrate that a flat-panel angiography system is appropriate for scanning both legs of subjects in vivo under weight-bearing conditions and further evaluate the three motion-correction algorithms using in vivo data. Methods: The geometry of a C-arm CT system for a horizontal scan trajectory was calibrated using the PDS-2 phantom. The authors acquired images of two healthy volunteers while lying supine on a table, standing, and squatting at several knee flexion angles. In order to identify the involuntary motion of the lower body, nine 1-mm-diameter tantalum fiducial markers were attached around the knee. The static mean marker position in 3D, a reference for motion compensation, was estimated by back-projecting detected markers in multiple projections using calibrated projection matrices and identifying the intersection points in 3D of the back-projected rays. Motion was corrected using three different methods (described in detail previously): (1) 2D projection shifting, (2) 2D deformable projection warping, and (3) 3D rigid body warping. For quantitative image quality analysis, SSIM indices for the three methods were compared using the supine data as a ground truth. Results: A 2D Euclidean distance-based metric of subjects’ motion ranged from 0.85 mm (±0.49 mm) to 3.82 mm (±2.91 mm) (corresponding to 2.76 to 12.41 pixels) resulting in severe motion artifacts in 3D reconstructions. Shifting in 2D, 2D warping, and 3D

  6. Fiducial marker-based correction for involuntary motion in weight-bearing C-arm CT scanning of knees. II. Experiment.

    PubMed

    Choi, Jang-Hwan; Maier, Andreas; Keil, Andreas; Pal, Saikat; McWalter, Emily J; Beaupré, Gary S; Gold, Garry E; Fahrig, Rebecca

    2014-06-01

    A C-arm CT system has been shown to be capable of scanning a single cadaver leg under loaded conditions by virtue of its highly flexible acquisition trajectories. In Part I of this study, using the 4D XCAT-based numerical simulation, the authors predicted that the involuntary motion in the lower body of subjects in weight-bearing positions would seriously degrade image quality and the authors suggested three motion compensation methods by which the reconstructions could be corrected to provide diagnostic image quality. Here, the authors demonstrate that a flat-panel angiography system is appropriate for scanning both legs of subjects in vivo under weight-bearing conditions and further evaluate the three motion-correction algorithms using in vivo data. The geometry of a C-arm CT system for a horizontal scan trajectory was calibrated using the PDS-2 phantom. The authors acquired images of two healthy volunteers while lying supine on a table, standing, and squatting at several knee flexion angles. In order to identify the involuntary motion of the lower body, nine 1-mm-diameter tantalum fiducial markers were attached around the knee. The static mean marker position in 3D, a reference for motion compensation, was estimated by back-projecting detected markers in multiple projections using calibrated projection matrices and identifying the intersection points in 3D of the back-projected rays. Motion was corrected using three different methods (described in detail previously): (1) 2D projection shifting, (2) 2D deformable projection warping, and (3) 3D rigid body warping. For quantitative image quality analysis, SSIM indices for the three methods were compared using the supine data as a ground truth. A 2D Euclidean distance-based metric of subjects' motion ranged from 0.85 mm (±0.49 mm) to 3.82 mm (±2.91 mm) (corresponding to 2.76 to 12.41 pixels) resulting in severe motion artifacts in 3D reconstructions. Shifting in 2D, 2D warping, and 3D warping improved the SSIM in

  7. Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study.

    PubMed

    van der Esch, Martin; Holla, Jasmijn F; van der Leeden, Marike; Knol, Dirk L; Lems, Willem F; Roorda, Leo D; Dekker, Joost

    2014-10-01

    To determine whether a decrease in muscle strength over 3 years is associated with an increase in activity limitations in persons with early symptomatic knee osteoarthritis (OA), and to examine whether the longitudinal association between muscle strength and activity limitations is moderated by knee joint proprioception and laxity. A longitudinal cohort study with 3-year follow-up. Measurements were performed at the second (t0) and fifth (t1) year of the Cohort Hip and Cohort Knee (CHECK) study. Statistical analyses included paired t tests, chi-square tests, and regression analyses. In regression analyses, the association between muscle strength and activity limitations was adjusted for confounders. A rehabilitation and rheumatology center. Subjects (N=146) with early symptomatic knee OA from the CHECK study. Not applicable. Muscle strength, proprioception, and laxity were assessed using specifically designed measurement devices. Self-reported and performance-based activity limitations were measured with the Western Ontario and McMaster Universities Osteoarthritis Index, the Get Up and Go test, the walk test, and the stair-climb test. A total of 116 women (79.5%) and 30 men (20.5%), with a mean age ± SD of 58.4±4.9 years and a mean body mass index ± SD of 25.5±3.6, were included in the study. Overall, small 3-year changes in muscle strength and activity limitations were observed. At the group level, the average muscle strength increased by 10% (1.0±0.3 to 1.1±0.3Nm/kg) over the 3 years. The 3-year decrease in muscle strength was independently associated with an increase in performance-based activity limitations on all 3 measures (B=-1.12, B=-5.83, and B=-1.25, respectively). Proprioception and laxity did not moderate this association. In patients with early knee OA, decreased muscle strength is associated with an increase in activity limitations. Our results are a step toward understanding the role of muscle weakness in the development of activity limitations

  8. Design and control of an active 1-DoF mechanism for knee rehabilitation.

    PubMed

    Naghavi, Nader; Mahjoob, Mohammad J

    2016-10-01

    A 1-DoF robot is designed and fabricated to be used for knee rehabilitation training. The mechanism (robot) is designed to perform specific set of exercises while the patient is sitting on a chair. The therapy process for patients has different stages; each stage consists of specific exercises to recover the knee to its condition before injury. The maximum torque of healthy joint during the extension/flexion exercise is evaluated by simulation and suitable actuator is selected based on the results. A prototype is then fabricated as a platform to evaluate the design and control concepts. The experiment procedure consisting of three stages of therapy indicates good tracking performance and safe operation of the system. Implication for Rehabilitation A 1-DoF mechanism for knee rehabilitation has been designed to perform three stages of therapy: passive, active assist and active resist. The assistive and resistive torque, during active assist and active resist stages, can be set according to the progress in therapy. The results of this study suggest the system has the potential to result in various benefits including reduction of physical workload of physiotherapists and improved repeatability.

  9. Technology Efficacy in Active Prosthetic Knees for Transfemoral Amputees: A Quantitative Evaluation

    PubMed Central

    El-Sayed, Amr M.; Abu Osman, Noor Azuan

    2014-01-01

    Several studies have presented technological ensembles of active knee systems for transfemoral prosthesis. Other studies have examined the amputees' gait performance while wearing a specific active prosthesis. This paper combined both insights, that is, a technical examination of the components used, with an evaluation of how these improved the gait of respective users. This study aims to offer a quantitative understanding of the potential enhancement derived from strategic integration of core elements in developing an effective device. The study systematically discussed the current technology in active transfemoral prosthesis with respect to its functional walking performance amongst above-knee amputee users, to evaluate the system's efficacy in producing close-to-normal user performance. The performances of its actuator, sensory system, and control technique that are incorporated in each reported system were evaluated separately and numerical comparisons were conducted based on the percentage of amputees' gait deviation from normal gait profile points. The results identified particular components that contributed closest to normal gait parameters. However, the conclusion is limitedly extendable due to the small number of studies. Thus, more clinical validation of the active prosthetic knee technology is needed to better understand the extent of contribution of each component to the most functional development. PMID:25110727

  10. Asymmetry of lower extremity force and muscle activation during knee extension and functional tasks.

    PubMed

    Bond, Colin W; Cook, Summer B; Swartz, Erik E; Laroche, Dain P

    2017-09-01

    Strength and power asymmetries of >10% may negatively impact physical function. Twenty-four healthy participants, 30-60 years of age, were assessed for muscle power asymmetry during isokinetic knee extension and ground reaction force asymmetry during chair-rise and vertical jump tasks. Neuromuscular activation asymmetry and coactivation of vastus lateralis (VL) and biceps femoris (BF) were assessed in each condition. Symmetric (SG) and asymmetric (AG) groups were identified using a 10% knee extension power asymmetry criterion. The AG had greater chair-rise rate of force development asymmetry (P = 0.003, d = 1.29), but a similar chair-rise and vertical jump peak force asymmetry as the SG. Large group effects were found for VL activation asymmetry during knee extension (P = 0.047, d = 0.87), BF activation asymmetry during vertical jump (P = 0.015, d = 1.12), and strong leg coactivation during vertical jump (P = 0.028, d = 0.96). Compensation for muscle power asymmetry may occur during functional tasks, potentially through differential activation of strong and weak leg muscles. Muscle Nerve 56: 495-504, 2017. © 2017 Wiley Periodicals, Inc.

  11. Technology efficacy in active prosthetic knees for transfemoral amputees: a quantitative evaluation.

    PubMed

    El-Sayed, Amr M; Hamzaid, Nur Azah; Abu Osman, Noor Azuan

    2014-01-01

    Several studies have presented technological ensembles of active knee systems for transfemoral prosthesis. Other studies have examined the amputees' gait performance while wearing a specific active prosthesis. This paper combined both insights, that is, a technical examination of the components used, with an evaluation of how these improved the gait of respective users. This study aims to offer a quantitative understanding of the potential enhancement derived from strategic integration of core elements in developing an effective device. The study systematically discussed the current technology in active transfemoral prosthesis with respect to its functional walking performance amongst above-knee amputee users, to evaluate the system's efficacy in producing close-to-normal user performance. The performances of its actuator, sensory system, and control technique that are incorporated in each reported system were evaluated separately and numerical comparisons were conducted based on the percentage of amputees' gait deviation from normal gait profile points. The results identified particular components that contributed closest to normal gait parameters. However, the conclusion is limitedly extendable due to the small number of studies. Thus, more clinical validation of the active prosthetic knee technology is needed to better understand the extent of contribution of each component to the most functional development.

  12. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study.

    PubMed

    McAlindon, T E; Wilson, P W; Aliabadi, P; Weissman, B; Felson, D T

    1999-02-01

    Because osteoarthritis may be caused by "wear and tear," we examined the association between level of physical activity and risk of knee osteoarthritis in the elderly. Eligible subjects were participants in the Framingham Heart Study cohort who had radiographically normal knees at biennial exam 18 (1983-1985) and who also completed a physical activity questionnaire at exam 20 (1988-1989). Follow-up knee radiographs were obtained at biennial exam 22 (1992-1993). The study outcomes were the development of incident radiographic or symptomatic knee osteoarthritis between the baseline and follow-up exams. The number of hours per day of heavy physical activity was associated with the risk of incident radiographic knee osteoarthritis (odds ratio = 1.3 per hour, 95% confidence limits 1.1-1.6, P for trend = 0.006). Adjustment for age, sex, body mass index, weight loss, knee injury, health status, total calorie intake, and smoking strengthened this association (eg, odds ratio for > or = 4 hours heavy physical activity/day compared with no heavy physical activity = 7.0, 95% confidence limits 2.4-20, P for trend = 0.0002). Risk was greatest among individuals in the upper tertile of body mass index (odds ratio for > or = 3 hours/day of heavy physical activity = 13.0, 95% confidence limits 3.3-51). For incident symptomatic knee osteoarthritis, the results were similar, although the number of cases was small. No effects on these outcomes were observed from moderate and light physical activity, number of blocks walked, or number of flights of stairs climbed daily. Heavy physical activity is an important risk factor for the development of knee osteoarthritis in the elderly, especially among obese individuals. Light and moderate activities do not appear to increase risk.

  13. Effects of activity modification on the patients with osteoarthritis of the knee.

    PubMed

    Shakoor, M A; Taslim, Md Abu; Hossain, Md Shahadat

    2007-08-01

    A prospective randomized clinical trial was conducted on 162 patients of osteoarthritis of knee were included in the study. The patients were divided into two groups- Group A and Group B. The Group A was treated with shortwave diathermy, exercise, naproxen and activity modification and the Group B was treated with shortwave diathermy, exercise and naproxen. Improvement was found more in Group A than Group B after 4th week (95% CI was -2.59 to 6.56). Then it was found that the improvement was gradually increased in Group A than Group B and finally, it was found that there was highly significant improvement in Group A than Group B after 6th week (95% CI was -3.45 to -0.70). This study suggests that activity modification play an important role for the treatment of the patients with osteoarthritis of knee.

  14. Statistics of Superluminal Motion in Active Galactic Nuclei

    NASA Astrophysics Data System (ADS)

    Zhang, Yong-Wei; Fan, Jun-Hui

    2008-08-01

    We have collected an up-to-date sample of 123 superluminal sources (84 quasars, 27 BL Lac objects and 12 galaxies) and calculated the apparent velocities (βapp) for 224 components in the sources with the Λ-CDM model. We checked the relationships between their proper motions, redshifts, βapp and 5 GHz flux densities. Our analysis shows that the radio emission is strongly boosted by the Doppler effect. The superluminal motion and the relativistic beaming boosting effect are, to some extent, the same in active galactic nuclei.

  15. Potential Functional Benefit From Light Intensity Physical Activity in Knee Osteoarthritis.

    PubMed

    White, Daniel K; Lee, Jungwha; Song, Jing; Chang, Rowland W; Dunlop, Dorothy

    2017-08-28

    Knee pain may preclude participation in higher intensity physical activity in people with knee osteoarthritis and benefits of light activity are unclear. The effect of replacing sedentary time with light intensity activity on incident functional limitation 2 years later was investigated. Included were people with or at high risk of knee osteoarthritis without baseline functional limitation using data from the Osteoarthritis Initiative collected between August 2008 and July 2010. Data were analyzed between May 2016 and August 2016 for time in sedentary, light, and moderate to vigorous physical activity from accelerometer monitoring. Incident functional limitation was defined as (1) slow gait speed <1.0 meters/second during a 20-meter walk, (2) Western Ontario and McMasters University Osteoarthritis Index physical function ≥28, or (3) Short Form 12 Physical Component scale <40. Inclusion criteria were met by 1,873 people (mean age=65.0 [SD=9.0] years, mean BMI=28.4 [SD=4.7] kg/m(2)). Replacing 60 minutes/day of sedentary time with 60 minutes/day of light activity was associated with a 17% reduced risk for incident slow gait speed 2 years later (Hazard Ratio=0.83, 95% CI=0.70, 0.99) after adjustment. Approximately 5 minutes/day of moderate to vigorous physical activity would be necessary to receive the equivalent benefit of 60 minutes/day of light activity. Effects in secondary patient-reported outcomes did not reach statistical significance. Replacing sedentary time with light activity may reduce the risk of performance-based functional limitation. As expected, moderate to vigorous physical activity rather than light provided stronger risk reduction. When moderate to vigorous physical activity is not an option, pursuing light activity may be a beneficial alternative to being sedentary. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  16. A combined system for measuring animal motion activities.

    PubMed

    Young, M S; Young, C W; Li, Y C

    2000-01-31

    In this study, we have developed a combined animal motion activity measurement system that combines an infrared light matrix subsystem with an ultrasonic phase shift subsystem for animal activity measurement. Accordingly, in conjunction with an IBM PC/AT compatible personal computer, the combined system has the advantages of both infrared and ultrasonic subsystems. That is, it can at once measure and directly analyze detailed changes in animal activity ranging from locomotion to tremor. The main advantages of this combined system are that it features real time data acquisition with the option of animated real time or recorded display/playback of the animal's motion. Additionally, under the multi-task operating condition of IBM PC, it can acquire and process behavior using both IR and ultrasound systems simultaneously. Traditional systems have had to make separate runs for gross and fine movement recording. This combined system can be profitably employed for normative behavioral activity studies and for neurological and pharmacological research.

  17. Knee braces can decrease tibial rotation during pivoting that occurs in high demanding activities.

    PubMed

    Giotis, Dimitrios; Tsiaras, Vasilios; Ristanis, Stavros; Zampeli, Franceska; Mitsionis, Grigoris; Stergiou, Nicholas; Georgoulis, Anastasios D

    2011-08-01

    The purpose of this study was to investigate whether knee braces could effectively decrease tibial rotation during high demanding activities. Using an in vivo three-dimensional kinematic analysis, 21 physically active, healthy, male subjects were evaluated. Each subject performed two tasks that were used extensively in the literature because they combine increased rotational and translational loads on the knee, (1) descending from a stair and subsequent pivoting and (2) landing from a platform and subsequent pivoting under three conditions: (A) wearing a prophylactic brace (braced), (B) wearing a patellofemoral brace (sleeved), and (C) unbraced condition. In the first task, tibial rotation during the pivoting phase was significantly decreased in the braced condition as compared to the sleeved condition (P = 0.019) and the non-braced condition (P = 0.002). In the second task, the same variable was significantly decreased in the braced condition as compared to the sleeved (P = 0.001) and the unbraced condition (P < 0.001). The sleeved condition also produced significantly decreased tibial rotation with respect to the unbraced condition (P = 0.021). Bracing decreased tibial rotation in activities where increased translational and rotational forces were applied. Because knee braces decreased tibial rotation, they can possibly be used with ACL-reconstructed and ACL-deficient patients to prevent such problems. Case-control study, Level III.

  18. Computational modelling of motion at the bone-implant interface after total knee arthroplasty: The role of implant design and surgical fit.

    PubMed

    Conlisk, Noel; Howie, Colin R; Pankaj, Pankaj

    2017-08-01

    Aseptic loosening, osteolysis, and infection are the most commonly reported reasons for revision total knee arthroplasty (TKA). This study examined the role of implant design features (e.g. condylar box, pegs) and stems in resisting loosening, and also explored the sensitivity of the implants to a loose surgical fit due to saw blade oscillation. Finite element models of the distal femur implanted with four different implant types: cruciate retaining (CR), posterior stabilising (PS), total stabilising (TS) with short stem (12mm×50mm), and a total stabilising (TS) with long stem (19mm×150mm) were developed and analysed in this study. Two different fit conditions were considered: a normal fit, where the resections on the bone exactly match the internal profile of the implant, and a loose fit due to saw blade oscillation, characterised by removal of one millimetre of bone from the anterior and posterior surfaces of the distal femur. Frictional interfaces were employed at the bone-implant interfaces to allow relative motions to be recorded. The results showed that interface motions increased with increasing flexion angle and loose fit. Implant design features were found to greatly influence the surface area under increased motion, while only slightly influencing the values of peak motion. Short uncemented stems behaved similarly to PS implants, while long canal filling stems exhibited the least amount of motion at the interface under any fit condition. In conclusion, long stemmed prostheses appeared less susceptible to surgical cut errors than short stemmed and stemless implants. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Sustained Rhythmic Brain Activity Underlies Visual Motion Perception in Zebrafish.

    PubMed

    Pérez-Schuster, Verónica; Kulkarni, Anirudh; Nouvian, Morgane; Romano, Sebastián A; Lygdas, Konstantinos; Jouary, Adrien; Dipoppa, Mario; Pietri, Thomas; Haudrechy, Mathieu; Candat, Virginie; Boulanger-Weill, Jonathan; Hakim, Vincent; Sumbre, Germán

    2016-10-18

    Following moving visual stimuli (conditioning stimuli, CS), many organisms perceive, in the absence of physical stimuli, illusory motion in the opposite direction. This phenomenon is known as the motion aftereffect (MAE). Here, we use MAE as a tool to study the neuronal basis of visual motion perception in zebrafish larvae. Using zebrafish eye movements as an indicator of visual motion perception, we find that larvae perceive MAE. Blocking eye movements using optogenetics during CS presentation did not affect MAE, but tectal ablation significantly weakened it. Using two-photon calcium imaging of behaving GCaMP3 larvae, we find post-stimulation sustained rhythmic activity among direction-selective tectal neurons associated with the perception of MAE. In addition, tectal neurons tuned to the CS direction habituated, but neurons in the retina did not. Finally, a model based on competition between direction-selective neurons reproduced MAE, suggesting a neuronal circuit capable of generating perception of visual motion. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

  20. Impact of decline-board squat exercises and knee joint angles on the muscle activity of the lower limbs.

    PubMed

    Lee, Daehee; Lee, Sangyong; Park, Jungseo

    2015-08-01

    [Purpose] This study aims to investigate how squat exercises on a decline board and how the knee joint angles affect the muscle activity of the lower limbs. [Subjects] The subjects were 26 normal adults. [Methods] A Tumble Forms wedge device was used as the decline board, and the knee joint angles were measured with a goniometer. To examine the muscle activity of the biceps femoris, rectus femoris, gastrocnemius lateralis, and tibialis anterior of the lower limbs, a comparison analysis with electromyography was conducted. [Results] The muscle activity of the biceps femoris, rectus femoris, gastrocnemius lateralis, and tibialis anterior increased with increased knee joint angles, both for squat exercises on the decline board and on a flat floor. When the knee joint angle was 45°, 60°, and 90°, the muscle activity of the rectus femoris was significantly higher and that of the tibialis anterior was significantly lower during squat exercises on the decline board than on the flat floor. When the knee joint angle was 90°, the muscle activity of the gastrocnemius lateralis was significantly lower. [Conclusion] Squat exercises on a decline board are an effective intervention to increase the muscle activity of the rectus femoris with increased knee joint angles.

  1. A conceptual framework for a sports knee injury performance profile (SKIPP) and return to activity criteria (RTAC)

    PubMed Central

    Logerstedt, David; Arundale, Amelia; Lynch, Andrew; Snyder-Mackler, Lynn

    2015-01-01

    Injuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and articular cartilage lesions, are commonplace within sports. Despite advancements in surgical techniques and enhanced rehabilitation, athletes returning to cutting, pivoting, and jumping sports after a knee injury are at greater risk of sustaining a second injury. The clinical utility of objective criteria presents a decision-making challenge to ensure athletes are fully rehabilitated and safe to return to sport. A system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to establish return to activity criteria is recommended to clear athletes to begin a progressive and systematic approach to activities and sports. Integration of a sports knee injury performance profile with return to activity criteria can guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and life-long knee joint health. PMID:26537805

  2. Does activity affect the outcome of the Oxford unicompartmental knee replacement?

    PubMed

    Ali, Adam M; Pandit, Hemant; Liddle, Alexander D; Jenkins, Cathy; Mellon, Stephen; Dodd, Christopher A F; Murray, David W

    2016-03-01

    High levels of activity are considered to be a contraindication to unicompartmental knee replacement (UKR) and are not recommended after UKR. To determine if these recommendations should apply to the mobile-bearing Oxford UKR, this study assessed the effect of post-operative activity level on the outcome of this device. The outcome of the first 1000 Phase 3 cemented Oxford UKRs implanted between 1998 and 2010 was assessed using survival analysis, the Oxford Knee Score (OKS) and the American Knee Society Objective (KSS-O) and Functional (KSS-F) Scores. Patients were grouped according to the maximum post-operative Tegner Activity Score. The mean follow-up was 6.1 years (range 1 to 14). Overall, increasing activity was associated with superior survival (p=0.025). In the high activity group, with Tegner≥5 (n=115) 2.6% were revised and the 12-year survival was 97.3% (confidence interval (CI): 92.0% to 99.1%). In the low activity group, with Tegner≤4, (n=885) 4.3% were revised and the 12-year survival was 94.0% (CI: 91.4 to 95.8). The difference between the two groups was not significant (p=0.44). Although the final OKS and KSS-F were significantly better in the high activity group compared to the low activity group (OKS 45v40, KSS-F 95v78), there was no difference in the change in OKS or KSS-O. High activity does not compromise the outcome of the Oxford UKR and may improve it. Activity should not be restricted nor considered to be a contraindication. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. A long term clinical outcome of the Medial Pivot Knee Arthroplasty System.

    PubMed

    Macheras, George A; Galanakos, Spyridon P; Lepetsos, Panagiotis; Anastasopoulos, Panagiotis P; Papadakis, Stamatios A

    2017-03-01

    The ideal total knee arthroplasty (TKA) should provide maximum range of motion and functional stability for all desired daily activities and, if possible, to replicate normal knee kinematics and function. The ADVANCE® Medial Pivot (AMP) Knee System was designed with a highly congruent medial compartment and a less conforming lateral compartment to more closely mimic the kinematics of the normal knee and to offer more stability through out of range of motion (ROM). The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of this TKA system. Three hundred and twenty-five (325) patients (347 knees) with knee osteoarthritis underwent a TKA using the AMP prosthesis in our Department. For evaluation, objective and subjective clinical rating systems along with radiograph series were used. The average follow-up was 15.2years. All patients showed a statistically significant improvement (p<0.0005) in the Knee Society clinical rating system, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, SF-12® questionnaire, and Oxford knee score. The majority of patients (94%) were able to perform age-appropriate activities with a mean knee flexion of 120° (range, 105°-135°) at final follow-up. Survival analysis showed a cumulative success rate of 98.8% at 17years. The obtained results demonstrate excellent long-term clinical outcome for this knee design. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  4. Predictors of Facility Discharge, Range of Motion, and Patient-Reported Physical Function Improvement Following Primary Total Knee Arthroplasty: A Prospective CohortAnalysis

    PubMed Central

    M.Rissman, Cody; Keeney, Benjamin J.; Ercolano, Ellyn M.; Koenig, Karl M.

    2015-01-01

    Patients are discharged to home or inpatient settings following primary unilateral total knee arthroplasty (TKA). We identified predictors of inpatient discharge and 3-month postoperative range of motion (ROM) and patient-reported physical function improvement (VR12 PCS) between these discharge settings. We studied prospectively collected cohortdata for 738 TKAs between April 2011 and April 2013. Significant adjusted predictors of inpatient discharge included older age, female gender, surgeon, comorbidity, lower PCS, and BMI >40. Only lower preoperative ROM predicted postoperative ROM. Inpatient discharge and higher preoperative PCS predicted lower PCS improvement. Home-based rehabilitation was associated with greater 3-month PCS improvement and showed no difference with 3-month ROM. TKA inpatient discharge should be based on patient care requirements rather than perceived benefit of improved ROM and physical function. PMID:26483260

  5. Effect of foot type on knee valgus, ground reaction force, and hip muscle activation in female soccer players.

    PubMed

    Rath, Meghan E; Stearne, David J; Walker, Cameron R; Cox, Jaime C

    2016-05-01

    The purpose of this study was to determine the degree to which subtalar joint pronation resulting from a supple planus foot affects knee alignment, hip muscle activation and ground reaction force attenuation in female athletes during a broad jump-to-cut maneuver. Twelve National Collegiate Athletic Association (NCAA) Division II female soccer players (age=19.4±1.4 years, height=1.64±0.05 m, mass=64.10±4.8 kg) were identified as having either supple planus (SP) or rigid feet (RF). Participants completed three broad jump-to-cut trials onto a force plate while EMG and motion data were collected. Muscle activation levels (percentage of maximal voluntary contraction [%MVC]) in the gluteus maximus, gluteus medius, biceps femoris, and rectus femoris were calculated, and peak vertical and medial shear force, rate of loading, and valgus angle were collected for each trial. Mann-Whitney U tests revealed no statistical significance between foot-type groups, however, effect size statistics revealed practical significance for between-group %MVC biceps femoris (d=1.107), %MVC gluteus maximus (d=1.069), and vertical ground reaction force (d=1.061). Athletes with a SP foot type may experience decreased hip muscle activation associated with increased vertical ground reaction force during a broad jump-to-cut maneuver. This might result in reduced dynamic stability and neuromuscular control during deceleration, potentially increasing the risk of non-contact ACL injury in female soccer players.

  6. Intra-articular intervention by hyaluronic acid for knee osteoarthritis can modify locomotor pattern of muscle activity.

    PubMed

    Tang, Alice Chu-Wen; Hong, Wei-Hsien; Chen, Hsieh-Ching; Tang, Simon Fuk-Tan

    2015-02-01

    To evaluate the muscle activation pattern of lower extremities can be modified by intraarticular injection of hyaluronic acid( IAHA). Twenty-three subjects with knee OA and 14 age-matched non-knee OA control subjects were recruited from an outpatient clinic. Three-dimensional gait analysis with using the MA- 100 EMG system was applied to measure the muscles activities. The quadriceps (QUA), hamstrings (HAM), tibialis anterior (TA), and medial gastrocnemius (MG) muscles were selected for this study. For the knee OA group, bilateral IA knee joint injections with HA were performed. During the stance phase of gait cycle, the quadriceps, hamstring, and tibialis anterior muscles had longer muscle contraction duration in the knee OA patients as compared with the control group. The muscle activities of quadriceps, hamstrings, tibialis anterior, and medial gastrocnemius muscles recovered to a pattern similar to the control group after the completion of IA HA injections in knee OA patients. The H/Q ratio improved significantly after the IA HA injections, and also lasted up to a period of six months (p<0.01). IA HA is an available treatment option as it effectively decreases co-contraction and improves motor activity of the lower extremity muscles. The improved muscle activities lasted up to a period up to six months. © 2015 Elsevier B.V. All rights reserved.

  7. Swinging motion of active deformable particles in Poiseuille flow

    NASA Astrophysics Data System (ADS)

    Tarama, Mitsusuke

    2017-08-01

    Dynamics of active deformable particles in an external Poiseuille flow is investigated. To make the analysis general, we employ time-evolution equations derived from symmetry considerations that take into account an elliptical shape deformation. First, we clarify the relation of our model to that of rigid active particles. Then, we study the dynamical modes that active deformable particles exhibit by changing the strength of the external flow. We emphasize the difference between the active particles that tend to self-propel parallel to the elliptical shape deformation and those self-propelling perpendicularly. In particular, a swinging motion around the centerline far from the channel walls is discussed in detail.

  8. Motion.

    ERIC Educational Resources Information Center

    Brand, Judith, Ed.

    2002-01-01

    This issue of Exploratorium Magazine focuses on the topic of motion. Contents include: (1) "First Word" (Zach Tobias); (2) "Cosmic Collisions" (Robert Irion); (3) "The Mobile Cell" (Karen E. Kalumuck); (4) "The Paths of Paths" (Steven Vogel); (5) "Fragments" (Pearl Tesler); (6) "Moving Pictures" (Amy Snyder); (7) "Plants on the Go" (Katharine…

  9. Motion.

    ERIC Educational Resources Information Center

    Gerhart, James B.; Nussbaum, Rudi H.

    This monograph was written for the Conference on the New Instructional Materials in Physics held at the University of Washington in summer, 1965. It is intended for use in an introductory course in college physics. It consists of an extensive qualitative discussion of motion followed by a detailed development of the quantitative methods needed to…

  10. Motion.

    ERIC Educational Resources Information Center

    Brand, Judith, Ed.

    2002-01-01

    This issue of Exploratorium Magazine focuses on the topic of motion. Contents include: (1) "First Word" (Zach Tobias); (2) "Cosmic Collisions" (Robert Irion); (3) "The Mobile Cell" (Karen E. Kalumuck); (4) "The Paths of Paths" (Steven Vogel); (5) "Fragments" (Pearl Tesler); (6) "Moving Pictures" (Amy Snyder); (7) "Plants on the Go" (Katharine…

  11. On Some Passive and Active Motion in Biology

    NASA Astrophysics Data System (ADS)

    Misbah, Chaouqi

    This contribution focuses on two main questions inspired by biology: (i) passive motion under flow, like advection of red blood cells in the circulatory system, and (ii) active motion generated by actin polymerization, as encountered in cells of the immune system and some micro-organisms (e.g. some bacteria and viruses). The first part is dedicated to the dynamics and rheology of vesicles (a simple model for red blood cells) under flow. Some results obtained on red blood cells are also presented and compared to vesicles. Vesicles and red blood cells under flow exhibit several interesting dynamics: tank-treading, tumbling, vacillating-breathing, and so on. These dynamics have a direct impact on rheology, as will be discussed both from the theoretical and experimental point of views. The second part addresses active motion. Some Bacteria (like Listeria) are known to transfect cells thanks to the polymerization on their surface of an actin gel. Monomeric actin proteins are recruited from the transfected cell when the bacteria gets in contact with the cell surface. It has been found that the bacteria propulsion into the cell occurs in the absence of molecular motors. Biomimetic experiments on beads and droplets have revealed that motion is a consequence of a spontaneous symmetry breaking that is accompanied with force generation. A simple basic model taking into account growth of actin and elasticity is sufficient to capture the essence of symmetry breaking and force generation, as will be presented in this contribution.

  12. Observing shadow motions: resonant activity within the observer's motor system?

    PubMed

    Alaerts, Kaat; Van Aggelpoel, Tinne; Swinnen, Stephan P; Wenderoth, Nicole

    2009-09-25

    Several studies have demonstrated that the human motor cortex is activated by the mere observation of actions performed by others. In the present study, we explored whether the perception of 'impoverished motion stimuli', such as shadow animations, is sufficient to activate motor areas. To do so, transcranial magnetic stimulation (TMS) was applied over the hand area of the primary motor cortex (M1) while subjects observed shadow animations depicting finger motions. Data showed that resonant motor responses in M1 were only found when a biological effector was recognized from the observed shadow animation. Interestingly, M1 responses were similar for observing shadow or real motions. Therefore, the loss of 'pictorial' movement features in a shadow animation appeared to have no effect on motor resonance in M1. In summary, these findings suggest that the 'recognition' of biological motion from sparse visual input is both necessary and sufficient to recruit motor areas. This supports the hypothesis that the motor system is involved in recognizing the actions performed by others.

  13. The Importance of Spatiotemporal Information in Biological Motion Perception: White Noise Presented with a Step-like Motion Activates the Biological Motion Area.

    PubMed

    Callan, Akiko; Callan, Daniel; Ando, Hiroshi

    2017-02-01

    Humans can easily recognize the motion of living creatures using only a handful of point-lights that describe the motion of the main joints (biological motion perception). This special ability to perceive the motion of animate objects signifies the importance of the spatiotemporal information in perceiving biological motion. The posterior STS (pSTS) and posterior middle temporal gyrus (pMTG) region have been established by many functional neuroimaging studies as a locus for biological motion perception. Because listening to a walking human also activates the pSTS/pMTG region, the region has been proposed to be supramodal in nature. In this study, we investigated whether the spatiotemporal information from simple auditory stimuli is sufficient to activate this biological motion area. We compared spatially moving white noise, having a running-like tempo that was consistent with biological motion, with stationary white noise. The moving-minus-stationary contrast showed significant differences in activation of the pSTS/pMTG region. Our results suggest that the spatiotemporal information of the auditory stimuli is sufficient to activate the biological motion area.

  14. Symptom Assessment in Knee Osteoarthritis Needs to Account for Physical Activity Level

    PubMed Central

    Lo, Grace H.; McAlindon, Timothy E.; Hawker, Gillian A.; Driban, Jeffrey B.; Price, Lori Lyn; Song, Jing; Eaton, Charles B.; Hochberg, Marc C.; Jackson, Rebecca D.; Kwoh, C. Kent; Nevitt, Michael C.; Dunlop, Dorothy D.

    2015-01-01

    Objective Pain is not always correlated with radiographic osteoarthritis (OA) severity possibly because people modify activities to manage symptoms. Measures of symptoms that consider pain in the context of activity level may therefore provide greater discrimination than pain alone. Our objective was to compare discrimination of a measure of pain alone with combined measures of pain relative to physical activity across radiographic OA levels. Methods This is a cross-sectional study of the Osteoarthritis Initiative accelerometer substudy, including those with and without knee OA. Two composite pain and activity knee symptom (PAKS) scores were calculated as Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Pain Scale plus one divided by physical activity measures (step and activity counts). Symptom score discrimination across Kellgren and Lawrence (KL) grades were evaluated using histograms and quantile regression. Results 1806 participants, mean age 65.1 (9.1) years, mean BMI 28.4 (4.8) kg/m2, and 55.6% female, were included. WOMAC, but not PAKS scores, exhibited a floor effect. Adjusted median WOMAC by KL grades 0 – 4 were 0, 0, 1, 1, and 3 respectively. Median PAKS1 and PAKS2 were 24.9, 26.0, 32.4, 46.1, 97.9, and 7.2, 7.2, 9.2, 12.9, 23.8, respectively. PAKS scores had more statistically significant comparisons between KL grades compared with WOMAC. Conclusions Symptom assessments incorporating pain and physical activity did not exhibit a floor effect and were better able to discriminate radiographic severity than pain alone, particularly in milder disease. Pain in the context of physical activity level should be used to assess knee OA symptoms. PMID:26407008

  15. Cryotherapy decreases synovial Doppler activity and pain in knee arthritis: A randomized-controlled trial.

    PubMed

    Guillot, Xavier; Tordi, Nicolas; Prati, Clément; Verhoeven, Frank; Pazart, Lionel; Wendling, Daniel

    2017-07-01

    To measure and compare the effects of 2 local cryotherapy techniques on synovial power Doppler activity (primary outcome) and pain in non-septic knee arthritis without any concurrent treatment. 30 patients were randomized (ice: 30min, n=15 or cold CO2: 2min, n=15 both applied twice at 8h interval). Contralateral non-treated arthritic knees were used as paired controls (n=11 and n=10 respectively). The PDUS semi-quantitative score (0-3) and pain visual analogic scale were evaluated before/after each cold application, 2min, 2h, 24h after the first application. PDUS scores were checked in double-blind by 2 ultrasonographists. The inter-class effect size of local cryotherapy on the power Doppler score remained significant the day after treatment in local cryotherapy-treated compared to contralateral non-treated knees (Global difference: -1 [95% confidence interval: -1.23; -0.77]; ice: -0.73 [-1.06; -0.4]; CO2: -0.7 [-1.18; -0.22]). Both techniques significantly and to the same extent reduced the power Doppler score and pain visual analogic scale at all evaluation times and globally throughout the 24 hour-study period. No dropout nor adverse event was reported. In multivariate analysis, the Power Doppler score decrease was associated with pain decrease, while pain decrease was associated with the female sex and ice technique. Local ice and cold CO2 applied twice equally reduced synovial Power Doppler activity and pain over 24h in knee arthritis. These effects remained significant the day after treatment. ClinicalTrials.gov identifier: NCT02573298. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  16. Patterns of knee osteoarthritis in Arabian and American knees.

    PubMed

    Hodge, W Andrew; Harman, Melinda K; Banks, Scott A

    2009-04-01

    This study illustrates differences in the cartilage degeneration in osteoarthritic knees in patients with more frequent hyperflexion activities of daily living compared with Western patients. Proximal tibial articular cartilage wear and cruciate ligament condition were assessed in Saudi Arabian and North American patients with varus osteoarthritis undergoing total knee arthroplasty. In anterior cruciate ligament (ACL) intact knees, there were significant differences in wear location, with a clearly more anterior pattern in Saudi Arabian knees. Complete ACL deficiency occurred in 25% of North American knees but only 14% of Saudi Arabian knees. These ACL-deficient knees showed the most severe cartilage wear in both groups and posterior medial wear patterns. Biomechanical descriptions of knee flexion and axial rotation during kneeling or squatting are consistent with the more pronounced anteromedial and posterolateral cartilage wear patterns observed on the Saudi Arabian knees. These observations provide insight into altered knee mechanics in 2 culturally different populations with different demands on knee flexion.

  17. Three trajectories of activity limitations in early symptomatic knee osteoarthritis: a 5-year follow-up study.

    PubMed

    Holla, Jasmijn F M; van der Leeden, Marike; Heymans, Martijn W; Roorda, Leo D; Bierma-Zeinstra, Sita M A; Boers, Maarten; Lems, Willem F; Steultjens, Martijn Pm; Dekker, Joost

    2014-07-01

    Knee osteoarthritis (OA) is a leading cause of activity limitations. The knee OA population is likely to consist of subgroups. The aim of the present study was to identify homogeneous subgroups with distinct trajectories of activity limitations in patients with early symptomatic knee OA and to describe characteristics of these subgroups. Follow-up data over a period of 5 years of 697 participants with early symptomatic knee OA from the Cohort Hip and Cohort Knee (CHECK) were used. Activity limitations were measured yearly with the Western Ontario and McMaster Universities Osteoarthritis Index. Latent class growth analyses identified homogeneous subgroups with distinct trajectories of activity limitations. Multivariable regression analyses examined differences in characteristics between the subgroups. Three subgroups were identified. Participants in Subgroup 1 ('good outcome'; n=330) developed or displayed slight activity limitations over time. Participants in Subgroup 2 ('moderate outcome'; n=257) developed or displayed moderate activity limitations over time. Participants in subgroup 3 ('poor outcome'; n=110) developed or displayed severe activity limitations over time. Compared with the 'good outcome' subgroup, the 'moderate outcome' and 'poor outcome' subgroups were characterised by: younger age, higher body mass index, greater pain, bony tenderness, reduced knee flexion, hip pain, osteophytosis, ≥3 comorbidities, lower vitality or avoidance of activities. Based on the 5-year course of activity limitations, we identified homogeneous subgroups of knee OA patients with good, moderate or poor outcome. Characteristics of these subgroups were consistent with existing knowledge on prognostic factors regarding activity limitations, which supports the validity of this classification. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Position-Specific Hip and Knee Kinematics in NCAA Football Athletes

    PubMed Central

    Deneweth, Jessica M.; Pomeroy, Shannon M.; Russell, Jason R.; McLean, Scott G.; Zernicke, Ronald F.; Bedi, Asheesh; Goulet, Grant C.

    2014-01-01

    Background: Femoroacetabular impingement is a debilitating hip condition commonly affecting athletes playing American football. The condition is associated with reduced hip range of motion; however, little is known about the range-of-motion demands of football athletes. This knowledge is critical to effective management of this condition. Purpose: To (1) develop a normative database of game-like hip and knee kinematics used by football athletes and (2) analyze kinematic data by playing position. The hypothesis was that kinematics would be similar between running backs and defensive backs and between wide receivers and quarterbacks, and that linemen would perform the activities with the most erect lower limb posture. Study Design: Descriptive laboratory study. Methods: Forty National Collegiate Athletic Association (NCAA) football athletes, representing 5 playing positions (quarterback, defensive back, running back, wide receiver, offensive lineman), executed game-like maneuvers while lower body kinematics were recorded via optical motion capture. Passive hip range of motion at 90° of hip flexion was assessed using a goniometer. Passive range of motion, athlete physical dimensions, hip function, and hip and knee rotations were submitted to 1-way analysis of variance to test for differences between playing positions. Correlations between maximal hip and knee kinematics and maximal hip kinematics and passive range of motion were also computed. Results: Hip and knee kinematics were similar across positions. Significant differences arose with linemen, who used lower maximal knee flexion (mean ± SD, 45.04° ± 7.27°) compared with running backs (61.20° ± 6.07°; P < .001) and wide receivers (54.67° ± 6.97°; P = .048) during the cut. No significant differences were found among positions for hip passive range of motion (overall means: 102° ± 15° [flexion]; 25° ± 9° [internal rotation]; 25° ± 8° [external rotation]). Several maximal hip measures were found

  19. Quantifying knee mechanics during balance training exercises.

    PubMed

    Benson, Lauren C; Almonroeder, Thomas G; O'Connor, Kristian M

    2017-01-01

    Patellofemoral pain (PFP) is common among runners and those recovering from anterior cruciate ligament reconstruction. Training programs designed to prevent or treat injuries often include balance training, although balance interventions have been reported to coincide with more knee injuries. Knowledge of the effect of balance exercises on knee mechanics may be useful when designing training programs. High knee abduction moment has been implicated in the development of PFP, and imbalance between vastus lateralis (VL) and vastus medialis oblique (VMO) may contribute to patellofemoral stress. The purpose was to quantify knee abduction moment and vasti muscle activity during balance exercises. Muscle activity of VMO and VL, three-dimensional lower-extremity kinematics, and ground reaction forces of healthy recreational athletes (12M, 13F) were recorded during five exercises. Peak knee abduction moment, ratio of VMO:VL activity, and delay in onset of VMO relative to VL were quantified for each exercise. The influence of sex and exercise on each variable was determined using a mixed-model ANOVA. All analyses indicated a significant main effect of exercise, p<0.05. Follow-up comparisons showed low peak knee abduction moment and high VMO:VL ratio for the task with anterior-posterior motion. Delay of VMO relative to VL was similar among balance board tasks. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Wear Testing of Moderate Activities of Daily Living Using In Vivo Measured Knee Joint Loading

    PubMed Central

    Reinders, Jörn; Sonntag, Robert; Vot, Leo; Gibney, Christian; Nowack, Moritz; Kretzer, Jan Philippe

    2015-01-01

    Resumption of daily living activities is a basic expectation for patients provided with total knee replacements. However, there is a lack of knowledge regarding the impact of different activities on the wear performance. In this study the wear performance under application of different daily activities has been analyzed. In vivo load data for walking, walking downstairs/upstairs, sitting down/standing up, and cycling (50 W & 120 W) has been standardized for wear testing. Wear testing of each activity was carried out on a knee wear simulator. Additionally, ISO walking was tested for reasons of comparison. Wear was assessed gravimetrically and wear particles were analyzed. In vivo walking produced the highest overall wear rates, which were determined to be three times higher than ISO walking. Moderate wear rates were determined for walking upstairs and downstairs. Low wear rates were determined for standing up/sitting down and cycling at power levels of 50 W and 120 W. The largest wear particles were observed for cycling. Walking based on in vivo data has been shown to be the most wear-relevant activity. Highly demanding activities (stair climbing) produced considerably less wear. Taking into account the expected number of loads, low-impact activities like cycling may have a greater impact on articular wear than highly demanding activities. PMID:25811996

  1. Reciprocal activation of gastrocnemius and soleus motor units is associated with fascicle length change during knee flexion

    PubMed Central

    Lauber, Benedikt; Lichtwark, Glen A.; Cresswell, Andrew G.

    2014-01-01

    Abstract While medial gastrocnemius (MG) and soleus (SOL) are considered synergists, they are anatomically exclusive in that SOL crosses only the ankle, while MG crosses both the knee and ankle. Due to the force‐length properties of both active and passive structures, activation of SOL and MG must be constantly regulated to provide the required joint torques for any planned movement. As such, the aim of this study was to investigate the neural regulation of MG and SOL when independently changing their length by changing only the knee joint angle, thus exclusively altering the length of MG fibers. MG and SOL motor units (MU) were recorded intramuscularly along with ultrasound imaging of MG and SOL fascicle lengths, while moving the knee through 60° of rotation and maintaining a low level of voluntary plantar flexor torque. The results showed a reciprocal activation of MG and SOL as the knee was moved into flexion and extension. A clear reduction in MG MU firing rates occurred as the knee was flexed (MG fascicles shortening), with de‐recruitment of most MG MU occurring at close to full knee flexion. A concomitant increase in SOL MU activity was observed while no change in the length of its fascicles was found. The opposite effects were found when the knee was moved into extension. A strong correlation (ICC = 0.78) was found between the fascicle length at which MG MUs were de‐recruited and subsequently re‐recruited. This was stronger than the relationship of de‐recruitment and re‐recruitment with knee angle (ICC = 0.52), indicating that in this instance, muscle fascicle length rather than joint angle is more influential in regulating MG recruitment. Such a reciprocal arrangement like the one presented here for SOL and MG is essential for human voluntary movements such as walking or cycling. PMID:24920126

  2. An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force.

    PubMed

    MacDonald, Graham Z; Penney, Michael D H; Mullaley, Michelle E; Cuconato, Amanda L; Drake, Corey D J; Behm, David G; Button, Duane C

    2013-03-01

    Foam rolling is thought to improve muscular function, performance, overuse, and joint range of motion (ROM); however, there is no empirical evidence demonstrating this. Thus, the objective of the study was to determine the effect of self-myofascial release (SMR) via foam roller application on knee extensor force and activation and knee joint ROM. Eleven healthy male (height 178.9 ± 3.5 cm, mass 86.3 ± 7.4 kg, age 22.3 ± 3.8 years) subjects who were physically active participated. Subjects' quadriceps maximum voluntary contraction force, evoked force and activation, and knee joint ROM were measured before, 2 minutes, and 10 minutes after 2 conditions: (a) 2, 1-minute trials of SMR of the quadriceps via a foam roller and (b) no SMR (Control). A 2-way analysis of variance (condition × time) with repeated measures was performed on all dependent variables recorded in the precondition and postcondition tests. There were no significant differences between conditions for any of the neuromuscular dependent variables. However, after foam rolling, subjects' ROM significantly (p < 0.001) increased by 10° and 8° at 2 and 10 minutes, respectively. There was a significant (p < 0.01) negative correlation between subjects' force and ROM before foam rolling, which no longer existed after foam rolling. In conclusion, an acute bout of SMR of the quadriceps was an effective treatment to acutely enhance knee joint ROM without a concomitant deficit in muscle performance.

  3. Effect of ACL graft material on anterior knee force during simulated in vivo ovine motion applied to the porcine knee: An in vitro examination of force during 2000 cycles.

    PubMed

    Boguszewski, Daniel V; Wagner, Christopher T; Butler, David L; Shearn, Jason T

    2015-12-01

    This study determined how anterior cruciate ligament (ACL) reconstruction affected the magnitude and temporal patterns of anterior knee force and internal knee moment during 2000 cycles of simulated gait. Porcine knees were tested using a six degree-of-freedom robot, examining three porcine allograft materials compared with the native ACL. Reconstructions were performed using: (1) bone-patellar tendon-bone allograft (BPTB), (2) reconstructive porcine tissue matrix (RTM), or (3) an RTM-polymer hybrid construct (Hybrid). Forces and moments were measured over the entire gait cycle and contrasted at heel strike, mid stance, toe off, and peak flexion. The Hybrid construct performed the best, as magnitude and temporal changes in both anterior knee force and internal knee moment were not different from the native ACL knee. Conversely, the RTM knees showed greater loss in anterior knee force during 2000 cycles than the native ACL knee at heel strike and toe off, with an average force loss of 46%. BPTB knees performed the least favorably, with significant loss in anterior knee force at all key points and an average force loss of 61%. This is clinically relevant, as increases in post-operative knee laxity are believed to play a role in graft failure and early onset osteoarthritis. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  4. An exploratory study into the effects of a 20 minute crushed ice application on knee joint position sense during a small knee bend.

    PubMed

    Alexander, Jill; Selfe, James; Oliver, Ben; Mee, Daniel; Carter, Alexandra; Scott, Michelle; Richards, Jim; May, Karen

    2016-03-01

    The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play or activity immediately following cryotherapy application at the knee. The aim of this study was to investigate whether a 20 min application of crushed ice at the knee immediately affects knee joint position sense during a small knee bend. Pre- and post-intervention. University movement analysis laboratory. Eleven healthy male participants. Kinematics of the knee were measured during a weight bearing functional task pre and post cryotherapy intervention using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden). Tissue cooling was measured via a digital thermometer at the knee. Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning in both sagittal (P = .035) and coronal (P = .011) planes during the descent phase of a small knee bend following cryotherapy. In conclusion a 20 min application of crushed ice to the knee has an adverse effect on knee joint repositioning. Team doctors, clinicians, therapists and athletes should consider these findings when deciding to return an athlete to functional weight bearing tasks immediately following ice application at the knee, due to the potential increase risk of injury. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. The effects of fatigue on the resultant joint moment, agonist and antagonist electromyographic activity at different angles during dynamic knee extension efforts.

    PubMed

    Kellis, E

    1999-06-01

    Examination of the effects of fatigue on antagonist function can provide information on the role of antagonists in limiting the resultant joint moment and stabilizing the knee. Therefore, the purpose of this study was to examine the moment, agonist and antagonist electromyographic (EMG) activity levels at different angular positions during an isokinetic muscular endurance knee extension test. Fifteen healthy males (age 22.6+/-1.9 yr) performed 34 maximal isokinetic concentric efforts of the knee extensors at 120 degrees s(-1). The EMG activity of vastus medialis and biceps femoris was recorded using surface electrodes. The motion ranged from 90 degrees to 0 degrees of knee flexion. The average moment and average EMG (AEMG) at 10-35 degrees, 36-55 degrees and 56-80 degrees angular position intervals were calculated for each repetition. Twenty eight efforts were further analysed. The moment of force demonstrated a decline of 70% at the end of the test. Two-way repeated measures analysis of variance tests indicated that this decline was significant (p < 0.05). No significant effects of angular position on fatigue moment characteristics were found. The agonist (vastus medialis) AEMG during the first repetition demonstrated a significant increase of 40-60% towards the middle part of the test (p < 0.05). In the second part of the test, the VM AEMG at longer muscle lengths was significantly higher compared to the initial efforts whereas the AEMG at short muscle lengths returned to initial values. The antagonist AEMG at all angular positions did not change significantly during the test. The decline in the resultant joint moment could be attributed to the effects of fatigue on the agonist muscle function. The agonist AEMG fatigue-patterns are dependent on the length of the muscle and may be due to alterations in the motor unit recruitment and/or activation failure in the quadriceps muscle. The biceps femoris maintains constant submaximal (21-33% of the maximum) AEMG

  6. Motion Sensor Reactivity in Physically Active Young Adults

    ERIC Educational Resources Information Center

    Behrens, Timothy K.; Dinger, Mary K.

    2007-01-01

    The purpose of this study was to examine whether young adults changed their physical activity (PA) behavior when wearing motion sensors. PA patterns of 119 young adults (M age = 20.82 years, SD = 1.50, M body mass index = 23.93 kg/m[superscript 2] , SD = 4.05) were assessed during 2 consecutive weeks. In Week 1, participants wore an accelerometer.…

  7. The effect of horse-riding simulator exercise on the gait, muscle strength and muscle activation in elderly people with knee osteoarthritis

    PubMed Central

    Kim, Seung-Kyu; Kim, Seong-Gil; HwangBo, Gak

    2017-01-01

    [Purpose] The aim of this study was to examine the effects of horse-riding simulator exercise on gait ability and muscle strength, muscle activation in elderly with knee osteoarthritis. [Subjects and Methods] Thirty elderly patients with knee osteoarthritis were recruited, a horse-riding simulator group consisted of fifteen subjects and they performed exercise three times a week for eight weeks. And each exercise was performed, horse riding simulator exercise for 15 minutes and knee strengthening exercise for 15 minutes. Knee strengthening exercise group consisted of fifteen subjects and performed knee strengthening exercise for 30 minutes. [Results] The horse-riding simulator group showed significant differences after the intervention in timed 10-meter walk test (10MWT), muscle strength, muscle activation. [Conclusion] The results of this study indicate that horse-riding simulator exercise is effective on knee osteoarthritis. Therefore, horse-riding simulator exercise can be used for gait training for knee osteoarthritis. PMID:28533611

  8. Cooling Does Not Affect Knee Proprioception

    PubMed Central

    Ozmun, John C.; Thieme, Heather A.; Ingersoll, Christopher D.; Knight, Kenneth L.

    1996-01-01

    The effect of cooling on proprioception of the knee has not been studied extensively. In this study, we investigated the movement reproduction (timing and accuracy) aspect of proprioception. Subjects were tested under two conditions: a 20-minute application of ice and control. Proprioceptive accuracy and timing were measured by passively moving the knee, then comparing the subject's active reproduction of the passive movement. Subjects were blindfolded, then tested in three sectors of the knee's range of motion: 90° to 60°, 60° to 30°, and 30° to full extension. Ice application had no apparent effect on the subject's ability to perform accurate movement reproductions in the sectors tested. However, accuracy of the subject's final angle reproduction varied between the sectors as did the total time of the movement. One possible explanation for the difference between sectors is that different receptors are active at different points in the knee's range of motion. We conclude that cooling the knee joint for 20 minutes does not have an adverse effect on proprioception. PMID:16558379

  9. Cooling does not affect knee proprioception.

    PubMed

    Ozmun, J C; Thieme, H A; Ingersoll, C D; Knight, K L

    1996-01-01

    The effect of cooling on proprioception of the knee has not been studied extensively. In this study, we investigated the movement reproduction (timing and accuracy) aspect of proprioception. Subjects were tested under two conditions: a 20-minute application of ice and control. Proprioceptive accuracy and timing were measured by passively moving the knee, then comparing the subject's active reproduction of the passive movement. Subjects were blindfolded, then tested in three sectors of the knee's range of motion: 90 degrees to 60 degrees , 60 degrees to 30 degrees , and 30 degrees to full extension. Ice application had no apparent effect on the subject's ability to perform accurate movement reproductions in the sectors tested. However, accuracy of the subject's final angle reproduction varied between the sectors as did the total time of the movement. One possible explanation for the difference between sectors is that different receptors are active at different points in the knee's range of motion. We conclude that cooling the knee joint for 20 minutes does not have an adverse effect on proprioception.

  10. In vivo prompt gamma neutron activation analysis for the screening of boron-10 distribution in a rabbit knee: a simulation study

    NASA Astrophysics Data System (ADS)

    Zhu, X.; Clackdoyle, R.; Shortkroff, S.; Yanch, J.

    2008-05-01

    Boron neutron capture synovectomy (BNCS) is under development as a potential treatment modality for rheumatoid arthritis (RA). RA is characterized by the inflammation of the synovium (the membrane lining articular joints), which leads to pain and a restricted range of motion. BNCS is a two-part procedure involving the injection of a boronated compound directly into the diseased joint followed by irradiation with a low-energy neutron beam. The neutron capture reactions taking place in the synovium deliver a local, high-linear energy transfer (LET) dose aimed at destroying the inflamed synovial membrane. For successful treatment via BNCS, a boron-labeled compound exhibiting both high synovial uptake and long retention time is necessary. Currently, the in vivo uptake behavior of potentially useful boronated compounds is evaluated in the knee joints of rabbits in which arthritis has been induced. This strategy involves the sacrifice and dissection of a large number of animals. An in vivo 10B screening approach is therefore under investigation with the goal of significantly reducing the number of animals needed for compound evaluation via dissection studies. The 'in vivo prompt gamma neutron activation analysis' (IVPGNAA) approach uses a narrow neutron beam to irradiate the knee from several angular positions following the intra-articular injection of a boronated compound whose uptake characteristics are unknown. A high-purity germanium detector collects the 478 keV gamma photons produced by the 10B capture reactions. The 10B distribution in the knee is then reconstructed by solving a system of simultaneous equations using a weighted least squares algorithm. To study the practical feasibility of IVPGNAA, simulation data were generated with the Monte Carlo N-particle transport code. The boron-containing region of a rabbit knee was partitioned into 8 compartments, and the 10B prompt gamma signals were tallied from 16 angular positions. Results demonstrate that for this

  11. Thermally activated depinning motion of contact lines in pseudopartial wetting.

    PubMed

    Du, Lingguo; Bodiguel, Hugues; Colin, Annie

    2014-07-01

    We investigate pressure-driven motion of liquid-liquid menisci in circular tubes, for systems in pseudopartial wetting conditions. The originality of this type of wetting lies in the coexistence of a macroscopic contact angle with a wetting liquid film covering the solid surface. Focusing on small capillary numbers, we report observations of an apparent contact angle hysteresis at first sight similar to the standard partial wetting case. However, this apparent hysteresis exhibits original features. We observe very long transient regimes before steady state, up to several hundreds of seconds. Furthermore, in steady state, the velocities are nonzero, meaning that the contact line is not strongly pinned to the surface defects, but are very small. The velocity of the contact line tends to vanish near the equilibrium contact angle. These observations are consistent with the thermally activated depinning theory that has been proposed to describe partial wetting systems on disordered substrates and suggest that a single physical mechanism controls both the hysteresis (or the pinning) and the motion of the contact line. The proposed analysis leads to the conclusion that the depinning activated energy is lower with pseudopartial wetting systems than with partial wetting ones, allowing the direct observation of the thermally activated motion of the contact line.

  12. Effect of posterior cruciate ligament creep on muscular co-activation around knee: a pilot study.

    PubMed

    Cheng, Xiangrong; Zhang, Tailai; Shan, Xinhai; Wang, Jingyuan

    2014-04-01

    The effect of posterior cruciate ligament (PCL) on muscle co-activation (MCO) is not known though MCO has been extensively studied. The purpose of the study was to investigate the effect of PCL creep on MCO and on joint moment around the knee. Twelve males and twelve females volunteered for this study. PCL creep was estimated via tibial posterior displacement which was elicited by a 20kg dumbbell hanged on horizontal shank near patella for 10min. Electromyography activity from both rectus femoris and biceps femoris as well as muscle strength on the right thigh was recorded synchronically during knee isokinetic flexion-extension performance in speed of 60deg/s as well as 120deg/s on a dynamometer before and after PCL creep. A one-way ANOVA with repeated measures was used to evaluate the effect of creep, gender and speed. The results showed that significant tibial posterior displacement was found (p=0.01) in both male and female groups. No significant increase of joint moment was found in flexion as well as in extension phase in both female and male groups. There was a significant effect of speed (p=0.036) on joint moment in extension phase. Co-activation index (CI) decreased significantly (p=0.049) in extension phase with a significant effect of gender (p⩽0.001). It was concluded that creep developed in PCL due to static posterior load on the proximal tibia could significantly elicit the increase of the activation of agonist muscles but with no compensation from the antagonist in flexion as well as in extension phase. The creep significantly elicited the decrease of the antagonist-agonist CI in extension phase. MCO in females was reduced significantly in extension phase. It was suggested that PCL creep might be one of risk factors to the knee injury in sports activity. Copyright © 2014. Published by Elsevier Ltd.

  13. 3D active-passive response of human knee joint in gait is markedly altered when simulated as a planar 2D joint.

    PubMed

    Marouane, H; Shirazi-Adl, A; Adouni, M

    2017-04-01

    Musculoskeletal models of the lower extremity make a number of important assumptions when attempting to estimate muscle forces and tibiofemoral compartmental loads in activities such as gait. The knee is commonly idealized as a planar 2D joint in the sagittal plane with no consideration of motions and equilibrium in remaining planes. With muscle forces predicted, the static equilibrium in the frontal plane is then used to estimate compartmental loads neglecting also joint passive resistance and assuming condylar contact centers. We aimed here to comprehensively investigate the effects of such assumptions on predicted results. While simulating gait and using a hybrid lower extremity model that incorporates a detailed validated 3D finite element model of the knee joint, analyses are repeated with out-of-sagittal plane rotations and moment equilibrium equations neglected (2D model) and tibial compartmental forces estimated using equilibrium in the frontal plane while disregarding passive resistance and assuming fixed contact centers (1D model). Large unbalanced out-of-sagittal plane moments reaching peaks of 30 Nm abduction moment and 12 Nm internal moment at 25 % stance period are computed that are overlooked in the 2D model. Consideration of the knee as a planar 2D joint substantially diminishes muscle forces, anterior cruciate ligament force and tibiofemoral contact forces/stresses when compared to the 3D reference model. Total tibiofemoral contact force peaks at 25 % stance at 4.2 BW in the 3D model that drops to 3.0 BW in the 2D model. The location of contact centers on each plateau also noticeably alters (by as much as 5 mm). Tibiofemoral contact forces further change when the location of contact centers on each plateau is fixed. Results highlight the importance of accurate simulation of 3D motions and equilibrium equations as well as passive joint properties and contact centers.

  14. Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty.

    PubMed

    Pellegrini, Christine A; Ledford, Gwendolyn; Chang, Rowland W; Cameron, Kenzie A

    2017-05-05

    We sought to identify patient-reported barriers and facilitators to healthy eating and physical activity among patients before or after knee arthroplasty. Twenty patients with knee osteoarthritis aged 40-79 years who had knee arthroplasty surgery scheduled or completed within 3 months were interviewed. Interview topics included perceived barriers and facilitators to healthy eating and activity before or after surgery. Interviews were coded and analyzed using constant comparative analysis. Interviews were completed with 11 pre-operative (67.1 ± 7.6 years, 45.5% female, BMI 31.2 ± 6.3) and nine post-operative patients (61.7 ± 11.7 years, 44.4% female, BMI 30.2 ± 4.7 kg/m(2)). The most commonly identified personal barriers to healthy eating identified were desire for high-fat/high-calorie foods, managing overconsumption and mood. Factors related to planning, portion control and motivation to improve health were identified as healthy eating facilitators. Identified personal barriers for activity included pain, physical limitations and lack of motivation, whereas facilitators included having motivation to improve knee symptoms/outcomes, personal commitment to activity and monitoring activity levels. Identifying specific eating and activity barriers and facilitators, such as mood and motivation to improve outcomes, provides critical insight from the patient perspective, which will aid in developing weight management programs during rehabilitation for knee arthroplasty patients. Implications for rehabilitation This study provides insight into the identified barriers and facilitators to healthy eating and physical activity in knee arthroplasty patients, both before and after surgery. Intrapersonal barriers that may hinder engagement in physical activity and rehabilitation include pain, physical limitations and lack of motivation; factors that may help to improve activity and the rehabilitation process include being motivated to improve knee outcomes

  15. Motion Sensor Use for Physical Activity Data: Methodological Considerations

    PubMed Central

    McCarthy, Margaret; Grey, Margaret

    2015-01-01

    Background Physical inactivity continues to be a major risk factor for cardiovascular disease, and only one half of adults in the United States meet physical activity (PA) goals. PA data are often collected for surveillance or for measuring change after an intervention. One of the challenges in PA research is quantifying exactly how much and what type of PA is taking place—especially because self-report instruments have inconsistent validity. Objective The purpose is to review the elements to consider when collecting PA data via motion sensors, including the difference between PA and exercise; type of data to collect; choosing the device; length of time to monitor PA; instructions to the participants; and interpretation of the data. Methods The current literature on motion sensor research was reviewed and synthesized to summarize relevant considerations when using a motion sensor to collect PA data. Results Exercise is a division of PA that is structured, planned, and repetitive. Pedometer data includes steps taken, and calculated distance and energy expenditure. Accelerometer data includes activity counts and intensity. The device chosen depends on desired data, cost, validity, and ease of use. Reactivity to the device may influence the duration of data collection. Instructions to participants may vary depending on purpose of the study. Experts suggest pedometer data be reported as steps—since that is the direct output—and distance traveled and energy expenditure are estimated values. Accelerometer count data may be analyzed to provide information on time spent in moderate or vigorous activity. Discussion Thoughtful decision making about PA data collection using motion sensor devices is needed to advance nursing science. PMID:26126065

  16. The Effects of Postdischarge Telephone Counseling and Short Message Service on the Knee Function, Activities of Daily Living, and Life Satisfaction of Patients Undergoing Total Knee Replacement.

    PubMed

    Park, Kyung Hye; Song, Mi Ryeong

    No study comparing short message service (SMS) texts and telephone counseling for patients undergoing total knee replacement (TKR) has been reported. The purpose of the study was to provide postdischarge telephone counseling and SMS texts to TKR patients and to analyze the effects of these services on their knee function (KF), activities of daily living (ADL), and life satisfaction (LS). This study used a randomized clinical trial design. This study was conducted with 40 patients (counseling group: 21; SMS group: 19). In the telephone counseling group and the SMS group, KF, ADL, and LS were assessed before surgery and 1 and 3 months after TKR. Telephone counseling and SMS texts have the same effects on KF, ADL, and LS of TKR patients. Future research is needed to determine optimal frequency and duration of post-TKR SMS to support patients who have undergone TKR.

  17. A study on muscle activity and ratio of the knee extensor depending on the types of squat exercise

    PubMed Central

    Kang, Jeong-Il; Park, Joon-Su; Choi, Hyun; Jeong, Dae-Keun; Kwon, Hye-Min; Moon, Young-Jun

    2017-01-01

    [Purpose] For preventing the patellofemoral pain syndrome, this study aims to suggest a proper squat method, which presents selective muscle activity of Vastus Medialis Oblique and muscle activity ratios of Vastus Medialis Oblique/Vastus Lateralis by applying squat that is a representative weight bearing exercise method in various ways depending on the surface conditions and knee bending angles. [Subjects and Methods] An isometric squat that was accompanied by hip adduction, depending on the surface condition and the knee joint flexion angle, was performed by 24 healthy students. The muscle activity and the ratio of muscle activity were measured. [Results] In a comparison of muscle activity depending on the knee joint flexion angle on a weight-bearing surface, the vastus medialis oblique showed a significant difference at 15° and 60°. Meanwhile, in a comparison of the muscle activity ratio between the vastus medialis oblique and the vastus lateralis depending on the knee joint flexion angle on a weight-bearing surface, significant differences were observed at 15° and 60°. [Conclusion] An efficient squat exercise posture for preventing the patellofemoral pain syndrome is to increase the knee joint bending angle on a stable surface. But it would be efficient for patients with difficulties in bending the knee joint to keep a knee joint bending angle of 15 degrees or less on an unstable surface. It is considered that in future, diverse studies on selective Vastus Medialis Oblique strengthening exercise methods would be needed after applying them to patients with the patellofemoral pain syndrome. PMID:28210036

  18. A study on muscle activity and ratio of the knee extensor depending on the types of squat exercise.

    PubMed

    Kang, Jeong-Il; Park, Joon-Su; Choi, Hyun; Jeong, Dae-Keun; Kwon, Hye-Min; Moon, Young-Jun

    2017-01-01

    [Purpose] For preventing the patellofemoral pain syndrome, this study aims to suggest a proper squat method, which presents selective muscle activity of Vastus Medialis Oblique and muscle activity ratios of Vastus Medialis Oblique/Vastus Lateralis by applying squat that is a representative weight bearing exercise method in various ways depending on the surface conditions and knee bending angles. [Subjects and Methods] An isometric squat that was accompanied by hip adduction, depending on the surface condition and the knee joint flexion angle, was performed by 24 healthy students. The muscle activity and the ratio of muscle activity were measured. [Results] In a comparison of muscle activity depending on the knee joint flexion angle on a weight-bearing surface, the vastus medialis oblique showed a significant difference at 15° and 60°. Meanwhile, in a comparison of the muscle activity ratio between the vastus medialis oblique and the vastus lateralis depending on the knee joint flexion angle on a weight-bearing surface, significant differences were observed at 15° and 60°. [Conclusion] An efficient squat exercise posture for preventing the patellofemoral pain syndrome is to increase the knee joint bending angle on a stable surface. But it would be efficient for patients with difficulties in bending the knee joint to keep a knee joint bending angle of 15 degrees or less on an unstable surface. It is considered that in future, diverse studies on selective Vastus Medialis Oblique strengthening exercise methods would be needed after applying them to patients with the patellofemoral pain syndrome.

  19. Anterior translation and rotational stability of anterior cruciate ligament-deficient knees during walking: speed and turning direction.

    PubMed

    Yim, Ji Hyeon; Seon, Jong Keun; Kim, Young Kwan; Jung, Sung Taek; Shin, Choongsoo S; Yang, Dong Hyun; Rhym, Inn Su; Song, Eun Kyoo

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is one of the most common injuries associated with the knee. After ACL injury, knee joint stability can be altered, resulting in abnormal loading during functional activities. Since ACL-deficient (ACLD) knees are also vulnerable to translational and rotational instability, patients need to be wary of certain motions encountered in daily life. The present study investigated the effect of walking speed and pivoting directional change during gait on knee joint kinematics of ACLD knees. We hypothesized that faster walking and crossover turning would induce severe kinematic changes. Thirty-five patients (22 males and 13 females) having a unilateral isolated subacute ACLD knee (from 1 to 3 months after injury) and contralateral intact (CLI) knee participated in this study. Spatiotemporal parameters, three-dimensional (3D) knee joint angles, and anterior-posterior (AP) translation were obtained by a 3D high-speed motion-capturing system. The CLI knee of each patient served as the control. The calculated AP stability and knee joint angles were used to test the research hypothesis. Mixed two-way repeated measures analysis of variance was performed to clarify the effects of walking speed and pivoting direction with a significance of 0.05. When a significance of mean comparison was detected, a post hoc test was performed. Significant and consistent increased AP translation of the tibia relative to the femur at the whole stance phase of the gait cycle was evident in ACLD knees compared to CLI knees for normal and faster (20 % greater than normal) walking speeds. Faster walking speed did not induce significantly more anterior location of the tibia. In addition, ACLD knees were significantly less extended than CLI knees during a large portion of midstance. Although there was a consistent varus offset between the curves of ACLD and CLI knees, the difference did not reach statistical significance during the stance phase. Also, ACLD knees

  20. Cortical activity differs between position- and force-control knee extension tasks.

    PubMed

    Poortvliet, Peter C; Tucker, Kylie J; Finnigan, Simon; Scott, Dion; Sowman, Paul; Hodges, Paul W

    2015-12-01

    Neural control differs between position- and force-control tasks as evident from divergent effects of fatigue and pain. Unlike force-control tasks, position-control tasks focus on a postural goal to maintain a joint angle. Cortical involvement is suggested to be less during postural control, but whether this differs between position- and force-control paradigms remains unclear. Coherence estimates the functional communication between spatially distinct active regions within the cortex (cortico-cortical coherence; CCC) and between the cortex and muscles (corticomuscular coherence; CMC). We investigated whether cortical involvement differed between force-control and more posturally focused, position-control tasks. Seventeen adults performed position- and force-control knee extensor efforts at a submaximal load (10 % maximum voluntary contraction). Surface electromyography was recorded from the right knee extensor and flexor muscles and brain activity using electroencephalography (EEG). CCC and CMC in the beta (13-30 Hz) and gamma (30-45 Hz) frequency bands were calculated between combinations of intra- and inter-hemispheric pairs of electrodes, and between four EEG electrodes that approximated the left motor cortical area, and right knee extensor EMG, respectively. Differences in EEG power and muscle activity were also calculated. CCC was greater across distributed regions in the force-control task. Beta EEG power in the left hemisphere was higher for the position-control task. Although averaged CMC data differed between tasks, there was no task difference for individual CMC data. Muscle activity and force did not differ between tasks. The results demonstrate differential cortical contributions to control force- versus position-control tasks. This might contribute to differences in performance outcomes of these tasks that have been shown previously.

  1. Muscle activation and knee biomechanics during squatting and lunging after lower extremity fatigue in healthy young women.

    PubMed

    Longpré, Heather S; Acker, Stacey M; Maly, Monica R

    2015-02-01

    Muscle activations and knee joint loads were compared during squatting and lunging before and after lower extremity neuromuscular fatigue. Electromyographic activations of the rectus femoris, vastus lateralis and biceps femoris, and the external knee adduction and flexion moments were collected on 25 healthy women (mean age 23.5 years, BMI of 23.7 kg/m(2)) during squatting and lunging. Participants were fatigued through sets of 50 isotonic knee extensions and flexions, with resistance set at 50% of the peak torque achieved during a maximum voluntary isometric contraction. Fatigue was defined as a decrease in peak isometric knee extension or flexion torque ≥25% from baseline. Co-activation indices were calculated between rectus femoris and biceps femoris; and between vastus lateralis and biceps femoris. Fatigue decreased peak isometric extension and flexion torques (p<0.05), mean vastus lateralis activation during squatting and lunging (p<0.05), and knee adduction and flexion moments during lunging (p<0.05). Quadriceps activations were greater during lunging than squatting (p<0.05). Thus, fatigue altered the recruitment strategy of the quadriceps during squatting and lunging. Lunging challenges quadriceps activation more than squatting in healthy, young women. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Collective motion in an active suspension of Escherichia coli bacteria

    NASA Astrophysics Data System (ADS)

    Gachelin, J.; Rousselet, A.; Lindner, A.; Clement, E.

    2014-02-01

    We investigate experimentally the emergence of collective motion in the bulk of an active suspension of Escherichia coli bacteria. When increasing the concentration from a dilute to a semi-dilute regime, we observe a continuous crossover from a dynamical cluster regime to a regime of ‘bio-turbulence’ convection patterns. We measure a length scale characterizing the collective motion as a function of the bacteria concentration. For bacteria fully supplied with oxygen, the increase of the correlation length is almost linear with concentration and at the largest concentrations tested, the correlation length could be as large as 24 bacterial body sizes (or 7-8 when including the flagella bundle). In contrast, under conditions of oxygen shortage the correlation length saturates at a value of around 7 body lengths.

  3. Articular contact kinematics of the knee before and after a cruciate retaining total knee arthroplasty.

    PubMed

    Li, Chunbao; Hosseini, Ali; Tsai, Tsung-Yuan; Kwon, Young-Min; Li, Guoan

    2015-03-01

    Accurate knowledge of tibiofemoral articular contact kinematics of the knee after total knee arthroplasty (TKA) is important for understanding the intrinsic knee biomechanics and improving the longevity of the components. The objective of this study was to compare the in vivo articular contact kinematics of the knees with end-stage medial osteoarthritis (OA) during a weight-bearing, single leg lunge activity before and after a posterior cruciate retaining TKA (CR-TKA) using a dual fluoroscopic imaging technique. We found that the CR-TKA resulted in more posterior contact positions on the tibial surface and a reduced range of motion in the medial and lateral compartments. The distances between medial and lateral contact locations in the CR-TKA knees were statistically larger than the OA knees. The articular contact centers have shifted from medial side of the tibial plateau pre-operatively to the lateral side after operation. This study indicated that the CR-TKA resulted in significant changes in contact kinematics of the knees in both anteroposterior and mediolateral directions. Further studies are needed to determine the influence of the altered in vivo contact kinematics on the longevity of polyethylene liner and long term clinical outcomes of the TKA. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  4. Influence of knee flexion angle and age on triceps surae muscle activity during heel raises.

    PubMed

    Hébert-Losier, Kim; Schneiders, Anthony G; García, José A; Sullivan, S John; Simoneau, Guy G

    2012-11-01

    Triceps surae and Achilles tendon injuries are frequent in sports medicine, particularly in middle-aged adults. Muscle imbalances and weakness are suggested to be involved in the etiology of these conditions, with heel-raise testing often used to assess and treat triceps surae (TS) injuries. Although heel raises are recommended with the knee straight for gastrocnemius and bent for soleus (SOL), the extent of muscle selectivity in these positions is not clear. This study aimed to determine the influence of knee angle and age on TS muscle activity during heel raises. Forty-eight healthy men and women were recruited from a younger-aged (18-25 years) and middle-aged (35-45 years) population. All the subjects performed unilateral heel raises in 0° and 45° knee flexion (KF). Soleus, gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) surface electromyography signals were processed to compute root-mean-square amplitudes, and data were analyzed using mixed-effects models and stepwise regression. The mean TS activity during heel raises was 23% of maximum voluntary isometric contraction when performed in 0° KF and 21% when in 45°. Amplitudes were significantly different between TS muscles (p < 0.001) and KF angles (p < 0.001), with a significant interaction (p < 0.001). However, the age of the population did not influence the results (p = 0.193). The findings demonstrate that SOL activity was 4% greater when tested in 45° compared with 0° KF and 5% lower in the GM and GL. The results are consistent with the recommended use of heel raises in select knee positions for assessing, training, and rehabilitating the SOL and gastrocnemius muscles; however, the 4-5% documented change in activity might not be enough to significantly influence clinical outcome measures or muscle-specific benefits. Contrary to expectations, TS activity did not distinguish between middle-aged and younger-aged adults, despite the higher injury prevalence in middle age.

  5. Motion of Euglena gracilis: Active fluctuations and velocity distribution

    NASA Astrophysics Data System (ADS)

    Romanczuk, P.; Romensky, M.; Scholz, D.; Lobaskin, V.; Schimansky-Geier, L.

    2015-07-01

    We study the velocity distribution of unicellular swimming algae Euglena gracilis using optical microscopy and active Brownian particle theory. To characterize a peculiar feature of the experimentally observed distribution at small velocities we use the concept of active fluctuations, which was recently proposed for the description of stochastically self-propelled particles [Romanczuk, P. and Schimansky-Geier, L., Phys. Rev. Lett. 106, 230601 (2011)]. In this concept, the fluctuating forces arise due to internal random performance of the propulsive motor. The fluctuating forces are directed in parallel to the heading direction, in which the propulsion acts. In the theory, we introduce the active motion via the depot model [Schweitzer, et al., Phys. Rev. Lett. 80(23), 5044 (1998)]. We demonstrate that the theoretical predictions based on the depot model with active fluctuations are consistent with the experimentally observed velocity distributions. In addition to the model with additive active noise, we obtain theoretical results for a constant propulsion with multiplicative noise.

  6. Stance controlled knee flexion improves stimulation driven walking after spinal cord injury

    PubMed Central

    2013-01-01

    Background Functional neuromuscular stimulation (FNS) restores walking function after paralysis from spinal cord injury via electrical activation of muscles in a coordinated fashion. Combining FNS with a controllable orthosis to create a hybrid neuroprosthesis (HNP) has the potential to extend walking distance and time by mechanically locking the knee joint during stance to allow knee extensor muscle to rest with stimulation turned off. Recent efforts have focused on creating advanced HNPs which couple joint motion (e.g., hip and knee or knee and ankle) to improve joint coordination during swing phase while maintaining a stiff-leg during stance phase. Methods The goal of this study was to investigate the effects of incorporating stance controlled knee flexion during loading response and pre-swing phases on restored gait. Knee control in the HNP was achieved by a specially designed variable impedance knee mechanism (VIKM). One subject with a T7 level spinal cord injury was enrolled and served as his own control in examining two techniques to restore level over-ground walking: FNS-only (which retained a stiff knee during stance) and VIKM-HNP (which allowed controlled knee motion during stance). The stimulation pattern driving the walking motion remained the same for both techniques; the only difference was that knee extensor stimulation was constant during stance with FNS-only and modulated together with the VIKM to control knee motion during stance with VIKM-HNP. Results Stance phase knee angle was more natural during VIKM-HNP gait while knee hyperextension persisted during stiff-legged FNS-only walking. During loading response phase, vertical ground reaction force was less impulsive and instantaneous gait speed was increased with VIKM-HNP, suggesting that knee flexion assisted in weight transfer to the leading limb. Enhanced knee flexion during pre-swing phase also aided flexion during swing, especially when response to stimulation was compromised. Conclusions

  7. Investigation on Inter-Limb Coordination and Motion Stability, Intensity and Complexity of Trunk and Limbs during Hands-Knees Crawling in Human Adults.

    PubMed

    Ma, Shenglan; Chen, Xiang; Cao, Shuai; Yu, Yi; Zhang, Xu

    2017-03-28

    This study aimed to investigate the inter-limb coordination pattern and the stability, intensity, and complexity of the trunk and limbs motions in human crawling under different speeds. Thirty healthy human adults finished hands-knees crawling trials on a treadmill at six different speeds (from 1 km/h to 2.5 km/h). A home-made multi-channel acquisition system consisting of five 3-axis accelerometers (ACC) and four force sensors was used for the data collection. Ipsilateral phase lag was used to represent inter-limb coordination pattern during crawling and power, harmonic ratio, and sample entropy of acceleration signals were adopted to depict the motion intensity, stability, and complexity of trunk and limbs respectively. Our results revealed some relationships between inter-limb coordination patterns and the stability and complexity of trunk movement. Trot-like crawling pattern was found to be the most stable and regular one at low speed in the view of trunk movement, and no-limb-pairing pattern showed the lowest stability and the greatest complexity at high speed. These relationships could be used to explain why subjects tended to avoid no-limb-pairing pattern when speed was over 2 km/h no matter which coordination type they used at low speeds. This also provided the evidence that the central nervous system (CNS) chose a stable inter-limb coordination pattern to keep the body safe and avoid tumbling. Although considerable progress has been made in the study of four-limb locomotion, much less is known about the reasons for the variety of inter-limb coordination. The research results of the exploration on the inter-limb coordination pattern choice during crawling from the standpoint of the motion stability, intensity, and complexity of trunk and limbs sheds light on the underlying motor control strategy of the human CNS and has important significance in the fields of clinical diagnosis, rehabilitation engineering, and kinematics research.

  8. Human-robot interaction: kinematics and muscle activity inside a powered compliant knee exoskeleton.

    PubMed

    Knaepen, Kristel; Beyl, Pieter; Duerinck, Saartje; Hagman, Friso; Lefeber, Dirk; Meeusen, Romain

    2014-11-01

    Until today it is not entirely clear how humans interact with automated gait rehabilitation devices and how we can, based on that interaction, maximize the effectiveness of these exoskeletons. The goal of this study was to gain knowledge on the human-robot interaction, in terms of kinematics and muscle activity, between a healthy human motor system and a powered knee exoskeleton (i.e., KNEXO). Therefore, temporal and spatial gait parameters, human joint kinematics, exoskeleton kinetics and muscle activity during four different walking trials in 10 healthy male subjects were studied. Healthy subjects can walk with KNEXO in patient-in-charge mode with some slight constraints in kinematics and muscle activity primarily due to inertia of the device. Yet, during robot-in-charge walking the muscular constraints are reversed by adding positive power to the leg swing, compensating in part this inertia. Next to that, KNEXO accurately records and replays the right knee kinematics meaning that subject-specific trajectories can be implemented as a target trajectory during assisted walking. No significant differences in the human response to the interaction with KNEXO in low and high compliant assistance could be pointed out. This is in contradiction with our hypothesis that muscle activity would decrease with increasing assistance. It seems that the differences between the parameter settings of low and high compliant control might not be sufficient to observe clear effects in healthy subjects. Moreover, we should take into account that KNEXO is a unilateral, 1 degree-of-freedom device.

  9. Activation to self-management and exercise in overweight and obese older women with knee osteoarthritis.

    PubMed

    Kawi, Jennifer; Schuerman, Sue; Alpert, Patricia T; Young, Daniel

    2015-12-01

    Knee osteoarthritis (OA) affects approximately 1 in 10 adults in the United States, with higher prevalence in women, aggravated by increased weight. This quasi-experimental pilot study implemented an online self-management (SM) program for older overweight and obese women with knee OA combined with a two-arm progressive exercise trial (walking and stepping groups). After the 10-week intervention using an interprofessional approach, activation to SM scores were significantly higher in all participants (N = 16) and between groups, with a higher increase in the stepping group. Those with higher activation scores pre-intervention obtained higher scores post-intervention. Activation levels also increased significantly among all participants with majority at the highest activation level. Follow-up data at 6 weeks and 6 months showed sustained SM and health-directed behaviors. These findings, although preliminary, highlight the value of combined SM and progressive exercise intervention using an interprofessional approach. Further investigations are essential toward potential practice and policy changes.

  10. A comparison of lower-body flexibility, strength, and knee stability between karate athletes and active controls.

    PubMed

    Probst, Manuel M; Fletcher, Richard; Seelig, Dayna S

    2007-05-01

    The purposes of this study were to compare the lower-body flexibility, strength, and knee stability of karate athletes against that of non-karate controls and to determine whether regular karate training results in adaptations that may result in an increased risk for knee injury. Flexibility measurements included knee flexion and extension, hip flexion and extension, hip internal and external rotation, and foot inversion and eversion. Nine karate athletes (4 women and 5 men, age = 24.3 +/- 6.7 years) and 15 active, non-karate controls (7 women and 8 men, age = 22.1 +/- 3.2 years) participated. No subjects reported recent knee surgery or chronic or acute knee pain. Concentric quadriceps and hamstrings strength and endurance were measured using a Biodex II isokinetic dynamometer at 60 degrees .s(-1) and 180 degrees .s(-1). Eccentric strength was measured at 150 degrees .s(-1) and 250 ft-lb (339 N.m). Knee stability was measured via varus and valgus stress and anterior drawer testing. Karate athletes demonstrated a significantly greater right hip flexion (p knees between the karate and control groups. The results indicate that this group of karate athletes may have demonstrated sport-specific adaptations in certain flexibility and strength measurements, but they showed no increased risk for knee injury.

  11. Congenital dislocation of the knee in a 16-year-old girl.

    PubMed

    Kazemi, Seyyed Morteza; Abbasian, Mohammad Reza; Hosseinzadeh, Hamid Reza Seyyed; Zanganeh, Ramin Farhang; Eajazi, Alireza; Daftari Besheli, Laleh

    2010-05-12

    Congenital dislocation of the knee ranges from hyperextension of the knee to translation of the femur on the tibia. Treatment options include bracing, splinting, manipulation and casting, and surgery. A 16-year-old girl presented with an inability to walk, stand upright, or bend her knees. She exhibited deformity of both lower extremities. She had deformed knees from birth, and they had been put in a cast for 2 months. No other therapeutic measures were taken. The patient walked on her abnormally hyperextended knees and could hyperextend the knees to 150 degrees recurvatum. She was diagnosed with a grade III congenital dislocation of the knee, and a flexion-shortening osteotomy at the distal femur above the trochlear level was performed on her knees in 2 sessions. Postoperatively, range of motion changed from hyperextention to 80 degrees flexion. A femoral supracondylar osteotomy was also performed 2 years later, and as a result, a 15 degrees flexion and 15 degrees valgus were added to the limb. The patient is now able to stand and walk without a knee brace and has 90 degrees passive and 80 degrees active knee flexion on both sides. Congenital dislocation of the knee is a rare congenital disorder. The results of treatment are favorable if started before age 3 months, or sometimes before age 2 years, but there is no effective treatment for older, neglected cases; therefore, we believe this case report demonstrates a novel surgical approach. Copyright 2010, SLACK Incorporated.

  12. Fusion of Smartphone Motion Sensors for Physical Activity Recognition

    PubMed Central

    Shoaib, Muhammad; Bosch, Stephan; Incel, Ozlem Durmaz; Scholten, Hans; Havinga, Paul J. M.

    2014-01-01

    For physical activity recognition, smartphone sensors, such as an accelerometer and a gyroscope, are being utilized in many research studies. So far, particularly, the accelerometer has been extensively studied. In a few recent studies, a combination of a gyroscope, a magnetometer (in a supporting role) and an accelerometer (in a lead role) has been used with the aim to improve the recognition performance. How and when are various motion sensors, which are available on a smartphone, best used for better recognition performance, either individually or in combination? This is yet to be explored. In order to investigate this question, in this paper, we explore how these various motion sensors behave in different situations in the activity recognition process. For this purpose, we designed a data collection experiment where ten participants performed seven different activities carrying smart phones at different positions. Based on the analysis of this data set, we show that these sensors, except the magnetometer, are each capable of taking the lead roles individually, depending on the type of activity being recognized, the body position, the used data features and the classification method employed (personalized or generalized). We also show that their combination only improves the overall recognition performance when their individual performances are not very high, so that there is room for performance improvement. We have made our data set and our data collection application publicly available, thereby making our experiments reproducible. PMID:24919015

  13. Fusion of smartphone motion sensors for physical activity recognition.

    PubMed

    Shoaib, Muhammad; Bosch, Stephan; Incel, Ozlem Durmaz; Scholten, Hans; Havinga, Paul J M

    2014-06-10

    For physical activity recognition, smartphone sensors, such as an accelerometer and a gyroscope, are being utilized in many research studies. So far, particularly, the accelerometer has been extensively studied. In a few recent studies, a combination of a gyroscope, a magnetometer (in a supporting role) and an accelerometer (in a lead role) has been used with the aim to improve the recognition performance. How and when are various motion sensors, which are available on a smartphone, best used for better recognition performance, either individually or in combination? This is yet to be explored. In order to investigate this question, in this paper, we explore how these various motion sensors behave in different situations in the activity recognition process. For this purpose, we designed a data collection experiment where ten participants performed seven different activities carrying smart phones at different positions. Based on the analysis of this data set, we show that these sensors, except the magnetometer, are each capable of taking the lead roles individually, depending on the type of activity being recognized, the body position, the used data features and the classification method employed (personalized or generalized). We also show that their combination only improves the overall recognition performance when their individual performances are not very high, so that there is room for performance improvement. We have made our data set and our data collection application publicly available, thereby making our experiments reproducible.

  14. Photothermally activated motion and ignition using aluminum nanoparticles

    NASA Astrophysics Data System (ADS)

    Abboud, Jacques E.; Chong, Xinyuan; Zhang, Mingjun; Zhang, Zhili; Jiang, Naibo; Roy, Sukesh; Gord, James R.

    2013-01-01

    The aluminum nanoparticles (Al NPs) are demonstrated to serve as active photothermal media, to enhance and control local photothermal energy deposition via the photothermal effect activated by localized surface plasmon resonance (LSPR) and amplified by Al NPs oxidation. The activation source is a 2-AA-battery-powered xenon flash lamp. The extent of the photothermally activated movement of Al NPs can be ˜6 mm. Ignition delay can be ˜0.1 ms. Both scanning electron microscopy and energy-dispersive X-ray spectroscopy measurements of motion-only and after-ignition products confirm significant Al oxidation occurs through sintering and bursting after the flash exposure. Simulations suggest local heat generation is enhanced by LSPR. The positive-feedback effects from the local heat generation amplified by Al oxidation produce a large increase in local temperature and pressure, which enhances movement and accelerates ignition.

  15. Intraoperative passive kinematics of osteoarthritic knees before and after total knee arthroplasty.

    PubMed

    Siston, Robert A; Giori, Nicholas J; Goodman, Stuart B; Delp, Scott L

    2006-08-01

    Total knee arthroplasty is a successful procedure to treat pain and functional disability due to osteoarthritis. However, precisely how a total knee arthroplasty changes the kinematics of an osteoarthritic knee is unknown. We used a surgical navigation system to measure normal passive kinematics from 7 embalmed cadaver lower extremities and in vivo intraoperative passive kinematics on 17 patients undergoing primary total knee arthroplasty to address two questions: How do the kinematics of knees with advanced osteoarthritis differ from normal knees?; and, Does posterior substituting total knee arthroplasty restore kinematics towards normal? Osteoarthritic knees displayed a decreased screw-home motion and abnormal varus/valgus rotations between 10 degrees and 90 degrees of knee flexion when compared to normal knees. The anterior-posterior motion of the femur in osteoarthritic knees was not different than in normal knees. Following total knee arthroplasty, we found abnormal varus/valgus rotations in early flexion, a reduced screw-home motion when compared to the osteoarthritic knees, and an abnormal anterior translation of the femur during the first 60 degrees of flexion. Posterior substituting total knee arthroplasty does not appear to restore normal passive varus/valgus rotations or the screw motion and introduces an abnormal anterior translation of the femur during intraoperative evaluation.

  16. Differential brain activity states during the perception and nonperception of illusory motion as revealed by magnetoencephalography.

    PubMed

    Crowe, David A; Leuthold, Arthur C; Georgopoulos, Apostolos P

    2010-12-28

    We studied visual perception using an annular random-dot motion stimulus called the racetrack. We recorded neural activity using magnetoencephalography while subjects viewed variants of this stimulus that contained no inherent motion or various degrees of embedded motion. Subjects reported seeing rotary motion during viewing of all stimuli. We found that, in the absence of any motion signals, patterns of brain activity differed between states of motion perception and nonperception. Furthermore, when subjects perceived motion, activity states within the brain did not differ across stimuli of different amounts of embedded motion. In contrast, we found that during periods of nonperception brain-activity states varied with the amount of motion signal embedded in the stimulus. Taken together, these results suggest that during perception the brain may lock into a stable state in which lower-level signals are suppressed.

  17. Sports activity following total knee arthroplasty in patients older than 60 years.

    PubMed

    Mayr, Hermann O; Reinhold, Maik; Bernstein, Anke; Suedkamp, Norbert P; Stoehr, Amelie

    2015-01-01

    In a retrospective study with a population over 65 years, sports activity was conducted 6 years after cruciate retaining (CR) total condylar knee arthroplasty (TKA) with rotating platform (RP). Eighty-one Patients (71.8±5.4years) were examined at follow-up 6.4±0.9 years postoperative. Sport was practiced 5.3 hours every week in mean. Patients were active in sports 3.5times per week. Twenty-five percent performed high impact sports, 47% medium impact sports and 52% low impact sports at follow-up. In KOOS sports 60±28 was reached, in WOMAC 12.1±15.1. It can be concluded that in this population 50% of patients were active in medium and low impact sport 6 years after surgery. However, a quarter of patients were also active in high impact sports. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat.

    PubMed

    Macrum, Elisabeth; Bell, David Robert; Boling, Michelle; Lewek, Michael; Padua, Darin

    2012-05-01

    Limitations in gastrocnemius/soleus flexibility that restrict ankle dorsiflexion during dynamic tasks have been reported in individuals with patellofemoral pain (PFP) and are theorized to play a role in its development. To determine the effect of restricted ankle-dorsiflexion range of motion (ROM) on lower extremity kinematics and muscle activity (EMG) during a squat. The authors hypothesized that restricted ankle-dorsiflexion ROM would alter knee kinematics and lower extremity EMG during a squat. Cross-sectional. 30 healthy, recreationally active individuals without a history of lower extremity injury. Each participant performed 7 trials of a double-leg squat under 2 conditions: a no-wedge condition (NW) with the foot flat on the floor and a wedge condition (W) with a 12° forefoot angle to simulate reduced plantar-flexor flexibility. 3-dimensional hip and knee kinematics, medial knee displacement (MKD), and ankle-dorsiflexion angle. EMG of vastus medialis oblique (VMO), vastus lateralis (VL), lateral gastrocnemius (LG), and soleus (SOL). One-way repeated-measures ANOVAs were performed to determine differences between the W and NW conditions. Compared with the NW condition, the wedge produced decreased peak knee flexion (P < .001, effect size [ES] = 0.81) and knee-flexion excursion (P < .001, ES = 0.82) while producing increased peak ankle dorsiflexion (P = .006, ES = 0.31), ankle-dorsiflexion excursion (P < .001, ES = 0.31), peak knee-valgus angle (P = .02, ES = 0.21), and MKD (P < .001, ES = 2.92). During the W condition, VL (P = 0.002, ES = 0.33) and VMO (P = .049, ES = 0.20) activity decreased while soleus activity increased (P = .03, ES = 0.64) compared with the NW condition. No changes were seen in hip kinematics (P > .05). Altering ankle-dorsiflexion starting position during a double-leg squat resulted in increased knee valgus and MKD, as well as decreased quadriceps activation and increased soleus activation. These changes are similar to those seen in

  19. Neutrophil elastase induces inflammation and pain in mouse knee joints via activation of proteinase-activated receptor-2.

    PubMed

    Muley, Milind M; Reid, Allison R; Botz, Bálint; Bölcskei, Kata; Helyes, Zsuzsanna; McDougall, Jason J

    2016-02-01

    Neutrophil elastase plays a crucial role in arthritis. Here, its potential in triggering joint inflammation and pain was assessed, and whether these effects were mediated by proteinase-activated receptor-2 (PAR2). Neutrophil elastase (5 μg) was injected into the knee joints of mice and changes in blood perfusion, leukocyte kinetics and paw withdrawal threshold were assessed. Similar experiments were performed in animals pretreated with the neutrophil elastase inhibitor sivelestat, the PAR2 antagonist GB83, the p44/42 MAPK inhibitor U0126 and in PAR2 receptor knockout (KO) mice. Neutrophil elastase activity was also evaluated in arthritic joints by fluorescent imaging and sivelestat was assessed for anti-inflammatory and analgesic properties. Intra-articular injection of neutrophil elastase caused an increase in blood perfusion, leukocyte kinetics and a decrease in paw withdrawal threshold. Sivelestat treatment suppressed this effect. The PAR2 antagonist GB83 reversed neutrophil elastase-induced synovitis and pain and these responses were also attenuated in PAR2 KO mice. The MAPK inhibitor U0126 also blocked neutrophil elastase-induced inflammation and pain. Active neutrophil elastase was increased in acutely inflamed knees as shown by an activatable fluorescent probe. Sivelestat appeared to reduce neutrophil elastase activity, but had only a moderate anti-inflammatory effect in this model. Neutrophil elastase induced acute inflammation and pain in knee joints of mice. These changes are PAR2-dependent and appear to involve activation of a p44/42 MAPK pathway. Blocking neutrophil elastase, PAR2 and p44/42 MAPK activity can reduce inflammation and pain, suggesting their utility as therapeutic targets. © 2015 The British Pharmacological Society.

  20. The use of knee braces during rehabilitation.

    PubMed

    Nelson, K A

    1990-10-01

    This article has profiled the use of knee braces as an augmentation to the overall rehabilitation program following knee injury. It has also outlined other aspects of rehabilitation, the use of continuous passive motion devices, and other forms of exercises and training that, together with bracing, may enhance patient recovery. Continuous passive motion devices have been used for many different orthopedic problems with good success. Understanding the mechanics of how these devices move the knee and the forces that can be applied to the knee is helpful in deciding on their use after ligamentous reconstructions. Rehabilitation of the knee following surgery requires a good understanding of the effects that each exercise has on the knee and the reconstruction. Gradual progression of exercises to the knee following knee ligament reconstruction will not overstress healing tissues. Many different types of knee braces exist, and careful evaluation of them may enhance patient recovery.

  1. Crew activity and motion effects on the space station

    NASA Technical Reports Server (NTRS)

    Rochon, Brian V.; Scheer, Steven A.

    1987-01-01

    Among the significant sources of internal disturbances that must be considered in the design of space station vibration control systems are the loads induced on the structure from various crew activities. Flight experiment T013, flown on the second manned mission of Skylab, measured force and moment time histories for a range of preplanned crew motions and activities. This experiment has proved itself invaluable as a source of on-orbit crew induced loads that has allowed a space station forcing function data base to be built. This will enable forced response such as acceleration and deflections, attributable to crew activity, to be calculated. The flight experiment, resultant database and structural model pre-processor, analysis examples and areas of combined research shall be described.

  2. The contribution of activated peripheral kappa opioid receptors (kORs) in the inflamed knee joint to anti-nociception.

    PubMed

    Moon, Sun Wook; Park, Eui Ho; Suh, Hye Rim; Ko, Duk Hwan; Kim, Yang In; Han, Hee Chul

    2016-10-01

    The systemic administration of opioids can be used for their strong analgesic effect. However, extensive activation of opioid receptors (ORs) beyond the targeted tissue can cause dysphoria, pruritus, and constipation. Therefore, selective activation of peripheral ORs present in the afferent fibers of the targeted tissue can be considered a superior strategy in opioid analgesia to avoid potential adverse effects. The purpose of this study was to clarify the role of peripheral kappa opioid receptors (kORs) in arthritic pain for the possible use of peripheral ORs as a target in anti-nociceptive therapy. We administered U50488 or nor-BNI/DIPPA, a selective agonist or antagonist of kOR, respectively into arthritic rat knee joints induced using 1% carrageenan. After the injection of U50488 or U50488 with nor-BNI or DIPPA into the inflamed knee joint, we evaluated nociceptive behavior as indicated by reduced weight-bearing on the ipsilateral limbs of the rat and recorded the activity of mechanosensitive afferents (MSA). In the inflamed knee joint, the intra-articular application of 1μM, 10nM, or 0.1nM U50488 resulted in a significant reduction in nociceptive behavior. In addition, 1μM and 10nM U50488 decreased MSA activity. However, in a non-inflamed knee joint, 1μM U50488 had no effect on MSA activity. Additionally, intra-articular pretreatment with 20μM nor-BNI or 10μM DIPPA significantly blocked the inhibitory effects of 1μM U50488 on nociceptive behavior and MSA activity in the inflamed knee joint. These results implicate that peripheral kORs can contribute to anti-nociceptive processing in an inflamed knee joint. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. The effect of ankle bracing on knee kinetics and kinematics during volleyball-specific tasks.

    PubMed

    West, T; Ng, L; Campbell, A

    2014-12-01

    The purpose of this study was to examine the effects of ankle bracing on knee kinetics and kinematics during volleyball tasks. Fifteen healthy, elite, female volleyball players performed a series of straight-line and lateral volleyball tasks with no brace and when wearing an ankle brace. A 14-camera Vicon motion analysis system and AMTI force plate were used to capture the kinetic and kinematic data. Knee range of motion, peak knee anterior-posterior and medial-lateral shear forces, and peak ground reaction forces that occurred between initial contact with the force plate and toe off were compared using paired sample t-tests between the braced and non-braced conditions (P < 0.05). The results revealed no significant effect of bracing on knee kinematics or ground reaction forces during any task or on knee kinetics during the straight-line movement volleyball tasks. However, ankle bracing was demonstrated to reduce knee lateral shear forces during all of the lateral movement volleyball tasks. Wearing the Active Ankle T2 brace will not impact knee joint range of motion and may in fact reduce shear loading to the knee joint in volleyball players.

  4. Knee Extensor Electromyographic Activity-to-Work Ratio is Greater With Isotonic Than Isokinetic Contractions.

    PubMed

    Schmitz, Randy J.; Westwood, Kevin C.

    2001-12-01

    OBJECTIVE: To determine whether isotonic or isokinetic contractions produced greater electromyographic (EMG) activity per unit of work during isotonic and isokinetic knee-extension exercise. DESIGN AND SETTING: Subjects performed three 3-second maximal voluntary isometric contractions of the dominant knee extensors for EMG normalization. Exercise testing performed on the Biodex System 3 Dynamometer involved 10 isokinetic contractions at 180 degrees.s(-1) and 10 isotonic contractions with the resistance set at 50% of the previously recorded maximal voluntary isometric contraction. SUBJECTS: Recreationally active college students (10 men and 11 women). MEASUREMENTS: Surface EMG signals were collected from the vastus medialis and lateralis muscles and then integrated (IEMG) over the concentric phase of each repetition for both exercises. The IEMG was divided by the total work performed during the concentric phase for each exercise (IEMG/W). RESULTS: We analyzed the IEMG/W data using a 1-between (sex), 2-within (exercise and muscle) repeated-measures analysis of variance. There was a significant main effect for exercise, with the isotonic IEMG/W value being significantly greater than the isokinetic IEMG/W value. Additionally, the IEMG/W relationship did not appear to be affected by sex or individual muscle tested. CONCLUSIONS: Per unit of work performed, the isotonic contractions resulted in greater motor unit recruitment or an increased rate of firing, or both. This finding may have implications for the early phase of rehabilitation, when goals include complete motor unit recruitment of injured or atrophied muscles.

  5. Knee Extensor Electromyographic Activity-to-Work Ratio is Greater With Isotonic Than Isokinetic Contractions

    PubMed Central

    Westwood, Kevin C.

    2001-01-01

    Objective: To determine whether isotonic or isokinetic contractions produced greater electromyographic (EMG) activity per unit of work during isotonic and isokinetic knee-extension exercise. Design and Setting: Subjects performed three 3-second maximal voluntary isometric contractions of the dominant knee extensors for EMG normalization. Exercise testing performed on the Biodex System 3 Dynamometer involved 10 isokinetic contractions at 180°·s−1 and 10 isotonic contractions with the resistance set at 50% of the previously recorded maximal voluntary isometric contraction. Subjects: Recreationally active college students (10 men and 11 women). Measurements: Surface EMG signals were collected from the vastus medialis and lateralis muscles and then integrated (IEMG) over the concentric phase of each repetition for both exercises. The IEMG was divided by the total work performed during the concentric phase for each exercise (IEMG/W). Results: We analyzed the IEMG/W data using a 1-between (sex), 2-within (exercise and muscle) repeated-measures analysis of variance. There was a significant main effect for exercise, with the isotonic IEMG/W value being significantly greater than the isokinetic IEMG/W value. Additionally, the IEMG/W relationship did not appear to be affected by sex or individual muscle tested. Conclusions: Per unit of work performed, the isotonic contractions resulted in greater motor unit recruitment or an increased rate of firing, or both. This finding may have implications for the early phase of rehabilitation, when goals include complete motor unit recruitment of injured or atrophied muscles. PMID:12937480

  6. Biomechanical effects of robot assisted walking on knee joint kinematics and muscle activation pattern.

    PubMed

    Thangavel, Pavithra; Vidhya, S; Li, Junhua; Chew, Effie; Bezerianos, Anastasios; Yu, Haoyong

    2017-07-01

    Since manual rehabilitation therapy can be taxing for both the patient and the physiotherapist, a gait rehabilitation robot has been built to reduce the physical strain and increase the efficacy of the rehabilitation therapy. The prototype of the gait rehabilitation robot is designed to provide assistance while walking for patients with abnormal gait pattern and it can also be used for rehabilitation therapy to restore an individual's normal gait pattern by aiding motor recovery. The Gait Rehabilitation Robot uses gait event based synchronization, which enables the exoskeleton to provide synchronous assistance during walking that aims to reduce the lower-limb muscle activation. This study emphasizes on the biomechanical effects of assisted walking on the lower limb by analyzing the EMG signal, knee joint kinematics data that was collected from the right leg during the various experimental conditions. The analysis of the measured data shows an improved knee joint trajectory and reduction in muscle activity with assistance. The result of this study does not only assess the functionality of the exoskeleton but also provides a profound understanding of the human-robot interaction by studying the effects of assistance on the lower limb.

  7. Prospective slice-by-slice motion correction reduces false positive activations in fMRI with task-correlated motion.

    PubMed

    Schulz, J; Siegert, T; Bazin, P-L; Maclaren, J; Herbst, M; Zaitsev, M; Turner, R

    2014-01-01

    We aimed to test the hypothesis that slice-by-slice prospective motion correction at 7T using an optical tracking system reduces the rate of false positive activations in an fMRI group study with a paradigm that involves task-correlated motion. Brain activation during right leg movement was measured using a block design on 15 volunteers, with and without prospective motion correction. Clearly erroneous activations were compared between both cases, at the individual level. Additionally, conventional group analysis was performed. The number of falsely activated voxels with T-values higher than 5 was reduced by 48% using prospective motion correction alone, without additional retrospective realignment. In the group analysis, the statistical power was increased - the peak T-value was 26% greater, and the number of voxels in the cluster representing the right leg was increased by a factor of 9.3. Slice-by-slice prospective motion correction in fMRI studies with task-correlated motion can substantially reduce false positive activations and increase statistical power. © 2013.

  8. Time-driven activity based costing of total knee replacement surgery at a London teaching hospital.

    PubMed

    Chen, Alvin; Sabharwal, Sanjeeve; Akhtar, Kashif; Makaram, Navnit; Gupte, Chinmay M

    2015-12-01

    The aim of this study was to conduct a time-driven activity based costing (TDABC) analysis of the clinical pathway for total knee replacement (TKR) and to determine where the major cost drivers lay. The in-patient pathway was prospectively mapped utilising a TDABC model, following 20 TKRs. The mean age for these patients was 73.4 years. All patients were ASA grade I or II and their mean BMI was 30.4. The 14 varus knees had a mean deformity of 5.32° and the six valgus knee had a mean deformity of 10.83°. Timings were prospectively collected as each patient was followed through the TKR pathway. Pre-operative costs including pre-assessment and joint school were £ 163. Total staff costs for admission and the operating theatre were £ 658. Consumables cost for the operating theatre were £ 1862. The average length of stay was 5.25 days at a total cost of £ 910. Trust overheads contributed £ 1651. The overall institutional cost of a 'noncomplex' TKR in patients without substantial medical co-morbidities was estimated to be £ 5422, representing a profit of £ 1065 based on a best practice tariff of £ 6487. The major cost drivers in the TKR pathway were determined to be theatre consumables, corporate overheads, overall ward cost and operating theatre staffing costs. Appropriate discounting of implant costs, reduction in length of stay by adopting an enhanced recovery programme and control of corporate overheads through the use of elective orthopaedic treatment centres are proposed approaches for reducing the overall cost of treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Physical Activity Levels in Early Knee Osteoarthritis Patients Measured by Accelerometry

    PubMed Central

    Farr, Joshua N.; Going, Scott B.; Lohman, Timothy G.; Rankin, Lucinda; Kasle, Shelley; Cornett, Michelle; Cussler, Ellen

    2008-01-01

    Objective: Physical activity (PA) is recommended for osteoarthritis (OA) management to reduce pain and improve function. The purpose of this study was to objectively assess the level and pattern of PA in male and female knee OA patients to determine adherence to CDC/ACSM and EPAC recommendations for PA. Methods: Early OA patients (n = 255, 76% women, 54.6 ± 7.1 years, body mass index (BMI) 27.8 ± 4.3 kg/m2) having radiographic status of Kellgren and Lawrence-defined grade II OA (and no higher) in at least one knee wore an accelerometer (Actigraph MTI) for 6-7 contiguous days. Light (LPA), moderate (MPA) and vigorous (VPA) PA intensities were defined as accelerometer recordings of 100 to 2,224, 2,225 to 5,950, and > 5,950 counts per minute, respectively. Results: Subjects wore accelerometers for 6.8 ± 0.3 days and 13.8 ± 2.2 hours per day (hr/day) and spent much more (P < 0.001) time in MPA (23.6 ± 17.2 min/day) compared to VPA (0.95 ± 3.5 min/day). Males spent significantly (P < 0.05) more time in all PA intensities than females. Only 30% of subjects achieved recommended PA levels. The proportion of males (47%) achieving the recommendation was significantly (P = 0.04) higher than females (24%). Conclusion: Knee OA patients accumulate little vigorous PA and most (70%) do not achieve recommended levels for moderate or greater intensity PA. New strategies to increase levels of PA in this population are needed. PMID:18759320

  10. Drop punt kicking induces eccentric knee flexor weakness associated with reductions in hamstring electromyographic activity.

    PubMed

    Duhig, Steven J; Williams, Morgan D; Minett, Geoffrey M; Opar, David; Shield, Anthony J

    2017-06-01

    To examine the effect of 100 drop punt kicks on isokinetic knee flexor strength and surface electromyographic activity of bicep femoris and medial hamstrings. Randomized control study. Thirty-six recreational footballers were randomly assigned to kicking or control groups. Dynamometry was conducted immediately before and after the kicking or 10min of sitting (control). Eccentric strength declined more in the kicking than the control group (p<0.001; d=1.60), with greater reductions in eccentric than concentric strength after kicking (p=0.001; d=0.92). No significant between group differences in concentric strength change were observed (p=0.089; d=0.60). The decline in normalized eccentric hamstring surface electromyographic activity (bicep femoris and medial hamstrings combined) was greater in the kicking than the control group (p<0.001; d=1.78), while changes in concentric hamstring surface electromyographic activity did not differ between groups (p=0.863; d=0.04). Post-kicking reductions in surface electromyographic activity were greater in eccentric than concentric actions for both bicep femoris (p=0.008; d=0.77) and medial hamstrings (p<0.001; d=1.11). In contrast, the control group exhibited smaller reductions in eccentric than concentric hamstring surface electromyographic activity for bicep femoris (p=0.026; d=0.64) and medial hamstrings (p=0.032; d=0.53). Reductions in bicep femoris surface electromyographic activity were correlated with eccentric strength decline (R=0.645; p=0.007). Reductions in knee flexor strength and hamstring surface electromyographic activity are largely limited to eccentric contractions and this should be considered when planning training loads in Australian Football. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  11. Computer-Assisted Hip and Knee Arthroplasty. Navigation and Active Robotic Systems

    PubMed Central

    2004-01-01

    Executive Summary Objective The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of computer assisted hip and knee arthroplasty. The two computer assisted arthroplasty systems that are the topics of this review are (1) navigation and (2) robotic-assisted hip and knee arthroplasty. The Technology Computer-assisted arthroplasty consists of navigation and robotic systems. Surgical navigation is a visualization system that provides positional information about surgical tools or implants relative to a target bone on a computer display. Most of the navigation-assisted arthroplasty devices that are the subject of this review are licensed by Health Canada. Robotic systems are active robots that mill bone according to information from a computer-assisted navigation system. The robotic-assisted arthroplasty devices that are the subject of this review are not currently licensed by Health Canada. Review Strategy The Cochrane and International Network of Agencies for Health Technology Assessment databases did not identify any health technology assessments on navigation or robotic-assisted hip or knee arthroplasty. The MEDLINE and EMBASE databases were searched for articles published between January 1, 1996 and November 30, 2003. This search produced 367 studies, of which 9 met the inclusion criteria. Summary of Findings Navigation-Assisted Arthroplasty Five studies were identified that examined navigation-assisted arthroplasty. A Level 1 evidence study from Germany found a statistically significant difference in alignment and angular deviation between navigation-assisted and free-hand total knee arthroplasty in favour of navigation-assisted surgery. However, the endpoints in this study were short-term. To date, the long-term effects (need for revision, implant longevity, pain, functional performance) are unknown.(1) A Level 2 evidence short-term study found that navigation-assisted total knee arthroplasty was

  12. Safety and function of a prototype microprocessor-controlled knee prosthesis for low active transfemoral amputees switching from a mechanic knee prosthesis: a pilot study.

    PubMed

    Hasenoehrl, Timothy; Schmalz, Thomas; Windhager, Reinhard; Domayer, Stephan; Dana, Sara; Ambrozy, Clemens; Palma, Stefano; Crevenna, Richard

    2017-04-11

    Aim of this pilot study was to assess safety and functioning of a microprocessor-controlled knee prosthesis (MPK) after a short familiarization time and no structured physical therapy. Five elderly, low-active transfemoral amputees who were fitted with a standard non-microprocessor controlled knee prosthesis (NMPK) performed a baseline measurement consisting of a 3 D gait analysis, functional tests and questionnaires. The first follow-up consisted of the same test procedure and was performed with the MPK after 4 to 6 weeks of familiarization. After being refitted to their standard NMPK again, the subjects undertook the second follow-up which consisted of solely questionnaires 4 weeks later. Questionnaires and functional tests showed an increase in the perception of safety. Moreover, gait analysis revealed more physiologic knee and hip extension/flexion patterns when using the MPK. Our results showed that although the Genium with Cenior-Leg ruleset-MPK (GCL-MPK) might help to improve several safety-related outcomes as well as gait biomechanics the functional potential of the GCL-MPK may have been limited without specific training and a sufficient acclimation period. Implications for Rehabilitation Elderly transfemoral amputees are often limited in their activity by safety issues as well as insufficient functioning regarding the non microprocessor-controlled knee prostheses (NMPK), thing that could be eliminated with the use of suitable microprocessor-controlled prostheses (MPK). The safety and functioning of a prototype MPK (GCL-MPK) specifically designed for the needs of older and low-active transfemoral amputees was assessed in this pilot study. The GCL-MPK showed indicators of increased safety and more natural walking patterns in older and low-active transfemoral amputees in comparison to the standard NMPK already after a short acclimatisation time and no structured physical therapy. Regarding functional performance it seems as if providing older and low-active

  13. Age-related changes in kinematics of the knee joint during deep squat.

    PubMed

    Fukagawa, Shingo; Leardini, Alberto; Callewaert, Barbara; Wong, Pius D; Labey, Luc; Desloovere, Kaat; Matsuda, Shuichi; Bellemans, Johan

    2012-06-01

    Researchers frequently use the deep knee squat as a motor task in order to evaluate the kinematic performance after total knee arthroplasty. Many authors reported about the kinematics of a normal squatting motion, however, little is known on what the influence of aging is. Twenty-two healthy volunteers in various age groups (range 21-75 years) performed a deep knee squat activity while undergoing motion analysis using an optical tracking system. The influence of aging was evaluated with respect to kinematics of the trunk, hip, knee and ankle joints. Older subjects required significantly more time to perform a deep squat, especially during the descending phase. They also had more knee abduction and delayed peak knee flexion. Older subjects were slower in descend than ascend during the squat. Although older subjects had a trend towards less maximal flexion and less internal rotation of the knee compared to younger subjects, this difference was not significant. Older subjects also showed a trend towards more forward leaning of the trunk, resulting in increased hip flexion and anterior thoracic tilt. This study confirmed that some aspects of squat kinematics vary significantly with age, and that the basic methodology employed here can successfully detect these age-related trends. Older subjects had more abduction of the knee joint, and this may indicate the load distribution of the medial and lateral condyles could be different amongst ages. Age-matched control data are therefore required whenever the performance of an implant is evaluated during a deep knee squat.

  14. Agonist-antagonist active knee prosthesis: a preliminary study in level-ground walking.

    PubMed

    Martinez-Villalpando, Ernesto C; Herr, Hugh

    2009-01-01

    We present a powered knee prosthesis with two series-elastic actuators positioned in parallel in an agonist-antagonist arrangement. To motivate the knee's design, we developed a prosthetic knee model that comprises a variable damper and two series-elastic clutch units that span the knee joint. Using human gait data to constrain the model's joint to move biologically, we varied model parameters using an optimization scheme that minimized the sum over time of the squared difference between the model's joint torque and biological knee values. We then used these optimized values to specify the mechanical and control design of the prosthesis for level-ground walking. We hypothesized that a variable-impedance control design could produce humanlike knee mechanics during steady-state level-ground walking. As a preliminary evaluation of this hypothesis, we compared the prosthetic knee mechanics of an amputee walking at a self-selected gait speed with those of a weight- and height-matched nonamputee. We found qualitative agreement between prosthetic and human knee mechanics. Because the knee's motors never perform positive work on the knee joint throughout the level-ground gait cycle, the knee's electrical power requirement is modest in walking (8 W), decreasing the size of the onboard battery required to power the prosthesis.

  15. Active motion and load control of floating offshore wind turbines

    NASA Astrophysics Data System (ADS)

    Jalili, Kaveh

    The research in this thesis is focused on stabilization and load reduction of floating offshore wind turbine (FOWT) structures for both the fore-aft (pitch) and side-to-side (roll) directions. Based on the Tuned Mass Damper (TMD) and Active Vane concepts recently proposed, two composite actuation schemes are investigated. The first scheme is to apply the horizontal vane and vertical vane to platform pitch and roll, respectively, resulting in the so-called Double Vane Actuation (DVA) scheme. The second scheme is the combination of the TMD based pitch control and active vertical vane based roll control, resulting in the so-called Hybrid Actuation (HA) scheme. Simulation results of DVA show great reductions of motions and loads in the fore-aft and side-to-side directions. Performance of HA is investigated by extensive simulations based on the IEC61400-3 standard and results show significant and consistent motions and loads reductions in both FA and SS directions.

  16. Active Motion Control of Tetrahymena pyriformis by Galvanotaxis and Geotaxis

    NASA Astrophysics Data System (ADS)

    Kim, Jihoon; Byun, Doyoung; Kim, Min Jun

    2013-11-01

    Recently, there has been increasing interest in the swimming behavior of microorganisms and biologically inspired micro-robots. These microorganisms naturally accompanied by complex motions. Therefore it is important to understand the flow characteristics as well as control mechanisms. One of eukaryotic cells, the protozoa are a diverse group of unicellular organisms, many of which are motile cilia. Motile cilia are cover on the surface of cell in large numbers and beat in oriented waves. Sequential beating motions of a single cilium form metachronal strokes, producing a propagation wave, and therefore the body is achieved propulsion force. So preliminary studies are achieved to understand the flow induced by swimming microorganisms. Based on hydrodynamic results, the follow study of a few micro-scale protozoa cell, such as the Tetrahymena pyriformis, has provided active or passive control into several external stimuli. In typical control methods, the galvanotaxis and geotaxis were adopted active and passive control, respectively. The validation of galvanotaxis is used DC and AC voltage. In terms of geotaxis, corrugated microstructures were used to control in the microchannel. This research was supported by the Ministry of Education, Science and Technology (MEST, 2011-0016461), National Science Foundation (NSF) CMMI Control Systems Program (#1000255) and Army Research Office (W911NF-11-1-0490).

  17. Flare Activity and Magnetic Helicity Injection By Photospheric Horizontal Motions

    NASA Astrophysics Data System (ADS)

    Moon, Y.-J.; Chae, J.; Choe, G.; Wang, H.; Park, Y. D.; Yun, H. S.; Yurchyshyn, V.; Goode, P. R.

    2002-05-01

    We present observational evidence that the occurrence of homologous flares in an active region is physically related to the injection of magnetic helicity by horizontal photospheric motions. We have analyzed a set of 1 minute cadence magnetograms of NOAA AR 8100 taken over a period of 6.5 hours by Michelson Doppler Imager (MDI) on board Solar and Heliospheric Observatory (SOHO). During this observing time span, seven homologous flares took place in the active region. We have computed the magnetic helicity injection rate into the solar atmosphere by photospheric shearing motions, and found that a significant amount of magnetic helicity was injected during the observing period. In a strong M4.1 flare, the magnetic helicity injection rate impulsively increased and peaked at the same time as the X-ray flux did. The flare X-ray flux integrated over the X-ray emission time strongly correlates with the magnetic helicity injected during the flaring interval. The integrated X-ray flux is found to be a logarithmically increasing function of the injected magnetic helicity. Our results suggest that injection of helicity and abrupt increase of helicity magnitude play a significant role in flare triggering. This work has been supported by NASA grants NAG5-10894 and NAG5-7837, by MURI grant of AFOSR, by the US-Korea Cooperative Science Program (NSF INT-98-16267), by NRL M10104000059-01J000002500 of the Korean government, and by the BK 21 project of the Korean government.

  18. Strength Training to Contraction Failure Increases Voluntary Activation of the Quadriceps Muscle Shortly After Total Knee Arthroplasty

    PubMed Central

    Mikkelsen, Elin Karin; Jakobsen, Thomas Linding; Holsgaard-Larsen, Anders; Andersen, Lars Louis; Bandholm, Thomas

    2016-01-01

    ABSTRACT Objective The objective of this study was to investigate voluntary activation of the quadriceps muscle during one set of knee extensions performed until contraction failure in patients shortly after total knee arthroplasty. Design This was a cross-sectional study of 24 patients with total knee arthroplasty. One set of knee extensions was performed until contraction failure, using a predetermined 10 repetition maximum loading. In the operated leg, electromyographic (EMG) activity of the lateral and medial vastus, semitendinosus, and biceps femoris muscles was recorded during the set. Muscle activity (%EMGmax) and median power frequency of the EMG power spectrum were calculated for each repetition decile (10%–100% contraction failure). Results Muscle activity increased significantly over contractions from a mean of 90.0 and 93.6 %EMGmax (lateral vastus and medial vastus, respectively) at 10% contraction failure to 99.3 and 105.5 %EMGmax at 100% contraction failure (P = 0.009 and 0.004). Median power frequency decreased significantly over contractions from a mean of 66.8 and 64.2 Hz (lateral vastus and medial vastus, respectively) at 10% contraction failure to 59.9 and 60.1 Hz at 100% contraction failure (P = 0.0006 and 0.0187). Conclusion In patients shortly after total knee arthroplasty, 10 repetition maximum–loaded knee extensions performed in one set until contraction failure increases voluntary activation of the quadriceps muscle during the set. Clinical Trials Gov-identifier: NCT01713140 to the abstract to increase trial transparency. PMID:26339729

  19. Individuals with medial knee osteoarthritis show neuromuscular adaptation when perturbed during walking despite functional and structural impairments.

    PubMed

    Kumar, Deepak; Swanik, Charles Buz; Reisman, Darcy S; Rudolph, Katherine S

    2014-01-01

    Neuromuscular control relies on sensory feedback that influences responses to changing external demands, and the normal response is for movement and muscle activation patterns to adapt to repeated perturbations. People with knee osteoarthritis (OA) are known to have pain, quadriceps weakness, and neuromotor deficits that could affect adaption to external perturbations. The aim of this study was to analyze neuromotor adaptation during walking in people with knee OA (n = 38) and controls (n = 23). Disability, quadriceps strength, joint space width, malalignment, and proprioception were assessed. Kinematic and EMG data were collected during undisturbed walking and during perturbations that caused lateral translation of the foot at initial contact. Knee excursions and EMG magnitudes were analyzed. Subjects with OA walked with less knee motion and higher muscle activation and had greater pain, limitations in function, quadriceps weakness, and malalignment, but no difference was observed in proprioception. Both groups showed increased EMG and decreased knee motion in response to the first perturbation, followed by progressively decreased EMG activity and increased knee motion during midstance over the first five perturbations, but no group differences were observed. Over 30 trials, EMG levels returned to those of normal walking. The results illustrate that people with knee OA respond similarly to healthy individuals when exposed to challenging perturbations during functional weight-bearing activities despite structural, functional, and neuromotor impairments. Mechanisms underlying the adaptive response in people with knee OA need further study.

  20. Qualitative Development of a Discrete Choice Experiment for Physical Activity Interventions to Improve Knee Osteoarthritis.

    PubMed

    Pinto, Daniel; Danilovich, Margaret K; Hansen, Paul; Finn, Daniel J; Chang, Rowland W; Holl, Jane L; Heinemann, Allen W; Bockenholt, Ulf

    2017-06-01

    To describe the qualitative process used to develop attributes and attribute levels for inclusion in a discrete choice experiments (DCE) for older adult physical activity interventions. Five focus groups (n=41) were conducted, grounded in the Health Action Process Approach framework. Discussion emphasized identification and prioritization attributes for a DCE on physical activity. Semi-structured interviews (n=6) investigated attribute levels and lay-language for the DCE. A focus group with physical activity researchers and health care providers was the final stakeholder group used to establish a comprehensive approach for the generation of attributes and levels. A DCE pilot test (n=8) was then conducted with individuals of the target patient population. All transcripts were analyzed using a constant comparative approach. General community and university-based research setting. Volunteers (N=55) aged >45 years with knee pain, aches, or stiffness for at least 1 month over the previous 12 months. Not applicable. Interview guides, attributes, attribute levels, and discrete choice experiment. The most influential identified attributes for physical activity were time, effort, cost, convenience, enjoyment, and health benefits. Each attribute had 3 levels that were understandable in the pilot test of the DCE. The identification of 6 physical activity attributes that are most salient to adults with knee osteoarthritis resulted from a systematic qualitative process, including attribute-ranking exercises. A DCE will provide insight into the relative importance of these attributes for participating in physical activity, which can guide intervention development. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Knee-extension-assist for knee-ankle-foot orthoses.

    PubMed

    Spring, Alexander; Kofman, Jonathan; Lemaire, Edward

    2011-01-01

    Individuals with quadriceps muscle weakness often have difficulty generating the knee-extension moments required for common mobility tasks. A new device that provides a knee-extension moment was designed to help individuals perform sit-to-stand and stand-to-sit. The knee-extension-assist (KEA) was designed as a modular component to be incorporated into existing knee-ankle-foot-orthoses (KAFO). The KEA loads a set of springs as the knee flexes under bodyweight and returns the stored energy as an extension moment during knee extension. The springs can be locked in place at the end of flexion to prevent unwanted knee extension while seated. When the affected leg is unloaded, the device disengages, allowing free joint motion. A prototype KEA underwent mechanical testing and biomechanical evaluation on an able-bodied individual during sit-to-stand and stand-to-sit.

  2. Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty.

    PubMed

    Ebert, Jay R; Joss, Brendan; Jardine, Berit; Wood, David J

    2013-11-01

    To investigate the efficacy of manual lymphatic drainage (MLD) in the early postoperative period after total knee arthroplasty (TKA) to reduce edema and pain and improve knee range of motion. Prospective randomized controlled trial. Private hospital and functional rehabilitation clinic. Consecutive sample of patients (N=43; 53 knees) scheduled for TKA. MLD (vs no MLD) on days 2, 3, and 4 postoperatively. Both groups underwent conventional, concomitant physical therapy. Clinical assessment was undertaken pre- and postoperatively prior to and after the designated postoperative MLD sessions (days 2, 3, and 4) and at 6 weeks postsurgery. This included active knee flexion and extension range of motion, lower limb girths (ankle, midpatella, thigh, and calf), and knee pain using a numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score. A significant group effect was observed for active knee flexion, with post hoc tests demonstrating a significantly greater active knee flexion in the MLD group when compared with the control (no MLD) group at the final measure prior to hospital discharge (day 4 postsurgery) and at 6 weeks postsurgery. There were no further group effects observed for the remaining patient-reported and functional outcomes. MLD in the early postoperative stages after TKA appears to improve active knee flexion up to 6 weeks postsurgery, in addition to conventional care. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. Documenting Western Burrowing Owl Reproduction and Activity Patterns Using Motion-Activated Cameras

    SciTech Connect

    Hall, Derek B.; Greger, Paul D.

    2014-08-01

    We used motion-activated cameras to monitor the reproduction and patterns of activity of the Burrowing Owl (Athene cunicularia) above ground at 45 burrows in south-central Nevada during the breeding seasons of 1999, 2000, 2001, and 2005. The 37 broods, encompassing 180 young, raised over the four years represented an average of 4.9 young per successful breeding pair. Young and adult owls were detected at the burrow entrance at all times of the day and night, but adults were detected more frequently during afternoon/early evening than were young. Motion-activated cameras require less effort to implement than other techniques. Limitations include photographing only a small percentage of owl activity at the burrow; not detecting the actual number of eggs, young, or number fledged; and not being able to track individual owls over time. Further work is also necessary to compare the accuracy of productivity estimates generated from motion-activated cameras with other techniques.

  4. Acute Orthotic Intervention Does Not Affect Muscular Response Times and Activation Patterns at the Knee

    PubMed Central

    Rose, Holly M.; Shultz, Sandra J.; Arnold, Brent L.; Gansneder, Bruce M.; Perrin, David H.

    2002-01-01

    Objective: To evaluate the short-term effect of a semirigid foot orthotic device on response times and activation patterns of knee musculature in individuals with hyperpronation after a lower extremity perturbation in a single-leg, weight-bearing stance. Design and Setting: We used a lower extremity perturbation device designed to produce a forward and either internal or external rotation of the trunk and femur on the weight-bearing tibia to evoke a reflex response. Subjects were tested both with and without orthotic devices. Subjects: Seventeen (13 male, 4 female) volunteers (age, 20.6 ± 1.8 years; height, 181.0 ± 8.1 cm; weight, 87.4 ± 19.5 kg; navicular drop, 12.1 ± 1.8 mm) with a navicular drop greater than 10 mm volunteered for this study. Measurements: Long latency reflex times were recorded via surface electromyography for the medial and lateral hamstrings, gastrocnemius, and quadriceps muscles. Results: A dependent-sample t test revealed a significant decrease in navicular drop with orthotic intervention (P < .0001). With that confirmed, separate repeated-measures analyses of variance with 2 within factors (orthotic condition and muscle) revealed no significant difference in muscle response time between orthotic and nonorthotic conditions for either internal or external rotation perturbation. Although we found a main effect for muscle for both internal (P < .0001) and external (P < .0001) rotation, indicating a preferred muscle activation order, this activation order did not differ between orthotic and nonorthotic conditions (internal rotation P = .674, external rotation P = .829). Conclusions: Our findings suggest that a short-term application of a semirigid orthotic device does not alter muscle response times or activation patterns of the muscles that stabilize the knee. Further research is needed to determine whether changes in activation patterns may occur over time since mechanical adaptations occur with long-term wear. PMID:12937425

  5. Generation of physiological parameter sets for hip joint motions and loads during daily life activities for application in wear simulators of the artificial hip joint.

    PubMed

    Fabry, Christian; Herrmann, Sven; Kaehler, Michael; Klinkenberg, Ernst-Dieter; Woernle, Christoph; Bader, Rainer

    2013-01-01

    At present, wear investigations of total hip replacements are performed in accordance with the ISO standard 14242, which is based on simplified kinematic and force data of the gait cycle. The aim of this analytical study was to generate parameter sets of daily life activities in order to replicate more realistic joint load situations in wear testing. Hence, published in vivo motion and force data of daily life activities were evaluated and adjusted using analytical techniques. The created kinematically and dynamically consistent parameter sets comprised time trajectories of three Cardan angles to describe the motion of the femur with respect to the pelvis and time trajectories of three force components, representing the hip joint contact force. The parameter sets include the activities of walking, knee bending, stair climbing and a combined load case of sitting down and standing up. Additionally, a motion sequence following the frequency of daily life activities was presented. Differences of the evaluated angular motions and joint contact forces in comparison to the ISO standard 14242-1 were pointed out. The results of this study offer the possibility to extend the kinematics and dynamics of the ISO standard test protocol and to support the loading conditions of hip wear simulators with a comprehensive set of motions and loads close to reality. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  6. Intracellular water motion decreases in apoptotic macrophages after caspase activation.

    PubMed

    Hortelano, S; García-Martín, M L; Cerdán, S; Castrillo, A; Alvarez, A M; Boscá, L

    2001-10-01

    Triggering of the macrophage cell line RAW 264.7 with lipopolysaccharide and interferon-gamma promoted apoptosis that was prevented by inhibitors of type 2 nitric oxide synthase or caspase. Using (1)H NMR analysis, we have investigated the changes of the intracellular transverse relaxation time (T(2)) and apparent diffusion coefficient (ADC) as parameters reflecting the rotational and translational motions of water in apoptotic macrophages. T(2) values decreased significantly from 287 to 182 ms in cells treated for 18 h with NO-donors. These changes of T(2) were prevented by caspase inhibitors and were not due to mitochondrial depolarization or microtubule depolymerization. The decrease of the intracellular values of T(2) and ADC in apoptotic macrophages was observed after caspase activation, but preceded phosphatidylserine exposure and nucleosomal DNA cleavage. The changes of water motion were accompanied by an enhancement of the hydrophobic properties of the intracellular milieu, as detected by fluorescent probes. These results indicate the occurrence of an alteration in the physicochemical properties of intracellular water during the course of apoptosis.

  7. Quadriceps Strength Asymmetry Following ACL Reconstruction Alters Knee Joint Biomechanics and Functional Performance at Time of Return to Activity

    PubMed Central

    Palmieri-Smith, RM; Lepley, LK

    2016-01-01

    Background Quadriceps strength deficits are observed clinically following anterior cruciate injury and reconstruction and are often not overcome despite rehabilitation. Given that quadriceps strength may be important for achieving symmetrical joint biomechanics and promoting long-term joint health, determining the magnitude of strength deficits that lead to altered mechanics is critical. Purpose To determine if the magnitude of quadriceps strength asymmetry alters knee and hip biomechanical symmetry, as well as functional performance and self-reported function. Study Design Cross-Sectional study. Methods Seventy-three patients were tested at the time they were cleared for return to activity following ACL reconstruction. Quadriceps strength and activation, scores on the International Knee Documentation Committee form, the hop for distance test, and sagittal plane lower extremity biomechanics were recorded while patients completed a single-legged hop. Results Patients with high and moderate quadriceps strength symmetry had larger central activation ratios as well as greater limb symmetry indices on the hop for distance compared to patients with low quadriceps strength symmetry (P<0.05). Similarly, knee flexion angle and external moment symmetry was higher in the patients with high and moderate quadriceps symmetry compared to those with low symmetry (P<0.05). Quadriceps strength was found to be associated with sagittal plane knee angle and moment symmetry (P<0.05). Conclusion Patients with low quadriceps strength displayed greater movement asymmetries at the knee in the sagittal plane. Quadriceps strength was related to movement asymmetries and functional performance. Rehabilitation following ACL reconstruction needs to focus on maximizing quadriceps strength, which likely will lead to more symmetrical knee biomechanics. PMID:25883169

  8. Comparison of Transcutaneous Electrical Nerve Stimulation and Cryotherapy for Increasing Quadriceps Activation in Patients With Knee Pathologies.

    PubMed

    Gabler, Conrad M; Lepley, Adam S; Uhl, Tim L; Mattacola, Carl G

    2016-08-01

    Proper neuromuscular activation of the quadriceps muscle is essential for maintaining quadriceps (quad) strength and lower-extremity function. Quad activation (QA) failure is a common characteristic observed in patients with knee pathologies, defined as an inability to voluntarily activate the entire alpha-motor-neuron pool innervating the quad. One of the more popular techniques used to assess QA is the superimposed burst (SIB) technique, a force-based technique that uses a supramaximal, percutaneous electrical stimulation to activate all of the motor units in the quad during a maximal, voluntary isometric contraction. Central activation ratio (CAR) is the formula used to calculate QA level (CAR = voluntary force/SIB force) with the SIB technique. People who can voluntarily activate 95% or more (CAR = 0.95-1.0) of their motor units are defined as being fully activated. Therapeutic exercises aimed at improving quad strength in patients with knee pathologies are limited in their effectiveness due to a failure to fully activate the muscle. Within the past decade, several disinhibitory interventions have been introduced to treat QA failure in patients with knee pathologies. Transcutaneous electrical nerve stimulation (TENS) and cryotherapy are sensory-targeted modalities traditionally used to treat pain, but they have been shown to be 2 of the most successful treatments for increasing QA levels in patients with QA failure. Both modalities are hypothesized to positively affect voluntary QA by disinhibiting the motor-neuron pool of the quad. In essence, these modalities provide excitatory afferent stimuli to the spinal cord, which thereby overrides the inhibitory afferent signaling that arises from the involved joint. However, it remains unknown whether 1 is more effective than the other for restoring QA levels in patients with knee pathologies. By knowing the capabilities of each disinhibitory modality, clinicians can tailor treatments based on the rehabilitation goals

  9. Sport and physical activity following unicompartmental knee arthroplasty: a systematic review.

    PubMed

    Waldstein, Wenzel; Kolbitsch, Paul; Koller, Ulrich; Boettner, Friedrich; Windhager, Reinhard

    2017-03-01

    Unicompartmental knee arthroplasty (UKA) can be a surgical treatment option for patients with high expectations regarding the post-operative level of physical activity. A systematic review was undertaken to answer three research questions: (1) is there an improvement of physical activity based on validated activity scores following UKA? (2) What are the sport disciplines and the sport patterns of UKA patients? (3) What are the pre- and post-operative sport participation rates and the return to activity rates of UKA patients? Following the PRISMA guidelines, EMBASE, MEDLINE, ISI Web of Science and the Cochrane Central Register of Controlled Trials were searched for studies reporting the level of sport and/or physical activity before and after UKA, and/or included at least one activity score before and after UKA. Seventeen studies were identified reporting on 2972 UKAs, of which 89 % were medial UKAs and 92 % were mobile-bearing implants, respectively. Ten studies reported a statistically significant improvement of physical activity following UKA according to the UCLA activity score, the Tegner activity score or the High Activity Arthroplasty Score, respectively. Hiking, cycling and swimming are the most common activities following UKA. Sport participation before the onset of restricting symptoms ranged from 64 to 93 % and slightly decreased by 2-9 % following UKA. The return to activity rate ranged from 87 to 98 %. Patients following UKA are physically active according to validated activity scores. A significant increase in low-impact activities and a decrease in high-impact activities after UKA was observed. Patients with a UKA regularly participate in sports; however, sport participation slightly decreased compared to pre-arthritic levels. This systematic review helps physicians to manage the expectations of patients regarding the level of physical activity following UKA. III.

  10. Modulation of Physical Activity to Optimize Pain Sensation following an Intra-Articular Corticosteroid Injection in Patients with Knee Osteoarthritis

    PubMed Central

    Dessery, Yoann; Belzile, Étienne L.; Turmel, Sylvie; Doré, Jean; Diallo, Binta

    2014-01-01

    Background. Intra-articular corticosteroid injection is often used to relieve pain caused by knee osteoarthritis. This study aims to assess the impact after an intra-articular corticosteroid injection treatment on objective and subjective measurement of physical function in knee osteoarthritis patients. Methods. Fourteen patients with unilateral knee osteoarthritis participated in this open-label uncontrolled trial. The intra-articular corticosteroid injection was given at the end of the second week. Physical activity was objectively measured by an accelerometer worn by the participants for eight weeks. Symptoms, quality of life and spatiotemporal parameters of gait were assessed every two weeks. Results. From the injection until six weeks later, pain and stiffness were reduced by approximately 60%. Patients' daily physical activity time was significantly improved after injection: participation in light and moderate physical activities increased during four and two weeks, respectively. Conclusions. The beneficial effects after the intra-articular corticosteroid injection are visible in the duration and intensity of the knee osteoarthritis patients' daily physical activity. However, these effects declined gradually two weeks after injection. Modulating the intensity and duration of physical activity would allow patients to optimize pain sensation over a longer period following an intra-articular corticosteroid injection. Trial Registration. This trial was registered with ClinicalTrials: NCT02049879. PMID:25478585

  11. Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study.

    PubMed

    Amusat, Nurudeen; Beaupre, Lauren; Jhangri, Gian S; Pohar, Sheri L; Simpson, Scot; Warren, Sharon; Jones, C Allyson

    2014-12-01

    In the 6 months after total knee arthroplasty (TKA), what is the pattern of pain resolution and functional recovery in people without diabetes, with diabetes that does not impact on routine activities, and with diabetes that does impact on routine activities? Is diabetes that impacts on routine activities an independent predictor of slower resolution of pain and functional recovery after TKA? Community-based prospective observational study. A consecutive cohort of 405 people undergoing primary TKA, of whom 60 (15%) had diabetes. PARTICIPANTS with diabetes were also asked preoperatively whether diabetes impacted on their routine activities. PARTICIPANTS were categorised into three groups: no diabetes (n=345), diabetes with no impact on activities (n=41), and diabetes that impacted activities (n=19). Pain and function were measured using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index within the month before surgery and 1, 3 and 6 months after surgery. Demographic, medical and surgical factors were also measured, along with depression, social support and health-related quality of life. No baseline differences in pain and function were seen among the three groups (p > 0.05). Adjusting for age, gender and contralateral joint involvement across the 6 postoperative months, participants with diabetes that impacted on routine activities had pain scores that were 8.3 points higher (indicating greater pain) and function scores that were 5.4 points higher (indicating lower function) than participants without diabetes. PARTICIPANTS with diabetes that doesn't impact on routine activities had similar recovery to those without diabetes. People undergoing TKA who report preoperatively that diabetes impacts on their routine activities have less recovery over 6 months than those without diabetes or those with diabetes that does not impact on routine activities. Physiotherapists could institute closer monitoring within the hospital and community settings

  12. Can a finite set of knee extension in supine position be used for a knee functional examination?

    PubMed

    Marin, F; Sangeux, M; Charleux, F; Ho Ba Tho, M-C; Dürselen, L

    2006-01-01

    The kinematic magnetic resonance imaging technique has been developed to provide a functional examination of the knee. Technical limitations require this examination to be performed in supine position, and the knee motion is represented by an assembly of static positions at different knee angles. However, the main knee function is to support the body weight and perform continuous motion, e.g. parallel squat. Our study quantified the knee kinematics of 20 healthy subjects in different motion conditions (finite and continuous) and in different mechanical conditions (continuous unloaded and continuous loaded). We evaluated the angular and localisation difference of a finite helical axis of the knee motion for parallel squat, continuous knee extension in supine position and the finite set of knee extension in supine position. We found large inter-individual dispersion. The majority of subjects had equivalent knee kinematics between continuous knee extension and the finite set of knee extension in supine position, but not between continuous knee extension in supine position and the parallel squat. Therefore, results from a functional examination of a finite set of knee extensions in supine position do not represent the knee motion in a parallel squat. Our results suggest that functional examination of the knee from magnetic resonance imaging do not necessarily reflect the physiological kinematics of the knee. Further investigation should focus on a new magnetic resonance imaging acquisition protocol that allows image acquisition during weight bearing or includes a special device which reproduces the loaded condition.

  13. Knee Proprioception and Strength and Landing Kinematics During a Single-Leg Stop-Jump Task

    PubMed Central

    Nagai, Takashi; Sell, Timothy C; House, Anthony J; Abt, John P; Lephart, Scott M

    2013-01-01

    Context The importance of the sensorimotor system in maintaining a stable knee joint has been recognized. As individual entities, knee-joint proprioception, landing kinematics, and knee muscles play important roles in functional joint stability. Preventing knee injuries during dynamic tasks requires accurate proprioceptive information and adequate muscular strength. Few investigators have evaluated the relationship between knee proprioception and strength and landing kinematics. Objective To examine the relationship between knee proprioception and strength and landing kinematics. Design Cross-sectional study. Setting University research laboratory. Patients or Other Participants Fifty physically active men (age = 26.4 ± 5.8 years, height = 176.5 ± 8.0 cm, mass = 79.8 ± 16.6 kg). Intervention(s) Three tests were performed. Knee conscious proprioception was evaluated via threshold to detect passive motion (TTDPM). Knee strength was evaluated with a dynamometer. A 3-dimensional biomechanical analysis of a single-legged stop-jump task was used to calculate initial contact (IC) knee-flexion angle and knee-flexion excursion. Main Outcome Measure(s) The TTDPM toward knee flexion and extension, peak knee flexion and extension torque, and IC knee-flexion angle and knee flexion excursion. Linear correlation and stepwise multiple linear regression analyses were used to evaluate the relationships of both proprioception and strength against landing kinematics. The α level was set a priori at .05. Results Enhanced TTDPM and greater knee strength were positively correlated with greater IC knee-flexion angle (r range = 0.281–0.479, P range = .001–.048). The regression analysis revealed that 27.4% of the variance in IC knee-flexion angle could be accounted for by knee-flexion peak torque and TTDPM toward flexion (P = .001). Conclusions The current research highlighted the relationship between knee proprioception and strength and landing kinematics. Individuals with enhanced

  14. Diffusion in different models of active Brownian motion

    NASA Astrophysics Data System (ADS)

    Lindner, B.; Nicola, E. M.

    2008-04-01

    Active Brownian particles (ABP) have served as phenomenological models of self-propelled motion in biology. We study the effective diffusion coefficient of two one-dimensional ABP models (simplified depot model and Rayleigh-Helmholtz model) differing in their nonlinear friction functions. Depending on the choice of the friction function the diffusion coefficient does or does not attain a minimum as a function of noise intensity. We furthermore discuss the case of an additional bias breaking the left-right symmetry of the system. We show that this bias induces a drift and that it generally reduces the diffusion coefficient. For a finite range of values of the bias, both models can exhibit a maximum in the diffusion coefficient vs. noise intensity.

  15. Unwinding Motion of a Twisted Active Region Filament

    NASA Astrophysics Data System (ADS)

    Yan, X. L.; Xue, Z. K.; Liu, J. H.; Kong, D. F.; Xu, C. L.

    2014-12-01

    To better understand the structures of active region filaments and the eruption process, we study an active region filament eruption in active region NOAA 11082 in detail on 2010 June 22. Before the filament eruption, the opposite unidirectional material flows appeared in succession along the spine of the filament. The rising of the filament triggered two B-class flares at the upper part of the filament. As the bright material was injected into the filament from the sites of the flares, the filament exhibited a rapid uplift accompanying the counterclockwise rotation of the filament body. From the expansion of the filament, we can see that the filament consisted of twisted magnetic field lines. The total twist of the filament is at least 5π obtained by using a time slice method. According to the morphology change during the filament eruption, it is found that the active region filament was a twisted flux rope and its unwinding motion was like a solar tornado. We also find that there was a continuous magnetic helicity injection before and during the filament eruption. It is confirmed that magnetic helicity can be transferred from the photosphere to the filament. Using the extrapolated potential fields, the average decay index of the background magnetic fields over the filament is 0.91. Consequently, these findings imply that the mechanism of solar filament eruption could be due to the kink instability and magnetic helicity accumulation.

  16. Unwinding motion of a twisted active region filament

    SciTech Connect

    Yan, X. L.; Xue, Z. K.; Kong, D. F.; Liu, J. H.; Xu, C. L.

    2014-12-10

    To better understand the structures of active region filaments and the eruption process, we study an active region filament eruption in active region NOAA 11082 in detail on 2010 June 22. Before the filament eruption, the opposite unidirectional material flows appeared in succession along the spine of the filament. The rising of the filament triggered two B-class flares at the upper part of the filament. As the bright material was injected into the filament from the sites of the flares, the filament exhibited a rapid uplift accompanying the counterclockwise rotation of the filament body. From the expansion of the filament, we can see that the filament consisted of twisted magnetic field lines. The total twist of the filament is at least 5π obtained by using a time slice method. According to the morphology change during the filament eruption, it is found that the active region filament was a twisted flux rope and its unwinding motion was like a solar tornado. We also find that there was a continuous magnetic helicity injection before and during the filament eruption. It is confirmed that magnetic helicity can be transferred from the photosphere to the filament. Using the extrapolated potential fields, the average decay index of the background magnetic fields over the filament is 0.91. Consequently, these findings imply that the mechanism of solar filament eruption could be due to the kink instability and magnetic helicity accumulation.

  17. The effect of gender on force, muscle activity, and frontal plane knee alignment during maximum eccentric leg-press exercise.

    PubMed

    Liebensteiner, Michael C; Platzer, Hans-Peter; Burtscher, Martin; Hanser, Friedrich; Raschner, Christian

    2012-03-01

    To investigate for gender differences during eccentric leg-press exercise. Tears of the anterior cruciate ligament (ACL) are considered to be related to eccentric tasks, altered neuromuscular control (e.g., reduced co-contraction of hamstrings), and increased knee abduction (valgus alignment). Based on these observations and the fact that ACL tears are more common in women, it was hypothesized that men and women differ significantly with regard to key parameters of force, knee stabilization, and muscle activity when exposed to maximum eccentric leg extension. Thirteen women and thirteen men were matched for age and physical activity. They performed maximum isokinetic eccentric leg-pressing against footplates of varied stability. The latter was done because earlier studies had shown that perturbational test conditions might be relevant in respect of ACL injuries. Key parameters of force, frontal plane knee stabilization, and muscle recruitment of significant muscles crossing the knee were recorded. The 'force stabilization deficit' (difference between maximum forces under normal and perturbed leg-pressing) did not differ significantly between genders. Likewise, parameters of muscle activity and frontal plane leg stabilization revealed no significant differences between men and women. This study is novel, in that gender differences in parameters of force, muscle activity, and leg kinematic were investigated during functional conditions of eccentric leg-pressing. No gender differences were observed in the measured parameters. However, the conclusion should be viewed with caution because the findings concurred with, but also contrasted, previous research in this field. Diagnostic study, Level III.

  18. Do radiographic disease and pain account for why people with or at high risk of knee osteoarthritis do not meet Physical Activity Guidelines?

    PubMed Central

    White, Daniel K.; Tudor-Locke, Catrine; Felson, David T.; Gross, K. Doug; Niu, Jingbo; Nevitt, Michael; Lewis, Cora E.; Torner, James; Neogi, Tuhina

    2012-01-01

    OBJECTIVE Knee Osteoarthritis (OA) and pain are assumed to be barriers for meeting physical activity guidelines, but this has not been formally evaluated. The purpose of this study was to determine the proportion of people with and without knee OA and knee pain who met recommended physical activity levels through walking. METHODS Cross-sectional analysis of community dwelling adults who have or who are at high risk of knee OA from The Multicenter Osteoarthritis Study. Participants wore a StepWatch activity monitor to record steps/day over 7 days. The proportion that met the recommended physical activity levels was determined as those accumulating ≥150 minutes/week at ≥100 steps/minute in bouts lasting ≥10 minutes. These proportions were also determined for those with and without knee OA, as classified by radiograph, and by severity of knee pain. RESULTS Of the 1788 study participants (age 67 sd 8 yrs, BMI 31 sd 6 kg/m2, 60% female), lower overall percentages of participants with radiographic knee OA and knee pain met recommended physical activity levels. However, these differences were not statistically significant between those with and without knee OA; 7.3% and 10.1% of men (p=0.34), and 6.3% and 7.8% of women (p=0.51), respectively, met recommended physical activity levels. Similarly, for those with moderate/severe pain versus no pain, 12.9% and 10.9% of men (p=0.74) and 6.7% and 11.0% (p=0.40) of women met recommended physical activity levels. CONCLUSIONS Disease and pain have little impact on achieving recommended physical activity levels among people with or at high risk of knee OA. PMID:23124774

  19. Reduced Maximal Force during Acute Anterior Knee Pain Is Associated with Deficits in Voluntary Muscle Activation

    PubMed Central

    Salomoni, Sauro; Tucker, Kylie; Hug, François; McPhee, Megan; Hodges, Paul

    2016-01-01

    Although maximal voluntary contraction (MVC) force is reduced during pain, studies using interpolated twitch show no consistent reduction of voluntary muscle drive. The present study aimed to test if the reduction in MVC force during acute experimental pain could be explained by increased activation of antagonist muscles, weak voluntary activation at baseline, or changes in force direction. Twenty-two healthy volunteers performed maximal voluntary isometric knee extensions before, during, and after the effects of hypertonic (pain) and isotonic (control) saline injections into the infrapatellar fat pad. The MVC force, voluntary activation, electromyographic (EMG) activity of agonist, antagonist, and auxiliary (hip) muscles, and pain cognition and anxiety scores were recorded. MVC force was 9.3% lower during pain than baseline (p < 0.001), but there was no systematic change in voluntary activation. Reduced MVC force during pain was variable between participants (SD: 14%), and was correlated with reduced voluntary activation (r = 0.90), baseline voluntary activation (r = − 0.62), and reduced EMG amplitude of agonist and antagonist muscles (all r > 0.52), but not with changes in force direction, pain or anxiety scores. Hence, reduced MVC force during acute pain was mainly explained by deficits in maximal voluntary drive. PMID:27559737

  20. Peak triceps surae muscle activity is not specific to knee flexion angles during MVIC.

    PubMed

    Hébert-Losier, Kim; Schneiders, Anthony G; García, José A; Sullivan, S John; Simoneau, Guy G

    2011-10-01

    There is limited research on peak activity of the separate triceps surae muscles in select knee flexion (KF) positions during a maximum voluntary isometric contraction (MVIC) used to normalize EMG signals. The aim of this study was to determine how frequent peak activity occurred during an MVIC for soleus (SOL), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL) in select KF positions, and if these peaks were recorded in similar KF positions. Forty-eight healthy individuals performed unilateral plantar-flexion MVIC in standing with 0°KF and 45°KF, and in sitting with 90°KF. Surface EMG of SOL, GM, and GL were collected and processed in 250 ms epochs to determine peak root-mean-square amplitude. Peak activity was most frequently captured in standing and rarely in sitting, with no position selective to SOL, GM or GL activity. Peak GM and GL activity was more frequent in 0°KF than 45°KF, and more often in similar KF positions than not. Peak SOL activity was just as likely in 45°KF as 0°KF, and more in positions similar to GM, but not GL. The EMG amplitudes were at least 20% greater in positions that captured peak activity over those that did not. The overall findings support performing an MVIC in more than one KF position to normalize triceps surae EMG. It is emphasized that no KF position is selective to SOL, GM, or GL alone.

  1. Knee kinematics during walking at different speeds in people who have undergone total knee replacement.

    PubMed

    McClelland, Jodie A; Webster, Kate E; Feller, Julian A; Menz, Hylton B

    2011-06-01

    People who have undergone total knee replacement (TKR) experience difficulties in some daily activities including walking. Walking at faster speeds requires more knee flexion and may therefore present a greater challenge following TKR. The aim of this study was to compare the knee kinematics of patients following TKR and unimpaired controls during comfortable and fast walking speeds. Forty patients (22 women, 18 men) 12 months following TKR and 40 control participants (matched for age and sex) were assessed during walking at self-selected comfortable and fast speeds using three dimensional motion analysis. The group averages of spatiotemporal and peak kinematic characteristics in the sagittal, coronal and transverse movement planes were compared using univariate analysis of variance with walking speed as a co-variate. The TKR group walked with significantly reduced cadence (p < 0.001 at both speeds) and reduced stride length (p < 0.001 at both speeds), less knee flexion during stance and swing phases (p < 0.001 for both speeds) and less knee extension during stance phase (p < 0.024 for comfortable speed; p < 0.042 for fast speed). The TKR group also walked with less peak knee external rotation than controls at both speeds (p < 0.001 for both speeds). Both groups increased their velocity, cadence and stride length by a similar proportion when walking at fast speed. When walking at a faster speed, spatiotemporal gait parameters and knee motion are altered in a similar manner for both TKR patients and controls. However, at both walking speeds, TKR patients exhibit residual deficits 12 months following surgery.

  2. Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions?

    PubMed

    Witjes, Suzanne; van Geenen, Rutger C I; Koenraadt, Koen L M; van der Hart, Cor P; Blankevoort, Leendert; Kerkhoffs, Gino M M J; Kuijer, P Paul F M

    2017-02-01

    Indications for total and unicondylar knee arthroplasty (KA) have expanded to younger patients, in which Patient-Reported Outcome Measures (PROMs) often show ceiling effects. This might be due to higher expectations. Our aims were to explore expectations of younger patients concerning activities in daily life, work and leisure time after KA and to assess to what extent PROMs meet and evaluate these activities of importance. Focus groups were performed among osteoarthritis (OA) patients <65 years awaiting KA, in which they indicated what activities they expected to perform better in daily life, work and leisure time after KA. Additionally, 28 activities of daily life, 17 of work and 27 of leisure time were depicted from seven PROMS, which were rated on importance, frequency and bother. A total score, representing motivation for surgery, was also calculated. Data saturation was reached after six focus groups including 37 patients. Younger OA patients expect to perform better on 16 activities after KA, including high-impact leisure time activities. From the PROMs, daily life and work activities were rated high in both importance and motivation for surgery, but for leisure time activities importance varied highly between patients. All seven PROMs score activities of importance, but no single PROM incorporates all activities rated important. Younger patients expect to perform better on many activities of daily life, work and leisure time after KA, and often at demanding levels. To measure outcomes of younger patients, we suggest using PROMs that include work and leisure time activities besides daily life activities, in which preferably scored activities can be individualized.

  3. Knee cartilage segmentation using active shape models and local binary patterns

    NASA Astrophysics Data System (ADS)

    González, Germán.; Escalante-Ramírez, Boris

    2014-05-01

    Segmentation of knee cartilage has been useful for opportune diagnosis and treatment of osteoarthritis (OA). This paper presents a semiautomatic segmentation technique based on Active Shape Models (ASM) combined with Local Binary Patterns (LBP) and its approaches to describe the surrounding texture of femoral cartilage. The proposed technique is tested on a 16-image database of different patients and it is validated through Leave- One-Out method. We compare different segmentation techniques: ASM-LBP, ASM-medianLBP, and ASM proposed by Cootes. The ASM-LBP approaches are tested with different ratios to decide which of them describes the cartilage texture better. The results show that ASM-medianLBP has better performance than ASM-LBP and ASM. Furthermore, we add a routine which improves the robustness versus two principal problems: oversegmentation and initialization.

  4. Improvement of the knee center of rotation during walking after opening wedge high tibial osteotomy.

    PubMed

    Kim, Kyungsoo; Feng, Jun; Nha, Kyung Wook; Park, Won Man; Kim, Yoon Hyuk

    2015-06-01

    Accurate measurement of the center of rotation of the knee joint is indispensable for prediction of joint kinematics and kinetics in musculoskeletal models. However, no study has yet identified the knee center of rotations during several daily activities before and after high tibial osteotomy surgery, which is one surgical option for treating knee osteoarthritis. In this study, an estimation method for determining the knee joint center of rotation was developed by applying the optimal common shape technique and symmetrical axis of rotation approach techniques to motion-capture data and validated for typical activities (walking, squatting, climbing up stairs, walking down stairs) of 10 normal subjects. The locations of knee joint center of rotations for injured and contralateral knees of eight subjects with osteoarthritis, both before and after high tibial osteotomy surgery, were then calculated during walking. It was shown that high tibial osteotomy surgery improved the knee joint center of rotation since the center of rotations for the injured knee after high tibial osteotomy surgery were significantly closer to those of the normal healthy population. The difference between the injured and contralateral knees was also generally reduced after surgery, demonstrating increased symmetry. These results indicate that symmetry in both knees can be recovered in many cases after high tibial osteotomy surgery. Moreover, the recovery of center of rotation in the injured knee was prior to that of symmetry. This study has the potential to provide fundamental information that can be applied to understand abnormal kinematics in patients, diagnose knee joint disease, and design a novel implants for knee joint surgeries.

  5. Effects of image noise, respiratory motion, and motion compensation on 3D activity quantification in count-limited PET images

    NASA Astrophysics Data System (ADS)

    Siman, W.; Mawlawi, O. R.; Mikell, J. K.; Mourtada, F.; Kappadath, S. C.

    2017-01-01

    The aims of this study were to evaluate the effects of noise, motion blur, and motion compensation using quiescent-period gating (QPG) on the activity concentration (AC) distribution—quantified using the cumulative AC volume histogram (ACVH)—in count-limited studies such as 90Y-PET/CT. An International Electrotechnical Commission phantom filled with low 18F activity was used to simulate clinical 90Y-PET images. PET data were acquired using a GE-D690 when the phantom was static and subject to 1-4 cm periodic 1D motion. The static data were down-sampled into shorter durations to determine the effect of noise on ACVH. Motion-degraded PET data were sorted into multiple gates to assess the effect of motion and QPG on ACVH. Errors in ACVH at AC90 (minimum AC that covers 90% of the volume of interest (VOI)), AC80, and ACmean (average AC in the VOI) were characterized as a function of noise and amplitude before and after QPG. Scan-time reduction increased the apparent non-uniformity of sphere doses and the dispersion of ACVH. These effects were more pronounced in smaller spheres. Noise-related errors in ACVH at AC20 to AC70 were smaller (<15%) compared to the errors between AC80 to AC90 (>15%). The accuracy of ACmean was largely independent of the total count. Motion decreased the observed AC and skewed the ACVH toward lower values; the severity of this effect depended on motion amplitude and tumor diameter. The errors in AC20 to AC80 for the 17 mm sphere were  -25% and  -55% for motion amplitudes of 2 cm and 4 cm, respectively. With QPG, the errors in AC20 to AC80 of the 17 mm sphere were reduced to  -15% for motion amplitudes  <4 cm. For spheres with motion amplitude to diameter ratio  >0.5, QPG was effective at reducing errors in ACVH despite increases in image non-uniformity due to increased noise. ACVH is believed to be more relevant than mean or maximum AC to calculate tumor control and normal tissue complication probability

  6. In Vivo Healthy Knee Kinematics during Dynamic Full Flexion

    PubMed Central

    Hamai, Satoshi; Moro-oka, Taka-aki; Dunbar, Nicholas J.; Miura, Hiromasa; Iwamoto, Yukihide; Banks, Scott A.

    2013-01-01

    Healthy knee kinematics during dynamic full flexion were evaluated using 3D-to-2D model registration techniques. Continuous knee motions were recorded during full flexion in a lunge from 85° to 150°. Medial and lateral tibiofemoral contacts and femoral internal-external and varus-valgus rotations were analyzed as a function of knee flexion angle. The medial tibiofemoral contact translated anteroposteriorly, but remained on the center of the medial compartment. On the other hand, the lateral tibiofemoral contact translated posteriorly to the edge of the tibial surface at 150° flexion. The femur exhibited external and valgus rotation relative to the tibia over the entire activity and reached 30° external and 5° valgus rotations at 150° flexion. Kinematics' data during dynamic full flexion may provide important insight as to the designing of high-flexion total knee prostheses. PMID:23509767

  7. In vivo healthy knee kinematics during dynamic full flexion.

    PubMed

    Hamai, Satoshi; Moro-oka, Taka-aki; Dunbar, Nicholas J; Miura, Hiromasa; Iwamoto, Yukihide; Banks, Scott A

    2013-01-01

    Healthy knee kinematics during dynamic full flexion were evaluated using 3D-to-2D model registration techniques. Continuous knee motions were recorded during full flexion in a lunge from 85° to 150°. Medial and lateral tibiofemoral contacts and femoral internal-external and varus-valgus rotations were analyzed as a function of knee flexion angle. The medial tibiofemoral contact translated anteroposteriorly, but remained on the center of the medial compartment. On the other hand, the lateral tibiofemoral contact translated posteriorly to the edge of the tibial surface at 150° flexion. The femur exhibited external and valgus rotation relative to the tibia over the entire activity and reached 30° external and 5° valgus rotations at 150° flexion. Kinematics' data during dynamic full flexion may provide important insight as to the designing of high-flexion total knee prostheses.

  8. Return to work and workplace activity limitations following total hip or knee replacement.

    PubMed

    Sankar, A; Davis, A M; Palaganas, M P; Beaton, D E; Badley, E M; Gignac, M A

    2013-10-01

    Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and 1, 3, 6 and 12 months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). 166 (87%) and 144 (85%) returned to work by 12 months following THR and TKR, respectively. Early (1 month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and every day functional limitations were associated with less workplace activity limitations at the time return to work. The majority of individuals working prior to surgery return to work following hip or knee replacement for osteoarthritis (OA) and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  9. Examining Ankle-Joint Laxity Using 2 Knee Positions and With Simulated Muscle Guarding

    PubMed Central

    Hanlon, Shawn; Caccese, Jaclyn; Knight, Christopher A.; Swanik, Charles “Buz”; Kaminski, Thomas W.

    2016-01-01

    Context:  Several factors affect the reliability of the anterior drawer and talar tilt tests, including the individual clinician's experience and skill, ankle and knee positioning, and muscle guarding. Objectives:  To compare gastrocnemius activity during the measurement of ankle-complex motion at different knee positions, and secondarily, to compare ankle-complex motion during a simulated trial of muscle guarding. Design:  Cross-sectional study. Setting:  Research laboratory. Patients or Other Participants:  Thirty-three participants aged 20.2 ± 1.7 years were tested. Intervention(s):  The ankle was loaded under 2 test conditions (relaxed, simulated muscle guarding) at 2 knee positions (0°, 90° of flexion) while gastrocnemius electromyography (EMG) activity was recorded. Main Outcome Measure(s):  Anterior displacement (mm), inversion-eversion motion (°), and peak EMG amplitude values of the gastrocnemius (μV). Results:  Anterior displacement did not differ between the positions of 0° and 90° of knee flexion (P = .193). Inversion-eversion motion was greater at 0° of knee flexion compared with 90° (P < .001). Additionally, peak EMG amplitude of the gastrocnemius was not different between 0° and 90° of knee flexion during anterior displacement (P = .101). As expected, the simulated muscle-guarding trial reduced anterior displacement compared with the relaxed condition (0° of knee flexion, P = .008; 90° of knee flexion, P = .016) and reduced inversion-eversion motion (0° of knee flexion, P = .03; 90° of knee flexion, P < .001). Conclusions:  In a relaxed state, the gastrocnemius muscle did not appear to affect anterior ankle laxity at the 2 most common knee positions for anterior drawer testing; however, talar tilt testing may be best performed with the knee in 0° of knee flexion. Finally, our outcomes from the simulated muscle-guarding condition suggest that clinicians should use caution and be aware of reduced perceived laxity when

  10. Knee Bursitis

    MedlinePlus

    ... make a diagnosis of knee bursitis during a physical exam. Your doctor will inspect your knee by: Comparing the condition of both knees, particularly if only one is painful Gently pressing on different areas of your knee to detect warmth, swelling and the source of pain Carefully moving ...

  11. Character, Incidence, and Predictors of Knee Pain and Activity after Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

    PubMed Central

    Obremskey, William; Agel, Julie; Archer, Kristin; To, Philip; Tornetta, Paul

    2015-01-01

    Objective To study the activity and incidence of knee pain after sustaining a isolated tibia fracture treated with an infrapatellar intramedullary nail at one year. Design Retrospective review of prospective cohort Setting Multicenter Academic and Community hospitals Patients 437 patients with an isolated tibia fracture completed a 12 month assessment on pain and self-reported activity. Intervention Infrapatellar Intramedullary Nail Outcomes Demographic information co-morbid conditions, injury characteristics, and surgical technique were recorded. Knee pain was defined on a 1-7 scale with 1 being “no pain” and 7 being a “very great deal of pain.” Knee pain > 4 was considered clinically significant. Patients reported if they were “able”, “able with difficulty” or “unable” to perform the following activities: kneel, run, climb stairs, and walk prolonged. Variables were tested in multilevel multivariable regression analyses. Results Knee Pain: 11% percent of patients reported a “good deal” to a “very great deal” of pain (> 4). 52% of patients reported “no” or “very little” pain at 12 months. Activity at 12 months: 26% and 29% of patients were unable to kneel or run, respectively. 31% and 35% of patients respectively stated they were able with difficulty or unable to use stairs or walk. Conclusion Clinically significant knee pain (>4/7) was present in 11% of patients one year after a tibia fracture. 31%-71% of patients had difficulty performing or were unable to perform routine daily activities of kneeling, running, and stair climbing or walking prolonged distances. PMID:26496180

  12. Character, Incidence, and Predictors of Knee Pain and Activity After Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture.

    PubMed

    Obremskey, William; Agel, Julie; Archer, Kristin; To, Philip; Tornetta, Paul

    2016-03-01

    To study the activity and incidence of knee pain after sustaining an isolated tibia fracture treated with an infrapatellar intramedullary nail at 1 year. Retrospective review of prospective cohort. Multicenter Academic and Community hospitals. Four hundred thirty-seven patients with an isolated tibia fracture completed a 12-month assessment on pain and self-reported activity. Infrapatellar intramedullary nail. Demographic information, comorbid conditions, injury characteristics, and surgical technique were recorded. Knee pain was defined on a 1-7 scale with 1 being "no pain" and 7 being a "very great deal of pain." Knee pain >4 was considered clinically significant. Patients reported if they were "able," "able with difficulty," or "unable" to perform the following activities: kneel, run, climb stairs, and walk prolonged. Variables were tested in multilevel multivariable regression analyses. In knee pain, 11% of patients reported a "good deal" to a "very great deal" of pain (>4), and 52% of patients reported "no" or "very little" pain at 12 months. In activity at 12 months, 26% and 29% of patients were unable to kneel or run, respectively, and 31% and 35% of patients, respectively, stated they were able with difficulty or unable to use stairs or walk. Clinically significant knee pain (>4/7) was present in 11% of patients 1 year after a tibia fracture. Of note, 31%-71% of patients had difficulty performing or were unable to perform routine daily activities of kneeling, running, and stair climbing, or walking prolonged distances. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  13. Acute effects of blood flow restriction on muscle activity and endurance during fatiguing dynamic knee extensions at low load.

    PubMed

    Wernbom, Mathias; Järrebring, Rickard; Andreasson, Mikael A; Augustsson, Jesper

    2009-11-01

    The purpose of this study was to investigate muscle activity and endurance during fatiguing low-intensity dynamic knee extension exercise with and without blood flow restriction. Eleven healthy subjects with strength training experience performed 3 sets of unilateral knee extensions with no relaxation between repetitions to concentric torque failure at 30% of the 1 repetition maximum. One leg was randomized to exercise with cuff occlusion and the other leg to exercise without occlusion. The muscle activity in the quadriceps was recorded with electromyography (EMG). Ratings of perceived exertion (RPE) and acute pain were collected immediately, and delayed onset muscle soreness (DOMS) was rated before and at 24, 48, and 72 hours after exercise. The results demonstrated high EMG levels in both experimental conditions, but there were no significant differences regarding maximal muscle activity, except for a higher EMG in the eccentric phase in set 3 for the nonoccluded condition (p = 0.005). Significantly more repetitions were performed with the nonoccluded leg in every set (p < 0.05). The RPE and acute pain ratings were similar, but DOMS was higher in the nonoccluded leg (p < 0.05). We conclude that blood flow restriction during low-intensity dynamic knee extension decreases the endurance but does not increase the maximum muscle activity compared with training without restriction when both regimes are performed to failure. The high levels of muscle activity suggest that performing low-load dynamic knee extensions in a no-relaxation manner may be a useful method in knee rehabilitation settings when large forces are contraindicated. However, similarly to fatiguing blood flow restricted exercise, th