Adduction Angle Research Articles

Walking biomechanics in women with patellofemoral osteoarthritis differ compared to men with and women without patellofemoral osteoarthritis

BackgroundDifferences in walking biomechanics between women and men with patellofemoral joint (PF) osteoarthritis (OA) may contribute to the development or progression of persistent symptoms in people with PFJ OA. ObjectiveEvaluate how walking biomechanics of women with PF OA differ from: (i) men with PFJ OA; and (ii) women without PF OA. Second, explore the relationship between knee-related symptoms/function and walking biomechanics in individuals with PF OA, and whether these are modified by sex. MethodsSixty-seven individuals with PF OA (43 women) and 14 women without PF OA were included. Biomechanics data were recorded during walking. Patient-reported symptoms and function were obtained using the Knee injury and Osteoarthritis Outcome Score. Differences in continuous biomechanical data were assessed using statistical parametric mapping, with discrete data and relationships evaluated using linear models. ResultsWomen with PF OA walked with a greater hip adduction angle throughout stance (t > 2.757) and lower impulses for the hip flexion, knee flexion, and ankle dorsiflexion moments (adjusted mean differences [95 % CI]:3.3 × 10–2 [-4.9 × 10–2, -1.6 × 10–2], -2.9 × 10–2 [-5.3 × 10–2, -0.4 × 10–2], -5.1 × 10–2 [-8.2 × 10–2, -2.0 × 10–2] Nms/kg, respectively) compared to men with PF OA. Compared to their asymptomatic peers, women with PF OA displayed a 5° offset towards greater hip flexion. Higher knee adduction moment impulse correlated with worse KOOS-ADL scores in men, not women. ConclusionObserved biomechanical differences were small in nature with moderate to weak relationship observed with the KOOS. Findings were not limited to the knee, indicating that women with PF OA display unique biomechanical features across the kinetic-chain.

Analysis of changes in lower limb joints of athletes during the movement of wild horses’ mane parting based on biomechanics

In the era of fitness, more and more young people are familiar with Taijiquan, a kind of physical fitness exercise. By conducting biomechanical analyses of the movements of Taijiquan, it is possible to exercise the body better. Numerous techniques in Taijiquan make it difficult to study each individually. Therefore, this paper studied the movement of “wild horses’ mane parting” in terms of biomechanics by analyzing the joint angle, stiffness, and impulse during this movement. Twenty male athletes were selected as subjects and divided into a professional group and a beginner group according to their training periods. High-speed cameras were used to shoot the “wild horses’ mane parting” movement. The angles of lower limb joints in these athletes were measured to calculate joint impulse and stiffness. The results showed that, compared with the professional group, there were significant differences in the adduction and abduction angle and the internal and external rotation angle between the beginner group and the professional group in the single-leg support movement stage (P< 0.05). There were also significant differences in joint impulse and stiffness (P< 0.05). Compared with beginners, long-term professional practitioners can make their movements more standardized. By comparing movements and data analysis, beginners can make their movements more standardized when practicing Taijiquan and avoid the risk of sports injury. The novelty of this article lies in the use of high-speed cameras to capture athletes’ movements, enabling accurate analyses of their joints and providing effective references for precise training.

Effectiveness of Injury Prevention Program Using a Global Systems Approach on High-Risk Movement Mechanics for Noncontact ACL Injury.

Injury prevention training using a global systems approach was designed to develop integrated trunk-lower extremity neuromuscular control using whole-body, rotational forces about the vertical Z-axis during simulated sports movements. Compared with traditional hip-focused exercises, injury prevention training using a global systems approach could improve kinetic and kinematic measures related to anterior cruciate ligament injury. Controlled laboratory study. Level 3. A total of 39 male and female athletes received 6 weeks of either global systems approach (n = 20), or hip-focused strengthening, balance, and plyometrics training (n = 19) exercises. Before and after the training program, participants performed a single-leg vertical drop jump task on their dominant leg. Peak vertical ground-reaction forces (GRFs), peak knee abduction, internal rotation moments, peak hip flexion, hip adduction, knee flexion, knee abduction, contralateral pelvic drop, and lateral trunk flexion angles were assessed. Biomechanical data were compared between the 2 groups using a random-intercept linear mixed-models analysis. A significant group × time interaction effect was found for vertical GRFs (P = 0.01; change difference relative to baseline: 4.5%), knee abduction moment (P = 0.01; 14.8%), hip adduction (P < 0.01; 16.7%), knee abduction (P < 0.01; 13.8%), contralateral pelvic drop (P < 0.01; change difference: 26.6%), and lateral trunk flexion (P = 0.04; 20.37%) angles, favoring the global systems approach group after 6 weeks of training. Participants who trained using the global systems approach had significantly decreased lateral trunk flexion, hip adduction, knee abduction and contralateral pelvic drop angles, peak vertical GRFs, and peak knee abduction moment during a single-leg vertical drop jump compared with participants who trained with hip-focused exercises. Incorporating additional external resistance at the proximal trunk results in improved biomechanics compared with conventional hip-focused exercises.

Correlation between the biomechanical characteristics and stability of the 143D movement during the balance phase in competitive Tai Chi.

To explore the biomechanical factors affecting the stability of athletes in the 143D balance phase of competitive Tai Chi. The Vicon 3D motion capture system, Kistler 3D force platform, and Noraxon surface electromyography (sEMG) system were used to measure the joint angle, joint moment, center of gravity, ground reaction force, and sEMG data of athletes. The stability index was then calculated according to the formula. Pearson's or Spearman's correlation tests were used to analyze the associations between the biomechanical factors and stability index. (1) Medial lateral stability index (MLSI): A significant negative correlation was found between the ankle inversion angle of the supporting leg (SL) and MLSI (p < 0.05). (2) Anterior posterior stability index (APSI): Significant negative correlations were observed between the ankle intorsion angle, integrated electromyography (iEMG) of the gastrocnemius, and muscle contribution rates of the tibialis anterior, external oblique, and gastrocnemius of the non-supporting leg (NL) with the APSI (p < 0.05). The ankle dorsiflexion moment, iEMG of the rectus femoris and tibialis anterior, muscle contribution rate of the biceps femoris, and root mean-squared (RMS) amplitude of the gluteus maximus of the SL also showed significant negative correlations with the APSI (p < 0.05). Strong and significant negative correlations were also identified between the hip intorsion angle, iEMG of the tibialis anterior, and RMS amplitude of the rectus femoris of the NL with the APSI (p < 0.01). Further strong and significant negative correlation was also found between the RMS amplitude of the biceps femoris of the SL and APSI (p < 0.01). The knee extorsion angle of the NL was positively correlated with the APSI (p < 0.05). (3) Dynamic postural stability index (DPSI): The knee adduction angle, iEMG of the tibialis anterior, and RMS amplitude of the erector spinae of the NL were significantly positively correlated with the DPSI (p < 0.05). The knee abduction and hip extension moments of the SL were also significantly positively correlated with the DPSI (p < 0.05). The ankle inversion angle of the SL impacts left-right stability, while the NL's hip and ankle intorsion angles, knee extorsion angle, and exertion on the core muscle and SL's main muscles, as well as exertion of specific muscles of the NL affect anterior-posterior stability. The hip extension and knee abduction moments of the SL, knee adduction angle, exertion on the tibialis anterior, and activation of the erector spinae of the NL significantly affect the overall stability of an athlete.

Construction and validation of a nomogram model for predicting different sites of ankle pain in runners with chronic ankle instability

This study aimed to establish a risk prediction nomogram model for anterolateral, mediolateral, and posterolateral ankle pain in runners with chronic ankle instability (CAI) and analyse the potential risk factors for pain at different ankle sites. Thirty recreational runners with CAI who reported ankle pain in the anterolateral, mediolateral, or posterolateral regions were recruited for this study. Kinematic, kinetic, and electromyographic data during running were collected using motion capture system, 3-D force platform, and surface electromyography system. These data were used to generate a dynamic nomogram. The results showed that anterolateral ankle pain in runners with CAI may be caused by insufficient gastrocnemius muscle strength (OR 0.85, 95% CI 0.73–0.97), excessive ground reaction force (GRF, OR 2.64, 95% CI 1.25–6.22), and an increased percentage of ankle energy absorption (OR 9.11, 95% CI 1.50–77.79). Mediolateral ankle pain might be contributed by greater ankle inversion angle (OR 1.08, 95% CI 1.01–1.00) and GRF (OR 2.13, 95% CI 1.17–4.31). Moreover, posterolateral ankle pain was predicted by increased ankle adduction angle (OR 1.06, 95% CI 1.00–1.12), increased GRF (OR 2.16, 95% CI 1.07–4.80), and decreased dynamic stability (OR 0.20, 95% CI 0.05–0.68). To prevent ankle pain, runners with CAI should be encouraged to focus on improving the neuroreceptor sensitivity of the gastrocnemius muscles, and retraining their energy absorption patterns.

The Estimation of Knee Medial Force with Substitution Parameters during Walking and Turning.

Knee adduction, flexion moment, and adduction angle are often used as surrogate parameters of knee medial force. To verify whether these parameters are suitable as surrogates under different walking states, we investigated the correlation between knee medial loading with the surrogates during walking and turning. Sixteen healthy subjects were recruited to complete straight walk (SW), step turn (ST), and crossover turn (CT). Knee joint moments were obtained using inverse dynamics, and knee medial force was computed using a previously validated musculoskeletal model, Freebody. Linear regression was used to predict the peak of knee medial force with the peaks of the surrogate parameters and walking speed. There was no significant difference in walking speed among these three tasks. The peak knee adduction moment (pKAM) was a significant predictor of the peak knee medial force (pKMF) for SW, ST, and CT (p < 0.001), while the peak knee flexion moment (pKFM) was only a significant predictor of the pKMF for SW (p = 0.034). The statistical analysis showed that the pKMF increased, while the pKFM and the peak knee adduction angle (pKAA) decreased significantly during CT compared to those of SW and ST (p < 0.001). The correlation analysis indicated that the knee parameters during SW and ST were quite similar. This study investigated the relationship between knee medial force and some surrogate parameters during walking and turning. KAM was still the best surrogate parameter for SW, ST, and CT. It is necessary to consider the type of movement when comparing the surrogate predictors of knee medial force, as the prediction equations differ significantly among movement types.

Mobility Requirements and Joint Loading during Straight Walking and 90° Turns in Healthy Older People and Those with Hip Osteoarthritis.

Background/Objectives: Hip mobility and joint loading in hip osteoarthritis (HOA) patients are mostly assessed during straight walking. Yet, mobility limitations in the frontal and transverse planes are rarely found during this task in subjects with mild-to-moderate symptoms. Turning movements are frequently encountered during everyday life and might require larger hip mobility compared to straight walking, especially in the frontal and transverse planes. Thus, hip mobility and hip loading during straight walking and 90° turns in persons with HOA and healthy older adults were compared in this study. Methods: A retrospective analysis was conducted on 21 subjects with mild-to-moderate HOA and 21 healthy controls. Hip angles and moments were assessed during straight walking and 90° step and spin turns. Gait analysis was conducted using a motion capture system and a force plate. Group and movement task differences were assessed with a mixed-model ANOVA. Results: Peak abduction and adduction angles were largest during the step and spin turn, respectively, as were the group differences between HOA subjects and healthy subjects. Both turns require a greater transverse hip range of motion compared to straight walking. Limitations in transverse hip mobility in the HOA group were especially prominent during the step turn. Both turns cause higher joint moments than straight walking. Conclusions: The additional inclusion of 90° step and spin turns into gait analysis can enhance early identification of hip mobility limitations in the frontal and transverse planes in subjects with mild-to-moderate hip osteoarthritis. Early diagnosis is crucial for the timely application of conservative treatment strategies.

Characteristics of pelvic obliquity in dysplastic hip osteoarthritis.

Factors affecting direction of pelvic obliquity (PO) in dysplastic hip osteoarthritis (DHOA) remains unclear. This retrospective cohort study evaluates morphological characteristics, spinal alignment, and hip function in patients with unilateral DHOA. Between 2018 and 2022, 104 patients with unilateral DHA were enrolled. Patients were categorized into flat PO (F-PO group; PO < 2°), affected side PO (A-PO group; PO downward by ≥ 2°), and unaffected side PO (U-PO group; PO upward by ≥ 2°). Demographics, radiographic hip and lower limb parameters, spinal parameters, and functional scores were compared between the groups. There were 39, 44, and 21 patients in the F-PO, A-PO, and U-PO group, respectively. The subluxation percentage of Crowe classification showed a significant difference among the three groups. The femoral head lateralization distance was significantly greater in the U-PO group than in the F-PO and A-PO groups. Furthermore, the hip adduction angle was significantly lower in the A-PO group than in the F-PO and U-PO groups. The lumbar scoliosis angle was significantly different between the groups. In multivariate analysis, hip adduction angle was extracted as an independent factor associated with the A-PO. Age, subluxation percentage, and hip adduction angle were identified as independent factors associated with the U-PO. Harris hip score was significantly poorer in U-PO group than in F-PO group. Hip adduction angle influenced A-PO, while age, subluxation percentage, and hip adduction angle influenced U-PO; lumbar scoliosis angle was associated with PO direction. U-PO patients had poorer functional scores, indicating the impact of hip contracture and subluxation on PO direction in DHOA.

Relationship between glenohumeral horizontal abduction angle and scapular internal rotation angle at maximum shoulder external rotation during baseball pitching

BackgroundIncreased scapulothoracic (ST) internal rotation at maximum external rotation (MER) during baseball pitching can decrease glenohumeral (GH) horizontal adduction, leading to excessive GH horizontal abduction. However, few studies have examined this direct relationship, and none have investigated the ST internal rotation angle at stride foot contact (FC) and MER. This study investigated the relationships between GH horizontal adduction and ST internal rotation angles at MER and between ST internal rotation angles at FC and MER. MethodsWe recruited 15 asymptomatic collegiate baseball pitchers and assessed the ST internal rotation angle at FC and MER and GH horizontal adduction angle at MER during pitching using an optical motion tracking system. Pearson’s correlation coefficients determined the relationships between GH horizontal adduction and ST internal rotation angles at MER and between ST internal rotation angles at FC and MER. ResultsThe GH horizontal adduction angle at MER was significantly related to the ST internal rotation angle at MER (r = -0.58, p = 0.022). The ST internal rotation angle at FC was significantly related to the ST internal rotation angle at MER (r = 0.53, p = 0.045). ConclusionsThe GH horizontal adduction angle at MER is associated with the ST internal rotation angle at MER in asymptomatic collegiate baseball pitchers and the ST internal rotation angle at FC is related to the ST internal rotation angle at MER. Thus, the scapula and humerus should be controlled from FC to MER during pitching to reduce internal impingement risk in asymptomatic baseball pitchers.

Classification of the foot kinematics during gait and the characteristics of the knee and hip kinematics in individuals with pronated foot

Overuse injuries are often caused by pronated foot and the associated abnormal lower-extremity kinematics during dynamic activities. Various patterns of foot kinematics are observed among individuals with pronated feet during dynamic activities, resulting in different dynamic kinematics of the proximal joint. This study aimed to identify the foot kinematic patterns during gait among individuals with pronated feet and evaluate the relationship between these foot kinematic patterns and the hip and knee kinematics. A three-dimensional motion capture system was used to collect data regarding the foot, knee, and hip kinematics during the stance phase of gait of 42 individuals with pronated feet. A hierarchical cluster analysis method was used to identify the optimal number of clusters based on the foot kinematics, including navicular height (NH) at initial contact and dynamic navicular drop (DND). The differences in the cluster and demographic variables were examined. One-dimensional statistical parametric mapping was used to evaluate the differences in the time histories of the NH, knee, and hip kinematics during the stance phase. Three subgroups were identified on the basis of the NH and DND: Cluster 1, moderate NH at initial contact and larger DND; Cluster 2, highest NH at initial contact and smaller DND; and Cluster 3, lowest NH at initial contact and smaller DND. The hip adduction angle of Cluster 1 was significantly higher than that of Cluster 3 from the 0% to 51% stance phases. Further longitudinal studies are needed to clarify the relationship between identified subgroups and the development of overuse injuries.

Influence of tactile and verbal guidance on lateral weight-shifting in double-leg standing after total hip arthroplasty

IntroductionAnomalous gait after total hip arthroplasty (THA), marked by increased trunk lateral flexion during weight-bearing, is a noteworthy aspect to consider for enhancing ambulatory capacity. One potential training modality that is feasible in the early post-THA period is lateral weight shifting during double-leg standing. However, the influence of physical therapists’ instructional guidance on trunk lateral flexion and hip abductor muscle activity in this context remains unclear. PurposeTo investigate the influence of physical therapist's guidance directed towards reducing the trunk lateral flexion angle during lateral weight-shifting in double-leg standing post-THA. MethodsTwenty THA patients, assessed at 2 weeks postoperatively, performed lateral weight-shifting under two conditions: the normal condition and the instructed condition, for comparison. The latter involved tactile and verbal guidance guidance to minimize trunk lateral flexion. Patients were categorized based on trunk flexion direction for comparison, exploring the correlations between hip abductor muscle activity and kinematic parameters. ResultsIn the instructed condition, a significant reduction in trunk lateral flexion and increased hip lever arm length were observed compared to those in the normal condition. Patients with trunk flexion towards the operated side exhibited a notable reduction, while those on the non-operated side showed no significant changes. Gluteus medius muscle activity correlated with trunk lateral flexion, and tensor fasciae latae muscle activity correlated with body's center of mass lateral displacement and hip adduction angle. ConclusionsPhysical therapist's guidance influenced lateral weight-shifting in double-leg standing post-THA. Differences in the trunk lateral flexion direction may lead to different effects from the guidance.

Lower limb kinematic changes during gait after hallux valgus surgery: A prospective observational study

BackgroundPatients with hallux valgus are known to alter lower limb joint kinematics during gait. However, little information is available about gait changes following hallux valgus surgery. We aimed to longitudinally investigate lower limb kinematic changes at the mid and terminal stances of gait after hallux valgus surgery. MethodsThis prospective observational study included 11 female patients (17 feet), who underwent first metatarsal osteotomy. Gait analyses were performed preoperatively and 1- and 2-year postoperatively using a three-dimensional motion capture system. Toe-out angle, ankle, knee, and hip joint angles during gait were calculated from the recorded data. The spatiotemporal parameters and these angles at the mid and terminal stances of gait were statistically compared between preoperative and postoperative periods. FindingsAll spatiotemporal parameters remained unchanged postoperatively. The toe-out angle was significantly greater at 1- and 2-year postoperatively. The ankle pronation angle, the knee abduction angle, and the hip adduction angle at the mid and terminal stances of gait were smaller postoperatively compared to the preoperative. These angular changes showed a similar trend at 1 and 2 years postoperatively. However, the postoperative changes of the sagittal joint angles were relatively small. InterpretationHallux valgus surgery can affect the toe-out angle and the lower limb coronal kinematics at the mid and terminal stances of gait in patients with hallux valgus. However, surgical correction of hallux valgus deformity did not directly improve the gait characteristics in patients with hallux valgus.

Task-specific differences in lower limb biomechanics during dynamic movements in individuals with chronic ankle instability compared with controls

BackgroundChronic ankle instability (CAI) has been associated with lower limb deficits that can lead to altered biomechanics during dynamic tasks. There have been contradictory findings in terms of ankle and hip joint biomechanics to date, influenced by the variety of movement tasks and varying definitions of the CAI condition. Research QuestionHow do biomechanical variables of the lower extremity differ during walking, running, and jump-landing in individuals with CAI compared with those without CAI? MethodsThirty-two individuals (17 CAI and 15 controls) participated in this retrospective case-control study. Sagittal and frontal plane ankle and hip joint angles and moments, and mediolateral foot balance (MLFB) were calculated during the tasks. Statistical parametric mapping (SPM) was used for the whole trajectory analysis to detect group differences. Discrete variables, including initial contact (IC) and peak angles and moments, were additionally compared. ResultsNo differences were found between groups during walking. During running, the CAI group exhibited a lower plantar flexor moment (p < 0.001) and more laterally deviated MLFB (p = 0.014) during mid-stance when compared to controls. Additionally, participants with CAI had a significantly greater peak plantar flexion angle in early stance (p = 0.022) and a reduced peak plantar flexor moment (p = 0.002). In the jump-landing, the CAI group demonstrated an increased hip extensor moment (p = 0.008), and a greater peak hip adduction angle (p = 0.039) shortly after ground contact compared to the control group. SignificanceDifferences in ankle and hip biomechanics were observed between groups during running and jump landing, but not during walking. These differences may be indicative of impairments in the sensorimotor system or of learnt strategies adopted to try to minimise instability and injury risk and can help to inform future intervention design.

Effects of overweight and obesity on lower limb walking characteristics from joint kinematics to muscle activations

BackgroundObesity is a crucial factor that increases the risk of initiating and advancing knee osteoarthritis. However, it remains unclear how obesity directly impacts the biomechanical experience of the lower limb joints, potentially triggering or exacerbating joint degeneration. This study investigated the interactive effects of BMI augmentation on lower limb kinematics, kinetics, and muscle activations during walking. MethodologyA group of 60 participants underwent a three-dimensional gait analysis. These individuals were categorized into three groups based on their body mass index (BMI): those with a BMI below 25 were classified as having a healthy weight, those with a BMI between 25 and 30 were categorized as overweight, and those with a BMI exceeding 30 were considered obese. This study analyzed the gait of 60 participants categorized by BMI. During walking trials, they recorded ground reaction forces electromyography of leg muscles like the gastrocnemii, hamstrings, and quadriceps. Lower limb joint angles and net moments were also calculated. Statistical mapping identified variations in kinematic, kinetic, and muscle activation patterns across the stance phase between BMI groups. ResultsThe results displayed distinct biomechanical patterns in obese individuals. Notably, there was a significant increase in flexion observed in the hip and knee joints (P < 0.001) during the initial stance phase and an increase in hip and knee adduction angles and moments throughout the entire stance phase (P < 0.001). Additionally, muscle activations underwent significant changes (P < 0.01), with a positive correlation noted with the BMI factor. This correlation was most pronounced during the early stance phase for the quadriceps and hamstring muscles and the late stance phase for the gastrocnemius. ConclusionThese findings represent a comprehensive picture that contributes to understanding how excess weight and obesity influence joint biomechanics, highlighting the associated risk of joint osteoarthritis.

Shoulder External Over Internal Rotation Ratio Is Related to Biomechanics in Collegiate Baseball Pitching.

Altering baseball pitching mechanics affects both performance and the risk of injury. The purpose of this study is to investigate the relationships of shoulder external over internal rotation ratio (SEIR) and other shoulder rotational properties during physical exam and biomechanics of pitching for 177 collegiate baseball pitchers. The shoulder range of motion was quantitatively measured using a custom-made wireless device. Pitching motion data were collected at 240Hz, and a custom program was created to calculate the throwing arm motion and loading during baseball pitching. Linear regression and analysis of variance tests were performed to investigate the relationships between the shoulder physical exam outcomes and throwing arm biomechanics. SEIR had significant correlations with shoulder horizontal adduction angle at foot contact, maximum shoulder external rotation angle, maximum shoulder linear velocity, and elbow angle at ball release. SEIR groups had significant differences in shoulder proximal force, adduction torque, internal rotation torque, and horizontal adduction torque, and in elbow medial force and varus torque. Glenohumeral internal rotation deficit and total rotational motion deficit had no relationships with throwing arm motions or joint loadings. Shoulder health should be monitored to improve understanding of pitching mechanics in collegiate baseball pitchers.

Males with patellofemoral pain have altered movements during step-down and single-leg squatting tasks compared to asymptomatic males: A cross-sectional study.

Patellofemoral pain (PFP) is common in males, causing reduced physical activity and chronic pain. One proposed cause of PFP is aberrant biomechanics during tasks loading the patellofemoral joint. Consistent evidence exists for females with PFP, but it is uncertain if males with PFP have altered biomechanics. This study investigated the kinematics of males with PFP compared to pain-free males during forward step-down (StDn) and single-leg squat (SLSq). A cross-sectional study including 40 males aged 20-39 years (28.28 ± 5.46) was conducted (20 PFP, 20 pain-free). Participants performed StDn and SLSq while motion was captured with a video-based motion capture system (Motion Analysis Corporation). Triplanar peak angles and angular ranges of motion (ROM) of the trunk, pelvis, and weight-bearing hip, knee, and ankle were dependent variables. Mixed-model ANOVA tests were used to determine the presence of significant interactions and main effects of group and task. Males with PFP had significantly lower peak knee adduction angles compared to pain-free males (p = 0.01). Significant group x task interactions were found for hip and pelvis ROM (p < 0.05). PFP participants had increased hip and pelvis ROM during StDn in the frontal and transverse planes but reduced or nearly equal ROM for these variables during SLSq. Peak hip adduction, hip internal rotation, contralateral pelvic drop and anterior tilt, trunk flexion, and ankle dorsiflexion were greater during StDn compared to SLSq (p < 0.05). ROM of the hip, pelvis, trunk, and ankle were greater during StDn compared to SLSq (p < 0.05). Males with PFP had reduced peak knee adduction angles in StDn and SLSq. Males with PFP demonstrated increased hip and pelvis ROM during StDn versus SLSq, particularly in the frontal and transverse planes. Clinicians should consider StDn as a clinical test since aberrant movement may be easier to detect than in SLSq.

Biomechanical improvements in gait following medial pivot knee implant surgery

BackgroundTotal knee replacements are used to improve function and reduce pain in patients with advanced osteoarthritis. The medially stabilising implant is designed to mimic a healthy knee. This study aims to provide a comprehensive analysis of the kinematics and kinetics of a medially stabilising knee implant, comparing it to a healthy control group, as well as to its pre-operative state and the contralateral limb. MethodsSixteen total knee replacement patients and ten healthy participants were recruited. Patients underwent testing 4–6 weeks before surgery and repeated the same tests 12 months after surgery. Healthy participants completed the same tests at a single time point. All participants completed three walking trials: kinematics was captured with eight cameras; kinetics with in-ground force plates. Subject-specific musculoskeletal models were developed in OpenSim. Inverse kinematics and inverse dynamics were used to determine gait parameters. Joint angles and joint moments were evaluated using Statistical Parametric Mapping. Patient-reported outcome measures were also collected at both time points. FindingsSpatiotemporal results indicate significant differences in velocity and step length between pre-operative patients and control participants. Differences are observed in the adduction angles between the contralateral and ipsilateral limbs pre-operatively. Postoperatively, there was an increase in the 1st peak flexion moment, reduced adduction moment and reduced internal rotation moment. In PROMs, patients all report improvements in pain levels and high satisfaction levels following surgery. InterpretationsFollowing medial stabilising total knee arthroplasty, patients displayed improved clinical parameters and joint moments reflecting a shift towards more normal, healthy gait.

Shoulder external rotation contracture following neonatal brachial plexus injury

BackgroundGlenohumeral posterior external rotation contractures and scapular winging are frequently overlooked problems in residual neonatal brachial plexus injury (NBPI). Recent attention has emphasized their impact on vital functions such as feeding and hygiene. This study aims to present the epidemiology of posterior glenohumeral (GH) contractures in a significant pediatric NBPI population and explore contributing factors. MethodsWe conducted a retrospective analysis of data collected from January 2019 to November 2022, involving a case series of 262 children with residual NBPI. The data included demographics, palsy level, prior surgical history, and the modified Mallet scale. Glenohumeral passive internal rotation in abduction (IRABD) and cross-body adduction (CBADD) angles were measured bilaterally. Subjects were categorized into 'Belly-' (Mallet Hand-to-Belly <3) and 'Belly+' (Mallet Hand-to-Belly ≥3) groups. ResultsMedian participant age was 7.9 years (range: 3.5 – 21 years). Extension injury patterns included Erb's palsy (56.5%), extended Erb's palsy (28.6%), and global palsy (14.9%). Contractures exceeding 10, 20, and 30 degrees were prevalent in both IRABD and CBADD angles. The 'Belly-' group (9.5%) demonstrated a significant reduction in both angles compared to the 'Belly+' group. Weak correlations were found between IRABD (r=0.390, p<0.0001) or CBADD (r=0.163, p=0.0083) angles and Mallet hand-to-abdomen item. Glenohumeral reduction and Hoffer procedures led to a notable decrease in CBADD angle, without affecting 'Belly-' prevalence. Global injuries exhibited decreased angles compared to Erb's group. ConclusionsExternal rotation glenohumeral contractures are prevalent in residual NBPI, impacting midline access. Surprisingly, history of glenohumeral procedures or extensive injuries did not increase the likelihood of losing the ability to reach the belly. ROC analysis suggests specific thresholds for maintaining this ability.

Effects of running-induced fatigue on joint kinematics and kinetics during overground running: a systematic review and meta-analysis.

This study evaluated the acute fatigue-inducing effect of distance running on kinematics and kinetics during overground running. Standardised mean differences (SMD) with 95% confidence intervals (95% CI) were used to pool data across 16 studies. Effects during consistent (pre- and post-fatigue running speed within ± 5%) versus varied speed running (difference of >5% between running speeds) were analysed separately. There was strong evidence that running-induced fatigue significantly increases ground contact times at consistent running speeds (SMD 0.52 [95% CI 0.22, 0.82]) and moderate evidence that step length shortens at varied running speeds (SMD -1.27 [95% CI -1.79, -0.75]). There was strong evidence that fatigue does not change peak: hip and knee flexion angles, hip adduction angle, hip and knee internal rotation angles, hip and knee extension moments, hip and knee abduction moments, knee abduction angle, knee flexion and extension moments, knee adduction moment, rearfoot eversion angle, and plantarflexion moments, or knee flexion and plantarflexion range of motion during stance. Running-induced fatigue increases contact times and reduces step length, whereas lower-body joint angles and moments are unchanged. Minimising changes in stride parameters could provide a mechanism for reducing the effects of fatigue on running performance.

The Putti Sign Following Residual Brachial Plexus Birth Injury: Prevalence and Significance.

The Putti sign, a common deformity and complaint in children with brachial plexus birth injury (BPBI), stems from a glenohumeral (GH) abduction contracture. Despite recent clinical studies offering insights into this deformity, none have explored the prevalence of the Putti sign or its correlation with GH abduction contractures. We conducted a prospective analysis of 238 patients (median age 7.5 years; range, 4.1-16.2) with residual BPBI seen in the clinic from December 2019 to December 2022. Epidemiological data, including demographics, palsy levels, modified Mallet scale sum, surgical history, and presence/absence of the Putti sign and glenohumeral adduction angle (GHADD), were collected. Patients were categorized into 4 age groups: 0 to 5 years (n=67), 6 to 10 years (n=102), 11 to 15 years (n=53), and 16 years and older (n=16). Results were expressed as medians (minimum-maximum), with frequency comparisons done using Pearson's chi-square analysis. Mann-Whitney U and Kruskal-Wallis tests were used for quantitative variable comparison, and receiver operating characteristic (ROC) analysis determined the threshold GHADD angle for Putti sign appearance. Main findings included: (1) 27% of patients with residual BPBI exhibited the Putti sign, (2) confirmed correlation between the Putti sign and GH adduction contractures, (3) Putti sign manifestation with GHADD angle measuring less than -5° because to abduction contracture, and (4) association between this deformity and reduced activities requiring external rotation. No significant differences in Putti sign prevalence were found across age groups. Our study underscores the common occurrence of the Putti sign in children with residual BPBI. It is important to note that we highlight its functional significance beyond cosmetic concerns. Contrary to prior literature, our analysis reveals functional impairment associated with the Putti sign. Although no age-based differences in Putti sign prevalence were observed, patients aged 0 to 5 years and 11 to 15 years showed more severe glenohumeral abduction contractures, possibly due to growth spurts. Diagnosis IV.