Changes In Gait Biomechanics Research Articles

Five-Year Changes in Gait Biomechanics After Concomitant High Tibial Osteotomy and ACL Reconstruction in Patients With Medial Knee Osteoarthritis

Background: Concomitant high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction is a combined surgical procedure intended to improve kinematics and kinetics in the unstable ACL-deficient knee with varus malalignment and medial compartment knee osteoarthritis (OA). Purpose: To investigate 5-year changes in gait biomechanics as well as radiographic and patient-reported outcomes bilaterally after unilateral, concomitant medial opening wedge HTO and ACL reconstruction. Study Design: Controlled laboratory study. Methods: A total of 33 patients (mean ± SD age, 40 ± 9 years) with varus malalignment (mean mechanical axis angle, −5.9° ± 2.9°), medial compartment knee OA, and ACL deficiency completed 3-dimensional gait analysis preoperatively and 2 and 5 years postoperatively. Primary outcomes were the peak external knee adduction (first peak) and flexion moments. Secondary outcomes were the peak external knee extension and transverse plane moments, peak knee angles in all 3 planes, radiographic static knee alignment measures (mechanical axis angle and posterior tibial slope), and the Knee injury and Osteoarthritis Outcome Score (KOOS). Results: There was a substantial decrease in the knee adduction moment in the surgical limb (%BW × H, −1.49; 95% CI, −1.75 to −1.22) and a slight increase in the nonsurgical limb (%BW × H, 0.16; 95% CI, 0.03 to 0.30) from preoperatively to 5 years postoperatively. There was also a decrease in the knee flexion moment for both the surgical (%BW × H, −0.67; 95% CI, −1.19 to −0.15) and nonsurgical limbs (%BW × H, –1.06; 95% CI, –1.49 to −0.64). Secondary outcomes suggested that substantial improvements were maintained at 5 years, although smaller declines were observed in several measures and in both limbs from 2 to 5 years. Conclusion: Changes in the peak external moments about the knee in all 3 planes during walking were observed 5 years after concomitant medial opening wedge HTO and ACL reconstruction. These findings are consistent with an intended, sustained shift in the mediolateral distribution of knee loads. Clinical Relevance: These findings suggest that concomitant HTO and ACL reconstruction results in substantial changes in gait biomechanics. Future clinical research comparing treatment strategies is both warranted and required for this relatively uncommon but seemingly biomechanically efficacious procedure.

A novel biomechanical analysis of gait changes in the MPTP mouse model of Parkinson's disease.

Parkinson’s disease (PD) is an age-associated neurodegenerative disorder hallmarked by a loss of mesencephalic dopaminergic neurons. Accurate recapitulation of the PD movement phenotype in animal models of the disease is critical for understanding disease etiology and developing novel therapeutic treatments. However, most existing behavioral assays currently applied to such animal models fail to adequately detect and subsequently quantify the subtle changes associated with the progressive stages of PD. In this study, we used a video-based analysis system to develop and validate a novel protocol for tracking locomotor performance in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of PD. We anticipated that (1) treated mice should use slower, shorter, and less frequent strides and (2) that gait deficits should monotonically increase following MPTP administration, as the effects of neurodegeneration become manifest. Video-based biomechanical analyses, utilizing behavioral measures motivated by the comparative biomechanics literature, were used to quantify gait dynamics over a seven-day period following MPTP treatment. Analyses revealed shuffling behaviors consistent with the gait symptoms of advanced PD in humans. Here we also document dramatic gender-based differences in locomotor performance during the progression of the MPTP-induced lesion, despite male and female mice showing similar losses of striatal dopaminergic cells following MPTP administration. Whereas female mice appeared to be protected against gait deficits, males showed multiple changes in gait kinematics, consistent with the loss of locomotor agility and stability. Overall, these data show that the novel video analysis protocol presented here is a robust method capable of detecting subtle changes in gait biomechanics in a mouse model of PD. Our findings indicate that this method is a useful means by which to easily and economically screen preclinical therapeutic compounds for protecting against or reversing neuropathology associated with PD neurodegeneration.

Preservation of gait biomechanics during offloading treatment of diabetic foot ulcers

Background Gold standard for the management of diabetic foot neuropathic ulcers is the irremovable total contact cast, however evidence of equal clinical effectiveness was proved for the removable walker OPTIMA DIAB [1]. Priority of this healing treatment is the offloading of the ulcerated foot area; however, the healing process may last for months, and eventual changes in gait biomechanics may entail risks for the contralateral foot, leg joints, or even spine. Aim of this study is to setup a reliable methodology to optimize the use of such offloading devices.

Time Course of Functional and Biomechanical Improvements During a Gait Training Intervention in Persons With Chronic Stroke

In rehabilitation, examining how variables change over time can help define the minimal number of training sessions required to produce a desired change. The purpose of this study was to identify the time course of changes in gait biomechanics and walking function in persons with chronic stroke. Thirteen persons who were more than 6 months poststroke participated in 12 weeks of fast treadmill training combined with plantar- and dorsiflexor muscle functional electrical stimulation (FastFES). All participants completed testing before the start of intervention, after 4, 8, and 12 weeks of FastFES locomotor training. Peak limb paretic propulsion, paretic limb propulsive integral, peak paretic limb knee flexion (P < 0.05 for all), and peak paretic trailing limb angle (P < 0.01) improved from pretraining to 4 weeks but not between 4 and 12 weeks. Self-selected walking speed and 6-minute walk test distance improved from pretraining to 4 weeks and from 4 to 12 weeks (P < 0.01 and P < 0.05, respectively for both). Timed Up & Go test time did not improve between pretraining and 4 weeks, but improved by 12 weeks (P = 0.24 and P < 0.01, respectively). The results demonstrate that walking function improves with a different time course compared with gait biomechanics in response to a locomotor training intervention in persons with chronic stroke. Thirty-six training sessions were necessary to achieve an increase in walking speed that exceeded the minimally clinically important difference. These findings should be considered when designing locomotor training interventions after stroke.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A63) for more insights from the authors.

Does Running Cause Osteoarthritis in the Hip or Knee?

Running is an excellent activity to promote general health and well-being. However, running injuries are common, and concern is sometimes raised that running might lead to osteoarthritis in weight-bearing joints. This article reviews the relevant in vitro and in vivo literature that looks at possible associations between running and the development of osteoarthritis. Also reviewed is the limited literature on running barefoot and with minimalist footwear. Low- and moderate-volume runners appear to have no more risk of developing osteoarthritis than nonrunners. The existing literature is inconclusive about a possible association between high-volume running and the development of osteoarthritis. The early literature on running barefoot and running with minimalist footwear has primarily focused on biomechanics but has not yet focused on any effect on cartilage health. Experienced and beginner runners should be encouraged to allow the body adequate time to adapt to changes in gait biomechanics caused by changing footwear, which can be done by slowly increasing running mileage in the new footwear. Clinicians can improve the health of runners by encouraging appropriate treatment of musculoskeletal injuries, encouraging maintenance of an optimal body mass index, and correcting gait abnormalities caused by deficits in flexibility, strength, or motor control along the kinetic chain.

Changes in gait when anticipating slippery floors.

Falls precipitated by slipping are listed among the leading causes of injuries. The biomechanical analysis of such events is a necessary component of the slips/falls prevention research. One of the challenges of biomechanical studies is reproducing the unexpected nature of real-life slipping accidents. Thus, the goal of this study was to quantify changes in gait biomechanics when subjects anticipate slippery environments. Foot ground reaction forces and body dynamics of 16 subjects were recorded during level walking and descending ramps of varying frictional properties and inclination. Gait biomechanics were compared among three types of dry trials: (1) baseline (subjects knew the floor was dry); (2) anticipation (subjects were uncertain of the contaminant condition, dry, water, soap or oil); and (3) recovery trials recorded after a contaminated trial (subjects again knew the floor was dry). Subjects were asked to walk as naturally as possible throughout testing. Anticipation trials produced peak required coefficient of friction (RCOF(peak)) values that were on average 16-33% significantly lower than those collected during baseline trials, thus reducing slip potential. During recovery trials, RCOF(peak) values did not return to baseline characteristics (5-12% lower). Postural and temporal gait adaptations, which affected ground reaction forces, were used to achieve RCOF(peak) reductions. Statistically significant gait adaptations included reductions in stance duration (SD) and loading speed on the supporting foot, shorter normalized stride length (NSL), reduced foot-ramp angle and slower angular foot velocity at heel contact. As a result of these adaptations, anticipation of slippery surfaces led to significant changes in lower extremity joint moments, a reflection of overall muscle reactions. Thus, this study suggests that significant gait changes are made when there is a potential risk of slipping even though subjects were asked to walk as naturally as possible. Insights are also gained into the adaptations that are used to reduce the potential of slips/falls.