External Joint Research Articles

Human Musculoskeletal and Energetic Adaptations to Unilateral Robotic Knee Gait Assistance.

This paper aims to analyse the human musculoskeletal and energetic adaptation mechanisms when physically interacting with a unilateral knee orthosis during treadmill walking. Test subjects participated in two walking trials, whereby the orthosis was controlled to deliver five predefined torque profiles of different duration (as % of a gait cycle). The adaptations to assistive torques of different duration were analysed in terms of gait parameters, metabolic effort, and muscle activity. Orthotic assistance's kinematic effects remain local to the assisted leg and joint, unlike the muscles spanning the knee joint, which engage in a balancing-out action to retain stability. Duration of assistive torque significantly affects only the timing of the knee joint's peak flexion angle in the stance phase, while the observed joint kinematics and muscle activity demonstrate different recovery times upon changing robotic support (washout effects). Human body adaptations to external robotic knee joint assistance during walking take place on multiple levels and to a different extent in a joint effort to keep the gait stable. This paper provides important insights into the human body's multiple adaptation mechanisms in the presence of external robotic assistance.

Influence of Compliance and Aging of Artificial Turf Surfaces on Lower Extremity Joint Loading

Background: Artificial turf (AT) has been related to increased injury rates when compared to natural grass (NG). One potential reason for the differences in injury rates is the difference in mechanical characteristics of the surfaces. Over the course of a season on artificial turf, due to heavy use and environmental factors, properties of the surface (such as compliance) may be altered. The purpose was to compare the effects of newly installed versus aged AT on injury risks at the metatarsophalangeal, ankle, and knee joint during soccer-specific movements. Methods: Eleven male soccer players performed three movements on newly installed and ‘aged’ AT. Kinematics and kinetics were collected for the different surfaces. Results: Knee adduction moments were increased during the v-cut (119 Nm vs. 164 Nm, p = 0.02), and knee external rotation joint moments were increased during the circle run (23 Nm vs. 28 Nm, p = 0.04) with the aged surface. No surface effects were seen during the jog-sprint transition. Conclusions: For movements associated with a high risk for non-contact injuries, the age of the AT resulted in greater risk factors for injury potential at the knee joint. Further research comparing injury rates associated with AT should consider mechanical features, specifically surface compliance.

Novel Ductile Enhancement in the Structural Characteristics of External Beam Column Joint with Potassium-Activated Green Concrete Technology

Ductility and energy dissipation capacity of the beam column joints are the two prominent characteristics which govern the stability of the entire structure constructed in the seismic prone areas. In this paper, the effect of potassium-activated geopolymer concrete in the exterior beam column joint application is investigated under low frequency cyclic loading. Numerical analysis has been done by using the finite element software Abaqus and compared with the experimental work. From the load deformation relationship, parametric studies are carried out in the aspects of ductility, stiffness degradation, energy dissipation capacity, drift ratio and cracking pattern. The use of potassium-activated geopolymer technology in the exterior beam column joint application resulted in the improved ductility, energy dissipation capacity with superior ultimate load carrying capacity of 1.05% over conventional cement reinforced concrete beam column joints with special confining reinforcement confirmed by IS 13920 due to the enormous polymerization activated by high molecular potassium ions. There is an improved energy dissipation capacity of 2.78% of potassium-based geopolymer specimen resulting in lesser number of non-structural cracks and 11.26% more deformation under 11.96% enlarged drift ratio than the conventional reinforced concrete specimen. From the observed results, it is clearly noted that the implementation of potassium-activated green polymer technology in the beam column joints possessed enhanced ductility characteristics to protect the structure susceptible to seismic environment and resulted in innovative, economical and sustainable mode of seismic-resistant building construction.

Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes

BackgroundProsthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes.MethodsSeven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated.ResultsProsthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF.ConclusionsThe studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.

Plantar flexor muscles of kangaroo rats (Dipodomys deserti) shorten at a velocity to produce optimal power during jumping.

The musculotendon work contributions across all joints during jumping by kangaroo rats are not well understood. Namely, measures of external joint work do not provide information on the contributions from individual muscles or in-series elastic structures. In this study, we examined the functional roles of a major ankle extensor muscle, the lateral gastrocnemius (LG), and a major knee extensor muscle, the vastus lateralis (VL), through in vivo sonomicrometry and electromyography techniques, during vertical jumping by kangaroo rats. Our data showed that both muscles increased shortening and activity with higher jumps. We found that knee angular velocity and VL muscle shortening velocity were coupled in time. In contrast, the ankle angular velocity and LG muscle shortening velocity were decoupled, and rapid joint extension near the end of the jump produced high power outputs at the ankle joint. Further, the decoupling of muscle and joint kinematics allowed the LG muscle to prolong the period of shortening velocity near optimal velocity, which likely enabled the muscle to sustain maximal power generation. These observations were consistent with an LG tendon that is much more compliant than that of the VL.

Model of the traction and external power supply system joint operation

The paper presents a description of mathematical model designed to study the joint operation of 25 kV alternating current traction power supply systems and 110 - 750 kV power supply systemsThe design concept of three-phase and single-phase PU-generators on the basis of the EMF source behind inductive resistance as well as three-phase and single-phase loads is considered. Based on the above mathematical expressions, a computer model has been developed to analyze the joint operation of three-phase networks of external power supply and single-phase traction networks. The model is implemented in the software package MATLAB -Simulink. Using this computer model the influence of power overflows in the 110 - 330 kV network of PJSC “Karelenergo” and PJSC “FGC UES” on the equalizing currents in the traction network of the Knyazhaya-Idel’ section of the October railroad was analyzed. Brief analysis of modeling results is presented.

Success of dental implants in patients with large bone defect and analysis of risk factors for implant failure: a non-randomized retrospective cohort study.

This study aimed to retrospectively investigate the success and survival rates of dental implants used for dentomaxillary prostheses at our hospital and the risk factors associated with large bone defects. A total of 138 external joint system implants used for dentomaxillary prostheses in 40 patients with large bone defects were included in this study. The alveolar bone at the site of implant insertion was evaluated using panoramic radiography and computed tomography. Various risk factors (demographic characteristics, dental status, and operative factors such as the employment of alveolar bone augmentation, the site, the length, and diameter of implants) for implant failure and complete implant loss were investigated using univariate and multivariate analyses. The associations between the variables and the success and survival rates of dental implants were analyzed using the multivariate Cox proportional hazard models. The 10-year overall success and survival rates were 81.3% and 88.4% in this study. Multivariable analysis showed that the male sex (HR 6.22), shorter implants (≤ 8.5mm) (HR 5.21), and bone augmentation (HR 2.58) were independent predictors of success rate. Bone augmentation (HR 5.14) and narrow implants (≤ 3.3mm) (HR 3.86) were independent predictors of the survival rate. Male sex, shorter or narrow implants, and bone augmentation were independent risk factors for dental implants used in dentomaxillary prostheses in patients with large bone defects. Clinicians should consider these risk factors and pay close attention to the management of these patients.

Experimental and Numerical Investigations on Seismic Performance of CFST Frame with External Diaphragm Joint

This paper aims to investigate the seismic performance of a steel frame with an external diaphragm joint between a concrete-filled steel tube (CFST) column and H-shaped steel beam through experiments and finite-element (FE) analysis. A quasistatic test was conducted on five steel frame specimens. The parameters involved in the test were joint stiffness, beam-to-column stiffness ratio and concrete strength. Based on the experimental results, failure mode, lateral load versus displacement hysteretic curve, skeleton curve, strength and stiffness degradation effects, ductility, and energy dissipation capacity were analyzed. The experimental results show the hysteretic curves have a plump shuttle shape; the strength degradation effect and stiffness degradation effect are relatively feeble; and the ductility and energy dissipation capacity are excellent. Therefore, the tested specimens have good seismic performance. Also, this suggests that larger joint stiffness brings about superior seismic performance; a stronger column leads to higher bearing capacity as well as inferior ductility and energy dissipation capacity; and a CFST frame performs better than a hollow steel tube column frame under cyclic loads. On the basis of the experimental results, the ABAQUS software version 6.14 was adopted to establish the FE models. The applicability and accuracy of FE simulation were first verified by experimental results. Then, quantitative parametric analysis was carried out to study the effects of different parameters on seismic performance of the CFST frame with an external diaphragm joint.

Shoulder External Rotational Properties During Physical Examination Are Associated With Injury That Requires Surgery and Shoulder Joint Loading During Baseball Pitching

Background: Throwing arm injuries are common because of the demand on the shoulder. The shoulder is qualitatively checked regularly by team physicians. Excessive instability and joint loading in baseball pitching are risk factors for throwing arm injuries. Knowledge of shoulder flexibility, range of motion, and joint loading may provide new insights for treatments to reduce the likelihood of injury incidence. Purpose: To investigate the relationship among injuries, shoulder external rotational properties, and shoulder joint loading in baseball pitchers. Study Design: Descriptive laboratory study. Methods: Pitching kinetics, shoulder rotational tests, and self-reported injury questionnaires were used to study 177 collegiate baseball pitchers. Pitching motion data were collected at 240 Hz using a motion capture system. A custom program calculated the shoulder joint loading. The shoulder rotational test quantitatively records shoulder range of motion and flexibility using a custom-made wireless device. Self-reported injury questionnaires were filled out during tests and yearly follow-ups. The total length of the study was 5 years. Analysis of variance, chi-square, and regression tests were performed to compare differences among groups and detect correlations with surgery and shoulder joint loadings. Results: There were significant differences in shoulder flexibility among surgery groups. Shoulder external rotational properties during physical examination were significantly associated with shoulder joint loading in baseball pitching. High shoulder external rotation was associated with 14% to 36% lower shoulder posterior force and adduction, internal rotation, and horizontal adduction torque (P < .05). High shoulder flexibility was associated with 13% higher anterior force (P < .05). High shoulder external rotation before external rotation torque was applied was associated with 13% to 33% lower shoulder inferior force and adduction, internal rotation, and horizontal adduction torque (P < .05). There were no significant differences in shoulder joint loading among the surgery groups. Conclusion: Shoulder injuries that require surgery were associated with shoulder external rotation flexibility. High shoulder external rotation may be advantageous because it lowers the force and torque on the shoulder joint. Clinical Relevance: The ability to understand shoulder external rotational properties, joint loading, and injury during baseball pitching helps further our understanding of injury mechanisms. The shoulder rotational test should be used as a screening tool to identify players at risk.

The Micro-genesis of Improvisational Co-creation

ABSTRACT Recent voices in creativity research emphasize the vital role that processes of active engagement and interaction play. These distributed, interactivity-based, and ecological accounts critique the reduction of creativity to mental mechanisms and eschew the methodological individualism that underlies this view. Instead, they elevate socio-material couplings to a genuine causal mechanism, hereby explaining why others “are good to be creative with” beyond mutual inspiration or mere constraints on creativity. With improvised dance duets as our example, we introduce a micro-analysis that unpacks these mechanisms from a first-person viewpoint: We describe how the embodied communication at the sub-second scale, a continuous “give and take” between dancers, mediates the co-creation process and how reciprocal micro-actions cumulate into more complex creative effects. Secondly, we distinguish convergent and divergent co-creation dynamics, degrees of playful exploration vs. adaptive pressures, and degrees of individual creative autonomy. Thirdly, we argue that the mix of external constraints, joint exploration, and individual ideation provides a fertile mechanism for co-creation. Finally, we discuss forms of individual creative vision that respect and exploit the dynamic ecology, which can manifest in immediate micro-inspirations, but also in subtle modulations of ongoing process, and in “cultivating” the wider system in ways that benefit novelty.

The incidence and risk factors of contralateral knee arthroplasty after primary unilateral unicompartmental knee arthroplasty.

Unicompartmental knee arthroplasty (UKA) is one of the commonly used surgical methods for unicompartmental osteoarthritis in recent years. Although the prognosis of the operated knee has been widely studied, there are relatively little data on the natural history of the contralateral knee after unilateral replacement. The aim of this study was to explore the incidence and risk factors of consequential knee arthroplasty in patients with bilateral knee osteoarthritis (KOA) after receiving primary unilateral UKA, so as to provide a theoretical basis for making a more comprehensive treatment strategy for patients with KOA.We conducted a retrospective study and enrolled patients with bilateral KOA received unilateral UKA from June 2015 to December 2019 in the third department of joint orthopedics, the third hospital of Hebei Medical University. The patients were divided into replacement group and non-replacement group according to whether the contralateral knee joint received knee arthroplasty. Information about treatment of contralateral knee joint was collected from medical records to determine the incidence. Univariate analysis and multivariate logistic regression analysis were performed to identify the independent risk factors.A total of 502 patients were enrolled in this study. The incidence of contralateral knee arthroplasty was 38.64%. In the univariate analysis, vertical angle of mechanical axis, knee joint's internal and external joint space, Kellgren–Lawrence (K-L) classification, femoral tibial angle were the significant risk factors for contralateral knee arthroplasty. In the multivariate model, only vertical angle of mechanical axis ≥3.03° (odds ratio [OR] 4.36, 95% confidence interval [CI], 2.47–9.11), K-L classification grades 3 and 4 (OR 2.46,3.72; 95%CI, 1.31–4.25, 1.98–6.87), and femoral tibial angle ≥187.32° (OR 6.32, 95%, 2.23–18.87) remained associated with the occurrence of knee arthroplasty.About a quarter of patients with bilateral KOA received unilateral UKA will receive contralateral knee arthroplasty. Higher K-L classification, femoral tibial angle, and mechanical axis vertical angle are identified risk factors.

Individual and cumulative measures of knee joint load associate with T2 relaxation times of knee cartilage in young, uninjured individuals: A pilot study

BackgroundArticular cartilage structure and chondrocyte health are sensitive and reliant on dynamic joint loading during activities. The purpose of this pilot study was to determine the association between measures of individual and cumulative knee joint loading with T2 relaxation times in the knee cartilage of young individuals without knee injury. MethodsTwelve participants (17–30 years old) without history of knee injury or surgery completed MRI, physical activity (PA), and biomechanical gait testing. T2 relaxation times were calculated in the cartilage within the patella and lateral and medial compartments. Accelerometry was used to measure mean daily step counts, minutes of PA, and % sedentary time over 7 days. Vertical ground reaction force, external knee joint moments and peak knee flexion angle were measured during stance phase of gait using three-dimensional motion capture. Cumulative knee joint loading was calculated as daily step count by external knee joint moment impulse. The relationship between measures of knee joint loading and T2 relaxation times was assessed using Pearson correlations. ResultsHigher T2 relaxation times in the femoral and tibial cartilage were consistently correlated to greater body mass, daily step counts, moderate and vigorous PA, and peak knee joint moments (r = 0.10–0.84). Greater cumulative knee flexion and adduction loading was associated with higher T2 relaxation times in the femoral and tibial cartilage (r = 0.16–0.65). ConclusionPreliminary findings suggest that individual loading factors and cumulative knee joint loading are associated with higher T2 relaxation times in the articular cartilage of young, healthy knees.

Do non-rearfoot runners experience greater second metatarsal stresses than rearfoot runners?

Stress fracture of the second metatarsal is a common and problematic injury for runners. The choice of foot strike pattern is known to affect external kinetics and kinematics but its effect on internal loading of the metatarsals is not well understood. Models of various complexities can be used to investigate the effects of running characteristics on metatarsal stresses. This study aimed to compare second metatarsal stress between habitual rearfoot and non-rearfoot strikers during barefoot running, using a novel participant-specific finite element model, including accurate metatarsal and soft tissue geometry. Synchronised force and kinematic data were collected during barefoot overground running from 20 participants (12 rearfoot strikers). Stresses were calculated using a previously evaluated and published 3D finite element model. Non-rearfoot strikers demonstrated greater external loading and joint contact forces than rearfoot runners, but there were no differences in stresses between groups. Additionally, the study allowed for a qualitative assessment of bone geometries and stresses. No correlation was found between bone volume and stresses, however, there was found to be a large variation in metatarsal shapes, possibly accounting for the lack of difference in stresses. This emphasises the importance of bone geometry when estimating bone stress and supports the suggestion that external forces should not be assumed to be representative of internal loading.

Relationships between tibial articular cartilage, in vivo external joint moments and static alignment in end-stage knee osteoarthritis: A micro-CT study.

Biomechanical factors (e.g., joint loading) have a significant role in the progression of osteoarthritis (OA). However, some relationships between in vivo joint loading indices and tibial cartilage thickness are conflicting. This study investigated relationships between pre-operative in vivo external knee joint moments, joint alignment and regional tibial cartilage thickness using micro-CT in subjects with end-stage knee OA. Tibial plateaus from 25 patients that underwent knee replacement for OA were micro-CT scanned (17 µm/voxel). Prior to surgery, subjects underwent gait analysis to calculate external knee moments. The mechanical axis deviation (MAD) was obtained from pre-operative radiographs. Cartilage thickness (Cart.Th) was analyzed from micro-CT images, in anteromedial, anterolateral, posteromedial and posterolateral subregions of interest. Medial-to-lateral Cart.Th ratios were also explored. Relationships between Cart.Th and joint loading indices were examined using Pearson's correlations. Significant correlations were found between Cart.Th and joint loading indices, positive anteromedially with the first peak knee adduction moment (r = 0.55, p < 0.01) and external rotation moment (ERM; r = 0.52, p < 0.01), and negative with MAD (r = -0.76, p < 0.001). In the lateral regions, these correlations had opposite signs. The medial-to-lateral Cart.Th ratio correlated strongly with ERM (r = 0.63, p = 0.001) and MAD (r = -0.75, p < 0.001). Joint loading indices correlated with regional cartilage thickness values and their medial-to-lateral ratios in end-stage knee OA subjects, with higher regional loads corresponding to thinner cartilage. These relationships have the opposite sign compared to the subchondral bone microarchitecture found in our previous study on the same specimens, which may suggest a complementary bone-cartilage interplay in response to loading.

Balance Recovery Based on Whole-Body Control Using Joint Torque Feedback for Quadrupedal Robots

Abstract In legged locomotion, the contact force between a robot and the ground plays a crucial role in balancing the robot. However, in quadrupedal robots, general whole-body controllers generate feed-forward force commands without considering the actual torque or force feedback. This paper presents a whole-body controller using the actual joint torque measured from a torque sensor, which enables the quadrupedal robot to demonstrate both dynamic locomotion and reaction to external disturbances. We compute external joint torque using the measured joint torque and the robot’s dynamics, and then we transform this to the moment of the center of mass (CoM). Using the computed CoM moment, the moment-based impedance controller distributes a feed-forward force corresponding to the desired moment of the CoM to stabilize the robot’s balance. Furthermore, to recover balance, the CoM motion is generated using capture point-based stepping control and zero moment point trajectory. The proposed whole-body controller was tested on a quadrupedal robot, named AiDIN-VI. Locomotive abilities on uneven terrains and slopes and in the presence of external disturbances are verified through experiments.

Reducing Metabolic Cost During Planetary Ambulation Using Robotic Actuation.

INTRODUCTION: Current spacesuits are cumbersome and metabolically expensive. The use of robotic actuators could improve extravehicular activity performance. We propose a novel method to quantify the benefit of robotic actuators during planetary ambulation.METHODS: Using the OpenSim framework, we completed a biomechanical analysis of three walking conditions: unsuited, suited with the extravehicular mobility unit (EMU) spacesuit (represented as external joint torques applied to human joints), and suited with the EMU and assisted by robotic actuators capable of producing up to 10 Nm of torque. For each scenario, we calculated the inverse kinematics and inverse dynamics of the lower body joints (hip, knee, and ankle). We also determined the activation of muscles and robotic actuators (when present). Finally, from inverse dynamics and muscle activation results, the metabolic cost of one gait cycle was calculated in all three conditions.RESULTS: The moments of lower body joints increased due to the increased resistance to movement from the spacesuit. The additional torque increased the overall metabolic cost by 85 compared to the unsuited condition. The assistive robotic actuators were able to reduce the metabolic cost induced by EMU resistance by 15.DISCUSSION: Our model indicates that the majority of metabolic cost reduction can be attributed to the actuators located at the hip. The robotic actuators reduced metabolic cost similar to that of modern-day actuators used to improve walking. During a Mars mission, the actuators could save one crewmember up to 100,000 kilocal on one 539-d planetary expedition.Kluis L, Keller N, Bai H, Iyengar N, Shepherd R, Diaz-Artiles A. Reducing metabolic cost during planetary ambulation using robotic actuation. Aerosp Med Hum Perform. 2021; 92(7):570578.

A half marathon shifts the mediolateral force distribution at the tibiofemoral joint

ABSTRACT Runners’ gait patterns vary during a half marathon and influence the knee joint mechanics. Joint contact force is a better estimate of the net joint loadings than external joint moments and closely correlates to injury risks. This study explored the changes of lower limb joint kinematics, muscle activities, and knee joint loading in runners across the running mileages of a half marathon. Fourteen runners completed a half marathon on an instrumented treadmill where motion capture was conducted every 2 km (from 2 to 20 km). A musculoskeletal model incorporating medial/lateral tibiofemoral compartments was used to process the movement data and report outcome variables at the selected distance checkpoints. Statistics showed no changes in joint angles, muscle co-contraction index, ground reaction force variables, and medial tibiofemoral contact force (p > 0.05). Knee adduction moment at 18 km was significantly lower than those at 2 km (p = 0.002, γ = 0.813) and 6 km (p = 0.001, γ = 0.663). Compared to that at 2 km, lateral tibiofemoral contact force was reduced at 18 km (p = 0.030, Hedges’ g = 0.690), 16 km (p < 0.001, Hedges’ g = 0.782), 14 km (p = 0.045, Hedges’ g = 0.859), and 10 km (p < 0.001, Hedges’ g = 0.771) respectively. Mechanical realignment of the lower limb may be the cause of the altered knee loadings and possibly led to reduced running economy in response to a prolonged run. The injury potential of the redistributed tibiofemoral forces warranted further studies.

Tibiofemoral Contact Measures During Standing in Toe-In and Toe-Out Postures.

Knee osteoarthritis is thought to result, in part, from excessive and unbalanced joint loading. Toe-in and toe-out gait modifications produce alterations in external knee joint moments, and some improvements in pain over the short- and long-term. The aim of this study was to probe mechanisms of altered joint loading through the assessment of tibiofemoral contact in standing with toe-in and toe-out positions using an open magnetic resonance scanner. In this study, 15 young, healthy participants underwent standing magnetic resonance imaging of one of their knees in 3 foot positions. Images were analyzed to determine contact in the tibiofemoral joint, with primary outcomes including centroid of contact and contact area for each compartment and overall. The centroid of contact shifted laterally in the lateral compartment with both toe-in and toe-out postures, compared with the neutral position (P < .01), while contact area in the medial and lateral compartments showed no statistical differences. Findings from this study indicate that changes in the loading anatomy are present in the tibiofemoral joint with toe-in and toe-out and that a small amount of lateralization of contact, especially in the lateral compartment, does occur with these altered lower limb orientations.

Identification of Patients with Similar Gait Compensating Strategies Due to Unilateral Hip Osteoarthritis and the Effect of Total Hip Replacement: A Secondary Analysis.

Despite good clinical functional outcome, deficits in gait biomechanics exist 2 years after total hip replacement surgery. The aims of this research were (1) to group patients showing similar gait adaptations to hip osteoarthritis and (2) to investigate the effect of the surgical treatment on gait kinematics and external joint moments. In a secondary analysis, gait data of 51 patients with unilateral hip osteoarthritis were analyzed. A k-means cluster analysis was performed on scores derived via a principal component analysis of the gait kinematics. Preoperative and postoperative datasets were statistically tested between clusters and 46 healthy controls. The first three principal components incorporated hip flexion/extension, pelvic tilt, foot progression angle and thorax tilt. Two clusters were discriminated best by the peak hip extension during terminal stance. Both clusters deviated from healthy controls in spatio-temporal, kinematic and kinetic parameters. The cluster with less hip extension deviated significantly more. The clusters improved postoperatively but differences to healthy controls were still present one year after surgery. A poor preoperative gait pattern in patients with unilateral hip osteoarthritis is associated with worse gait kinematics after total hip replacement. Further research should focus on the identification of patients who can benefit from an adapted or individualized rehabilitation program.

Mechanics of cadaveric anterior cruciate ligament reconstructions during simulated jump landing tasks: Lessons learned from a pilot investigation

BackgroundAround half of anterior cruciate ligament (ACL) injuries are treated through reconstruction, but the literature lacks mechanical investigation of reconstructions in a dynamic athletic task and rupture environment. The current objective was to ascertain the feasibility of investigating ACL reconstructions in a rupture environment during simulated landing tasks in a validated mechanical impact simulator. MethodsFour cadaveric lower extremities were subjected to simulated landing in a mechanical impact simulator. External joint loads that mimicked magnitudes recorded from an in vivo population were applied to each joint in a stepwise manner. Simulations were repeated until ACL failure was achieved. Repeated measures design was used to test each specimen in the native ACL and hamstrings, quadriceps, and patellar tendon reconstructed states. FindingsACL injuries were generated in 100% of specimens. Graft substance damage occurred in 58% of ACLRs, and in 75% of bone tendon bone grafts. Bone tendon bone and quadriceps grafts survived greater simulated loading than hamstrings grafts, but smaller simulated loading than the native ACL. Median peak strain prior to failure was 20.3% (11.6, 24.5) for the native ACL and 17.4% (9.5, 23.3) across all graft types. InterpretationThe simulator was a viable construct for mechanical examination of ACLR grafts in rupture environments. Post-surgery, ACL reconstruction complexes are weaker than the native ACL when subjected to equivalent loading. Bone tendon bone grafts most closely resembled the native ligament and provided the most consistently relevant rupture results. This model advocated reconstruction graft capacity to sustain forces generated from immediate gait and weightbearing during rehabilitation from an ACL injury.