Internal Knee Abduction Moment Research Articles

Residual Performance and Biomechanical Asymmetries During Jumping Tasks in Female Athletes at 9 Months After Anterior Cruciate Ligament Reconstruction.

Biomechanics and anterior cruciate ligament injury mechanisms differ in males and females. There is a need for more data on between-limb biomechanical differences after anterior cruciate ligament reconstruction (ACLR) in females. To explore biomechanical asymmetries throughout the kinetic chain during the single-legged (SL) and double-legged (DL) countermovement jump (CMJ) and drop jump (DJ) in female athletes after ACLR. Descriptive laboratory study. Kinematic and kinetic between-limb differences were analyzed during the SL and DL CMJ and DJ in 67 female athletes 9 months after ACLR. Biomechanical and performance asymmetries between limbs during the jumps and isokinetic strength testing were analyzed with statistical parametric mapping. The entire stance phase was used for the paired t tests of the biomechanical variables, with Cohen d effect sizes of significant portions of the stance phase (reported as % of stance) calculated in a point-by-point manner. Decreased vertical ground-reaction force, internal knee abduction moment, knee internal rotation angle, hip external rotation angle, internal ankle eversion, and external rotation moments were seen in the ACLR limb during all 4 vertical jump tests. The greatest number and highest value of differences were found during the DLDJ, with asymmetries having medium to large effect sizes. They tended to appear more frequently in the concentric phase (50% to 100% of stance) during the SLCMJ and DLCMJ and in the eccentric (0% to 49% of stance) and concentric (50% to 100% of stance) phase during the SLDJ and DLDJ. For the SLCMJ, SLDJ, and quadriceps strength, performance asymmetries of >15% were detected but not for change of direction. The findings suggest that return-to-play testing in female athletes should examine the entire stance phase and include assessments of kinetic and kinematic variables throughout the kinetic chain. Greater deficits were highlighted in the DJ than in the CMJ, and greater performance asymmetries were evident in the SL tasks, with greater kinetic and kinematic and compensatory strategies evident in the DL tests. Biomechanical analysis focusing on contralateral compensation strategies and sex-specific interventions are necessary before return to play.

Biomechanical Threshold Values for Identifying Clinically Significant Knee-Related Symptoms Six Months Following Anterior Cruciate Ligament Reconstruction.

Slower habitual walking speed and aberrant gait biomechanics are linked to clinically significant knee-related symptoms and articular cartilage composition changes linked to posttraumatic osteoarthritis (PTOA) following anterior cruciate ligament reconstruction (ACLR). To determine specific gait biomechanical variables that can accurately identify individuals with clinically significant knee-related symptoms post-ACLR, and the corresponding threshold values, sensitivity, specificity, and odds ratios for each biomechanical variable. Cross-sectional analysis. Laboratory. Seventy-one individuals (n=38 female; age=21±4 years; height=1.76±0.11 m; mass=75.38±13.79 kg) who were 6 months post-primary unilateral ACLR (6.2±0.4 months). 3D motion capture of 5 overground walking trials was used to calculate discrete gait biomechanical variables of interest during stance phase (1st and 2nd peak vertical ground reaction force [vGRF]; midstance minimum vGRF; peak internal knee abduction and extension moments; and peak knee flexion angle), along with habitual walking speed. Knee Injury and Osteoarthritis Outcome Scores (KOOS) was used to dichotomize patients as symptomatic (n=51) or asymptomatic (n=20) using the Englund et al. 2003 KOOS guidelines for defining clinically significant knee-related symptoms. Separate receiver operating characteristic (ROC) curves and respective areas under the curve (AUC) were used to evaluate the capability of each biomechanical variable of interest for identifying individuals with clinically significant knee-related symptoms. Habitual walking speed (AUC=0.66), vGRF at midstance (AUC=0.69), and 2nd peak vGRF (AUC=0.76), demonstrated low-to-moderate accuracy for identifying individuals with clinically significant knee-related symptoms. Individuals who exhibited habitual walking speeds ≤1.27 m/s, midstance vGRF ≥0.82 BW, and 2nd peak vGRF ≤1.11 BW, demonstrated 3.13, 6.36, and 9.57 times higher odds of experiencing clinically significant knee-related symptoms, respectively. Critical thresholds for gait variables may be utilized to identify individuals with increased odds of clinically significant knee-related symptoms and potential targets for future interventions.

Effects of shoe collar height and limb dominance on landing knee biomechanics in female collegiate volleyball players

ABSTRACT Volleyball-specific footwear with higher collar heights (a mid-cut shoe) are worn to restrict ankle motion. Reduced ankle dorsiflexion has been associated with increased frontal plane motion and injury risk at the knee. With the high frequency of unilateral landings in volleyball, the purpose of this study was to determine the effect of volleyball-specific shoes and limb dominance on knee landing mechanics in collegiate volleyball players. It was hypothesized that participants would exhibit smaller sagittal plane and greater frontal plane knee joint mechanics in mid-cut and dominant limb and that vertical and posterior directed ground reaction forces would be greater wearing mid-cut, yet similar between limbs. Seventeen female volleyball players performed unilateral landings on each limb in mid-cut and low-top volleyball shoes. For shoe main effects, smaller peak dorsiflexion angle and internal peak plantarflexion moment and greater peak medial ground reaction force were found in the mid-cut but with no impact on knee mechanics. For limb main effects, the internal peak knee abduction moment was greater in the dominant limb. Greater peak lateral ground reaction force was found in the interaction between the non-dominant limb and low-top. Further research is warranted to better understand shoe and limb impact in volleyball players.

The effect of incline walking on lower extremity and trunk mechanics in older adults

Older adults are at an increased risk of developing knee osteoarthritis. High internal knee abduction moment during daily activities may elevate the risk of knee osteoarthritis. Incline walking exercise has been found to decrease knee abduction moment in healthy young adults. However, it is unknown if this occurs in healthy older adults. The purpose of this study was to quantify the internal knee abduction moment at different treadmill grades to determine if incline walking could reduce the knee abduction moment in healthy older adults. Twelve healthy older adult males walked on a treadmill at five incline grades (0%, 5%, 10%, 15%, and 20%) at 1.34 ​m⋅s-1. The primary outcome variable was the internal knee abduction moment. A one-way repeated measures multivariate analysis of variance was performed to determine differences in the dependent variables among incline gradients. Peak knee abduction moment significantly decreased from level walking at all gradients in 10% increments (0%–10%, p ​< ​0.001; 5%–15%, p ​< ​0.002; and 10%–20%, p ​= ​0.04). A reduction in knee abduction moment during incline walking could result in decreased knee joint loading on the medial knee compartment. For older adults, who are looking to exercise to improve their health, incline walking may be beneficial to promote lower body strength and cardiovascular ability without inflicting further harm to the aging knee joints. However, because the frontal plane knee joint was of primary interest in this study, further research is needed to determine the effects of incline walking on other joints and in other planes of motion.

Acutely Normalizing Walking Speed Does Not Normalize Gait Biomechanics Post-Anterior Cruciate Ligament Reconstruction.

To determine the effect of acutely increasing walking speed on gait biomechanics in ACLR individuals compared with their habitual speed and uninjured matched-controls. Gait biomechanics were collected on 30 ACLR individuals (20 females; age, 22.0 ± 4.2 yr; body mass index, 24.0 ± 3.0 kg·m -2 ) at their habitual speed and at 1.3 m·s -1 , a speed similar to controls, and 30 uninjured matched-controls (age: 21.9 ± 3.8, body mass index: 23.6 ± 2.5) at their habitual speed. Functional waveform analyses compared biomechanics between: i) walking at habitual speed vs 1.3 m·s -1 in ACLR individuals; and ii) ACLR individuals at 1.3 m·s -1 vs controls. In the ACLR group, there were no statistically significant biomechanical differences between walking at habitual speed (1.18 ± 0.12 m·s -1 ) and 1.3 m·s -1 (1.29 ± 0.05 m·s -1 ). Compared with controls (habitual speed: 1.34 ± 0.12 m·s -1 ), the ACLR group while walking at 1.3 m·s -1 exhibited smaller vertical ground reaction force (vGRF) during early and late stance (13-28, 78-90% stance phase), greater midstance vGRF (47-61%), smaller early-to-midstance knee flexion angle (KFA; 1-44%), greater mid-to-late stance KFA (68-73, 96-101%), greater internal knee abduction moment (69-101%), and smaller internal knee extension moment (4-51, 88-96%). Increasing walking speed to a speed similar to uninjured controls did not elicit significant changes to gait biomechanics, and ACLR individuals continued to demonstrate biomechanical profiles that are associated with PTOA development and differ from controls.

Knee kinetics and the medial femoral cartilage cross-sectional area response to loading in indviduals with anterior cruciate ligament reconstruction

BackgroundUltrasonography is capable of detecting morphological changes in femoral articular cartilage cross-sectional area in response to an acute bout of walking; yet, the response of femoral cartilage cross-sectional area varies between individuals. It is hypothesized that differences in joint kinetics may influence the response of cartilage to a standardized walking protocol. Therefore, the study purpose was to compare internal knee abduction and extension moments between individuals with anterior cruciate ligament reconstruction who demonstrate an acute increase, decrease, or unchanged medial femoral cross-sectional area response following 3000 steps. MethodsThe medial femoral cartilage in the anterior cruciate ligament reconstructed limb was assessed with ultrasonography before and immediately following 3000 steps of treadmill walking. Knee joint moments were calculated in the anterior cruciate ligament reconstructed limb and compared between groups throughout the stance phase of gait using linear regression and functional, mixed effects waveform analyses. FindingsNo associations between peak knee joint moments and the cross-sectional area response were observed. The group that demonstrated an acute cross-sectional area increase exhibited 1) lower knee abduction moments in early stance in comparison to the group that exhibited a decreased cross-sectional area response; and 2) greater knee extension moments in early stance in comparison to the group with an unchanged cross-sectional area response. InterpretationThe propensity of femoral cartilage to acutely increase cross-sectional area in response to walking is consistent with less-dynamic knee abduction and knee extension moment profiles.

Aberrant gait biomechanics in individuals with ACL reconstruction are magnified during treadmill walking

Aberrant gait biomechanics following anterior cruciate ligament reconstruction (ACLR) likely contribute to post-traumatic osteoarthritis (PTOA) development. Gait biomechanics are typically assessed overground, but the use of instrumented/force-measuring treadmills is increasingly common. The purpose of this study was to compare gait biomechanics overground and on an instrumented treadmill in individuals with ACLR and healthy controls. Twenty-four individuals with ACLR and 24 healthy controls completed overground and gait biomechanics assessments. Biomechanical outcomes included peak vertical ground reaction force (vGRF), internal knee extension (KEM) and abduction (KAM) moments, and knee flexion (KFA) and adduction angles; KFA at heel strike; knee flexion displacement; and inter-limb symmetry for each outcome. Peak KEM (P < 0.001, 95%CI [−0.016, −0.007 xBW*Ht]) and vGRF (P < 0.001, 95%CI [−0.09. −0.03 xBW]) were significantly less symmetrical in the ACLR group compared to the control group on the treadmill but not overground. Additionally, peak KEM was smaller in the ACLR limb compared to the contralateral limb both overground (P = 0.005, 95%CI [−0.010, −0.001 xBW*Ht]) and on the treadmill (P < 0.001, 95%CI [−0.015, −0.007 xBW*Ht]), but this difference was 1.8x larger on the treadmill compared to overground. Peak KFA (P = 0.001, 95%CI [−4.2, −1.2°]) and vGRF (P < 0.001, 95%CI [−0.07, −0.03 xBW]) were smaller in the ACLR limb on the treadmill but not overground. These findings suggest aberrant gait biomechanics are exacerbated during treadmill walking post-ACLR and that evaluating kinematics and kinetics on instrumented treadmills may be valuable for assessing risk factors of PTOA development.

Influence of Whole Body Vibration on Drop Jump Landings and Knee Loading Mechanics

Plyometric training is one commonly used method of improving jump performance through improving explosive power generation. Research has also demonstrated that whole body vibration (WBV) can improve jumping and enhance explosive strength especially when supplementing resistance and plyometric training programs. With the drop jump being a common training skill, proper lower extremity landing mechanics are important to consider. Limited evidence suggests that WBV may reduce ground reaction forces and improve knee stability however, its influence on knee loading have not been reported. This study sought to examine the effects of WBV on ground reaction forces and knee valgus during a drop jump. 19 participants (10 female) completed drop jumps pre, immediately post, 10 &amp; 20 minutes post WBV. Results were analyzed by repeated measures ANOVA. Main findings indicated that valgus knee angle increased significantly (p=0.011) post vibration and remained elevated across the 10 &amp; 20 minute post vibration time intervals. Significant differences between sexes revealed that females demonstrated greater internal knee abduction moments (p=0.038). Findings that WBV increases knee valgus angle, a position linked to anterior cruciate ligament injury, suggest further investigation understand the effects of WBV on neuromuscular control and eccentric loading. Strength and conditioning professionals should exercise caution when incorporating WBV into plyometric protocols.

Effects of obesity and foot arch height on gait mechanics: A cross-sectional study.

Foot arch structure contributes to lower-limb joint mechanics and gait in adults with obesity. However, it is not well-known if excessive weight and arch height together affect gait mechanics compared to the effects of excessive weight and arch height alone. The purpose of this study was to determine the influences of arch height and obesity on gait mechanics in adults. In this study, 1) dynamic plantar pressure, 2) spatiotemporal gait parameters, 3) foot progression angle, and 4) ankle and knee joint angles and moments were collected in adults with normal weight with normal arch heights (n = 11), normal weight with lower arch heights (n = 10), obesity with normal arch heights (n = 8), and obesity with lower arch heights (n = 18) as they walked at their preferred speed and at a pedestrian standard walking speed, 1.25 m/s. Digital foot pressure data were used to compute a measure of arch height, the Chippaux-Smirak Index (CSI). Our results revealed that BMI and arch height were each associated with particular measures of ankle and knee joint mechanics during walking in healthy young adults: (i) a higher BMI with greater peak internal ankle plantar-flexion moment and (ii) a lower arch height with greater peak internal ankle eversion and abduction moments and peak internal knee abduction moment (i.e., external knee adduction moment). Our results have implications for understanding the role of arch height in reducing musculoskeletal injury risks, improving gait, and increasing physical activity for people living with obesity.

Does saddle height influence knee frontal-plane biomechanics during stationary cycling?

IntroductionCycling is a common modality for rehabilitation and exercise. However, there is a lack of information in the literature on the effects of saddle height adjustments on internal peak knee abduction moment, which is an important loading variable for the medial compartment of tibiofemoral joint for patients with knee osteoarthritis. The purpose of this study was to examine effects of saddle height on frontal-plane biomechanics of the knee during cycling. MethodsFourteen recreational cyclists (age: 57.1 ± 6.37 years) performed 2-min bouts of cycling at three saddle heights of 40°, 30° and 20° knee extension angle at bottom crank position, at two workrates of 80 and 120 W. Three-dimensional kinematic, kinetic, and electromyography data were collected and analyzed using a 3 × 2 (height × workrate) analysis of variance (ANOVA). ResultsThere were no changes in internal knee abduction moment across saddle heights. Increases in saddle height from 40° to both 30° and 20° reduced the knee extension moment (d = 0.3 and 0.4, respectively, P = 0.012). Increases in workrate increased both knee abduction and extension moments (η2p = 0.75 and 0.88, respectively, P < 0.001 for both). ConclusionsIncreased knee extension moment with decreased saddle height is likely to indicate increased knee joint load.

Increased Q-factor increases medial compartment knee joint contact force during cycling

As Q-Factor (QF: inter-pedal distance) is increased, the internal knee abduction moment (KAbM) also increases, however it is unknown if this increased KAbM is associated with increased medial compartment knee joint contact force in cycling. In the absence of in vivo measurement, musculoskeletal modeling simulations may provide a viable option for estimating knee joint contact forces in cycling. The primary purpose of this study was to investigate the effect of increasing QF on knee joint total (TCF), and medial (MCF) compartment contact force during ergometer cycling. The secondary purpose was to evaluate whether KAbM and knee extension moment are accurate predictors of MCF in cycling. Musculoskeletal simulations were performed to estimate TCF and MCF for sixteen participants cycling at an original QF (150 mm), and wide QF (276 mm), at 80 W and 80 rotations per minute. Paired samples t-tests were used to detect differences between QF conditions. MCF increased significantly, however, TCF did not change at wide QF. Peak knee extensor muscle force did not change at wide QF. Peak knee flexor muscle force was significantly reduced with wide QF. Regression analyses showed KAbM and knee extension moments explained 87.4% of the variance in MCF when considered alongside QF. The increase of MCF may be attributed to increased frontal-plane pedal reaction force moment arm. Future research may seek to implement QF modulation as a part of rehabilitation or training procedures utilizing cycling in cases where medial compartment joint loading is of importance.

Relationship between kinematic gait parameters during three gait modifications designed to reduce peak knee abduction moment

PurposeGait modifications designed to change a single kinematic parameter have reduced first peak internal knee abduction moment (PKAM). Prior research suggests unintended temporospatial and kinematic changes occur naturally while performing these modifications. We aimed to investigate i) the concomitant kinematic and temporospatial changes and ii) the relationship between gait parameters during three gait modifications (toe-in, medial knee thrust, and trunk lean gait). MethodsUsing visual real-time biofeedback, we collected 10 trials for each modification using individualized target gait parameters based on participants’ baseline mean and standard deviation. Repeated measures ANOVA was performed to determine significant differences between conditions. Mixed effects linear regression models were then used to estimate the linear relationships among variables during each gait modification. All modifications reduced KAM by at least 5%. ResultsModifications resulted in numerous secondary changes between conditions such as increased knee abduction during toe-in gait and increased knee flexion with medial knee thrust. Within gait modifications, relationships between kinematic parameters were similar for toe-in gait and medial knee thrust (i.e. increased toe-in and decreased knee abduction), while increased trunk lean showed no relationship with any other kinematic parameters during trunk lean trials. ConclusionTwo main mechanisms were found as a result of this investigation; the first being a pattern of toeing-in, knee abduction, flexion, and internal hip rotation, while trunk lean modification presented as a separate gait pattern with limited secondary changes. Future studies should consider providing feedback on multiple linked parameters, as it may feel more natural and optimize KAM reductions.

The medial inclination of the proximal tibia is associated with the external knee adduction moment in advanced varus knee osteoarthritis.

Whether the inclined articular surface on the medial proximal tibia and the external knee adduction moment (KAM) correlate remains unclear. The hypothesis was that a steeper inclined articular surface correlated with a larger KAM in advanced knee osteoarthritis (OA). A total of 44 females (non-OA, 9 knees; early OA, 14 knees; advanced OA, 21 knees; mean age, 58 ± 16years) were examined. Three-dimensional (3D) assessment was used on biplanar long-leg radiographs and 3D bone models using a 3D to 2D image registration technique. The approximation plane in the proximal tibia was determined using the least-square method. The joint moments were mathematically calculated in a gait analysis, applying a motion capture system and force plates. The main evaluation parameters were the femorotibial angle (FTA), the coronal inclination of the approximation plane in the medial proximal tibia (coronal inclination), and internal knee joint moments. The KAM means the external moments balanced with the internal knee abduction moments. The advanced OA showed a larger internal abduction moment (p = 0.017) at the loading response than the other groups. The larger FTA and steeper coronal inclination correlated with the larger internal abduction moment (FTA, p < 0.001; coronal inclination, p = 0.003) at the loading response. As the clinical relevance, the association among the coronal inclination of the medial proximal tibia, lower extremity alignment, and KAM is one of the key factors to help better understand the etiology of knee OA. III.

Effects of BMI on Walking Speed and Gait Biomechanics after Anterior Cruciate Ligament Reconstruction.

History of an anterior cruciate ligament reconstruction (ACLR) and high body mass index (BMI) are strong independent risk factors for knee osteoarthritis (KOA) onset. The combination of these risk factors may further negatively affect joint loading and KOA risk. We sought to determine the combined influence of BMI and ACLR on walking speed and gait biomechanics that are hypothesized to influence KOA onset. Walking speed and gait biomechanics (peak vertical ground reaction force [vGRF], peak vGRF instantaneous loading rate [vGRF-LR], peak knee flexion angle, knee flexion excursion [KFE], peak internal knee extension moment [KEM], and peak internal knee abduction moment [KAM]) were collected in 196 individuals with unilateral ACLR and 106 uninjured controls. KFE was measured throughout stance phase, whereas all other gait biomechanics were analyzed during the first 50% of stance phase. A 2 × 2 ANOVA was performed to evaluate the interaction between BMI and ACLR and main effects for both BMI and ACLR on walking speed and gait biomechanics between four cohorts (high BMI ACLR, normal BMI ACLR, high BMI controls, and normal BMI controls). History of an ACLR and high BMI influenced slower walking speed (F1,298 = 7.34, P = 0.007), and history of an ACLR and normal BMI influenced greater peak vGRF-LR (F1,298 = 6.56, P = 0.011). When evaluating main effects, individuals with an ACLR demonstrated lesser KFE (F1,298 = 7.85, P = 0.005) and lesser peak KEM (F1,298 = 6.31, P = 0.013), and individuals with high BMI demonstrated lesser peak KAM (F1,297 = 5.83, P = 0.016). BMI and history of ACLR together influence walking speed and peak vGRF-LR. History of an ACLR influences KFE and peak KEM, whereas BMI influences peak KAM. BMI may need to be considered when designing interventions aimed at restoring gait biomechanics post-ACLR.

Vibration improves gait biomechanics linked to posttraumatic knee osteoarthritis following anterior cruciate ligament injury.

Anterior cruciate ligament reconstruction (ACLR) incurs a high risk of posttraumatic knee osteoarthritis (PTOA). Aberrant gait biomechanics contribute to PTOA and are attributable in part to quadriceps dysfunction. Vibration improves quadriceps function following ACLR, but its effects on gait biomechanics are unknown. The purpose of this study was to evaluate the effects of whole-body vibration (WBV) and local muscle vibration (LMV) on gait biomechanics in individuals with ACLR. Seventy-five volunteers (time since ACLR 27 ± 16 months) were randomized to WBV, LMV, or Control interventions. Walking biomechanics were assessed prior to and following a single exposure to the interventions. Outcomes included pre-post change scores in the ACLR limb for the peak vertical ground reaction force (vGRF) and its loading rate, peak internal knee extension (KEM) and abduction moments, and peak knee flexion and varus angles. LMV produced a significant decrease in the vGRF loading rate (-3.6 BW/s) that was greater than the changes in the WBV (-0.3 BW/s) and Control (0.5 BW/s) groups. Additionally, WBV produced an increase in the peak KEM (0.27% BW × Ht) that was greater than the change in the Control group (-0.17% BW × Ht) but not the LMV group (0.01% BW × Ht). Lower KEM and greater loading rates have been linked to declines in joint health following ACLR. WBV acutely increased the peak KEM and LMV decreased loading rates. These data suggest that vibration has the potential to mitigate aberrant gait biomechanics, and may represent an effective approach for reducing PTOA risk following ACLR.

Effects of Increased Step-Width on Knee Biomechanics During Inclined and Declined Walking.

The purpose of this study was to investigate effects of preferred step width and increased step width modification on knee biomechanics of obese and healthy-weight participants during incline and decline walking. Seven healthy-weight participants and 6 participants who are obese (body mass index ≥ 30) performed 5 walking trials on level ground and a 10° inclined and declined instrumented ramp system at both preferred and wide step-widths. A 2 × 2 (step-width × group) mixed-model analysis of variance was used to examine selected variables. There were significant increases in step-width between the preferred and wide step-width conditions for all 3 walking conditions (all P < .001). An interaction was found for peak knee extension moment (P = .048) and internal knee abduction moment (KAM) (P = .025) in uphill walking. During downhill walking, there were no interaction effects. As step-width increased, KAM was reduced (P = .007). In level walking, there were no interaction effects for peak medial ground reaction force and KAM (P = .007). There was a step-width main effect for KAM (P = .007). As step-width increased, peak medial ground reaction force and peak knee extension moment increased, while KAM decreased for both healthy weight and individuals who are obese. The results suggest that increasing step-width may be a useful strategy for reducing KAM in healthy and young populations.

Changes In Gait Biomechanics Between Level And Downhill Walking Do Not Differ Between Those With Anterior Cruciate Ligament Reconstruction And Controls

Conflicting evidence exists regarding the presence of aberrant gait biomechanics after the first year post-anterior cruciate ligament reconstruction. Overground walking may not elucidate differences in those further removed from surgery due to the unexacting nature of the task. Deleterious gait biomechanics following ACLR are partly attributable to quadriceps dysfunction. Downhill walking may exacerbate aberrant gait biomechanics, as this task places greater demands on the quadriceps compared to level walking. PURPOSE: To compare gait biomechanics between individuals with ACLR and healthy controls during level and downhill walking conditions. METHODS: 24 individuals more than 1 year removed from primary ACLR (83% female, age= 21 ± 3 yr, time since ACLR 44 ± 26 mo, BMI= 23 ± 3 kg/m2) and 24 healthy controls (79% female, age= 21 ± 1 yr, BMI= 24 ± 3 kg/m2) completed both level and downhill (10°grade) gait biomechanics assessments on an instrumented split-belt treadmill at their preferred walking speed. Peak variables were evaluated over the first 50% of stance including the vertical ground reaction force (vGRF), internal knee abduction moment, internal knee extension moment, knee flexion angle, and knee abduction angle. Moments were normalized to %body weight∗height (%BW∗Ht) and vGRF was normalized to %body weight. Dependent variables were compared across groups and conditions via two-way repeated measures ANCOVA controlling for gait speed. RESULTS: There were no significant condition∗group interaction effects nor group main effects for any outcomes. However, there were significant condition main effects for peak internal knee extension moment (p = 0.020, level to downhill mean increase of 0.042 %BW∗Ht) and peak knee flexion angle (p = 0.018, level to downhill mean increase of 13.2&#176;). CONCLUSIONS: Downhill walking necessitates a larger internal extension moment and knee flexion angle compared to level gait. Our results suggest that changes in gait biomechanics between level and downhill conditions do not differ between individuals with ACLR > 1 year post reconstruction and controls. These results suggest that aberrant gait biomechanics may be mitigated over time in those with ACLR.

Biomechanical effects of manipulating peak vertical ground reaction force throughout gait in individuals 6–12 months after anterior cruciate ligament reconstruction

BackgroundWe aimed to determine the effect of cueing an increase or decrease in the vertical ground reaction force impact peak (peak in the first 50% of stance) on vertical ground reaction force, knee flexion angle, internal knee extension moment, and internal knee abduction moment waveforms throughout stance in individuals 6–12 months after an anterior cruciate ligament reconstruction. MethodsTwelve individuals completed 3 conditions (High, Low, and Control) where High and Low Conditions cue a 5% body weight increase or decrease, respectively, in the vertical ground reaction force impact peak compared to usual walking. Biomechanics during High and Low Conditions were compared to the Control Condition throughout stance. FindingsThe High Condition resulted in: (a) increased vertical ground reaction forces at each peak and decreased during mid-stance, (b) greater knee excursion (i.e., greater knee flexion angle in early stance and a more extended knee in late stance), (c) greater internal extension moment for the majority of stance, and (d) lesser second internal knee abduction moment peak. The Low Condition resulted in: (a) vertical ground reaction forces decreased during early stance and increased during mid-stance, (b) decreased knee excursion, (c) increased internal extension moment throughout stance, and (d) decreased internal knee abduction moment peaks. InterpretationCueing a 5% body weight increase in vertical ground reaction force impact peak resulted in a more dynamic vertical ground reaction force loading pattern, increased knee excursion, and a greater internal extension moment during stance which may be useful in restoring gait patterns following anterior cruciate ligament reconstruction.

Reductions in peak knee abduction moment in three previously studied gait modification strategies

BackgroundFirst peak internal knee abduction moment (KAM) has been associated with knee osteoarthritis. Gait modification including trunk lean, medial knee thrust, and toe-in gait have shown to reduce KAM. Due to heterogeneity between study designs, it remains unclear which strategy is most effective. We compared the effects of these modifications in healthy individuals to determine their effectiveness to reduce KAM, internal knee extension moment (KEM), and medial contact force (MCF). MethodsTwenty healthy individuals volunteered for this study (26.7 ± 4.7 years, 1.75 ± 0.1 m, 73.4 ± 12.4 kg). Using real-time biofeedback, we collected 10 trials for each modification using individualized gait parameters based on participants' baseline mean and standard deviation (SD). Two sizes of each modification were tested: 1–3 SD greater (toe-in and trunk lean) or lesser (knee adduction) than baseline for the first five trials and 3–5 SD greater or lesser than baseline for the last five trials. ResultsA significant main effect was found for KAM and KEM (p < .001). All modifications reduced KAM from baseline by at least five percent; however, only medial knee thrust and small trunk lean resulted in significant KAM reductions. Only medial knee thrust reduced KEM from baseline. MCF was unchanged. Conclusion: Medial knee thrust was superior to trunk lean and toe-in modifications in reducing KAM. Subsequent increases in KEM and variation in individual responses to modification suggests that future interventions should be individualized by type and magnitude to optimize KAM reductions and avoid detrimental effects.

Cut-off frequencies matter: the effects of filtering strategies and footwear on internal knee abduction moments in running

Cut-off frequencies matter: the effects of filtering strategies and footwear on internal knee abduction moments in running