Knee Extension Movements Research Articles

Design and development of an EMG controlled transfemoral prosthesis

Electromyography (EMG) signals are biomedical signals that measure electrical currents generated by the activity of muscles when they contract. EMG is essential for optimizing the control of various prosthetic devices, particularly for transfemoral amputees, where the complexity of muscle signal integration presents significant challenges. The proposed study aims to develop a prosthetic knee that actuates in real-time using the EMG signals from the amputee’s residual limb. Pre-processing techniques are employed to obtain EMG signals from the femoris and vastus muscle targets in the transfemoral region. Moving average filters and Butterworth bandpass filters are implemented to process the raw signals. Sliding windows of various widths were applied for feature extraction. The window size of 200 ms is determined for our study based on the outcomes of the t-SNE plots and the corresponding silhouette scores. After the extraction of the pertinent features, several supervised classifier algorithms are put into practice to classify the knee flexion and extension motion. The k-nearest Neighbor (KNN) algorithm, with an accuracy rating of 80 %, proved to be suitable for motor control. Real-time control is implemented using the Raspberry Pi board to power the prosthesis allowing above-the-knee amputees to voluntarily move the leg back and forth. The EMG signals are then extracted and used to drive the DC motor. The prosthesis would therefore be able to move more precisely since the EMG readings are being gathered in real-time. Thus, this work can enhance the patient’s comfort with the ease of carrying out knee movements.

Test–Retest Reliability of Concentric and Eccentric Muscle Strength in Knee Flexion–Extension Controlled by Functional Electromechanical Dynamometry in Female Soccer

In the field of sports performance, sports medicine, and physical rehabilitation, there is a great interest in the development of protocols and reliable techniques and instruments for the evaluation of strength produced by athletes. In the last ten years, women’s football has increased its popularity and participation in numerous countries, which has contributed to players developing more professionally and requiring more specific muscle strength training to improve their performance. The aim of this study was to analyze the absolute and relative test–retest reliabilities of peak muscle strength in knee flexion (FLE) and extension (EXT) controlled using a functional electromechanical dynamometer (FEMD) in a group of seventeen professional female soccer players (age = 18.64 ± 0.62 years; weight = 54.72 ± 7.03 kg; height = 1.58 ± 0.04 m; BMI = 21.62 ± 2.70 kg/m2). Peak muscle strength was measured with knee flexion (FLE) and extension (EXT) movements at a speed of 0.4 m·s−1 unilaterally in a concentric phase (CON) and an eccentric phase (ECC). No significant mean differences were found in the test–retest analysis (p > 0.05; effect size < 0.14), and high reliability was reported for peak muscle strength assessments in both the CON (ICC) = 0.90–0.95) and the ECC (ICC = 0.85–0.97). Furthermore, stable repeatability was presented for extension in the CON (CV = 7.39–9.91%) and ECC (CV = 8.65–13.64). The main findings of this study show that peak muscle strength in knee flexion and extension in CON and ECC is a measure with acceptable absolute reliability and extremely high relative reliability using the FEMD in professional female soccer players.

Effectiveness of Proprioceptive Neuromuscular Facilitation on Walking Speed, Discomfort, and Knee Extension in an Acute Stroke Patient: A Case Study

This study investigates the impact of proprioceptive neuromuscular facilitation (PNF) on improving functional mobility in a stroke patient, with a focus on walking speed, discomfort levels, and knee extension range of motion (ROM). PNF techniques were applied over four weeks to assess their effectiveness. The patient's walking performance was evaluated using the 6-minute walk test (6MWT), and discomfort was measured using the visual analogue scale (VAS) during walking and knee extension movements in both seated and standing positions. The results revealed a significant reduction in 6MWT time from 16.47 seconds to 14.2 seconds post-intervention. VAS scores showed a marked decrease in discomfort during the 6MWT from 8 to 1 and during knee extension from 7 to 4 in both positions. Additionally, the knee extension ROM increased significantly, with the most pronounced improvement observed in the seated position (from 141.3° to 158.5°). These findings suggest that PNF is an effective therapeutic approach for enhancing walking performance and reducing discomfort related to hamstring stiffness in acute stroke patients. The study's limitations include its single-case design, limiting the generalizability of the results. Future research with a larger sample size and more objective assessment tools is recommended to validate these findings.

Kinematic gait analysis for patients with meniscus injury

To investigate application of the Codamotion 2CX1 three-dimensional dynamic joint motion capture system to analyze the kinematic characteristics of patients with different degrees of meniscus injury. From December 2020 to June 2022, 135 patients with meniscus injury and recruited normal people were collected, including 82 males and 53 females, aged 14 to 29 years old, with disease duration of 1 to 3 months. Combined with clinical symptoms and MRI examination, the diagnosis of meniscus injury was confirmed, and the patients were divided into stages, including 37 cases of grade 0(normal), 30 cases of gradeⅠ, 33 cases of gradeⅡ, 35 cases of grade Ⅲ according to Stoller grading standard. Subjects in each group were tested walking by using Codamotion 2CX1 three-dimensional dynamic joint motion capture system. Quantitative indexes of walking and kinematics were collected, including knee flexion and extension, internal and external rotation and internal and external turning, and their kinematics were analyzed. In the distribution of knee flexion/extension, there were significant differences in maximum knee flexion, minimum knee extension and knee flexion and extension range among 4 groups(P<0.05). In the distribution of internal/external rotation of knee joint, there were significant differences in the range of internal rotation and rotation of knee joint among 4 groups(P<0.05). In the distribution of internal/external turning of knee joint, there were significant differences in the range of internal and external turning of knee joint among 4 groups(P<0.05). The clinical stage progression was positively correlated with the range of motion of knee extension, external rotation, internal and external turning and turning range(P<0.05). It was negatively correlated with knee flexion, internal rotation, flexion extension and rotation range(P<0.05). The internal and external rotation angles of knee joint could be used as independent factors influencing the clinical stage of meniscus injury (P=0.006, 0.019<0.05). The knee movement of patients with meniscus injury has obvious changes, and the changes are different under different clinical stages. Gait analysis provides a reliable basis for the kinematic analysis of meniscus injury, helps to better understand the kinematic indexes of joints, and provides a reliable auxiliary diagnosis and treatment plan, which provides a new direction for the follow-up medical research.

Combining robotics and functional electrical stimulation for assist-as-needed support of leg movements in stroke patients: A feasibility study

PurposeRehabilitation technology can be used to provide intensive training in the early phases after stroke. The current study aims to assess the feasibility of combining robotics and functional electrical stimulation (FES), with an assist-as-needed approach to support actively-initiated leg movements in (sub-)acute stroke patients. MethodNine subacute stroke patients performed repetitions of ankle dorsiflexion and/or knee extension movements, with and without assistance. The assist-as-needed algorithm determined the amount and type of support needed per repetition. The number of repetitions and range of motion with and without assistance were compared with descriptive statistics. Fatigue scores were obtained using the visual analogue scale (score 0–10). ResultsSupport was required in 44 % of the repetitions for ankle dorsiflexion and in 5 % of the repetitions of knee extension, The median fatigue score was 2.0 (IQR: 0.2) and 4.0 (IQR: 1.5) for knee and ankle, respectively, indicating mild to moderate perceived fatigue. ConclusionThis study demonstrated the feasibility of assist-as-needed assistance through combined robotic and FES support of leg movements in stroke patients. It proved particularly useful for ankle dorsiflexion. Future research should focus on implementing this approach in a clinical setting, to assess clinical applicability and potential effects on leg function.

The Effect of Planovalgus on Balance and Motor Function in Children With Cerebral Palsy

Objective Lower limb deformity in children with cerebral palsy (CP) is a common musculoskeletal problem and planovalgus is the most prevalent, characterized by talus median subluxation, calcaneal valgus, and supinated forefoot. According to studies, one issue in orthopedics and pathology is the accurate diagnosis and proper treatment of planovalgus deformity in children with bilateral spastic cerebral palsy, which has attracted researchers’ attention. Accordingly, the present study investigates the effect of planovalgus deformity on the motor performance and balance of these children. Materials &amp; Methods This cross-sectional study employed a descriptive-analytical design. The convenient sampling method was used among children with bilateral spastic cerebral palsy, diagnosed with unilateral planovalgus, who were referred to the clinics of the University of Social Welfare and Rehabilitation Sciences (Nezam Mafi) and occupational therapy clinics from September 2022 to February 2023 in Tehran City, Iran. Meanwhile, all participants were willing to cooperate in this research. A total of 27 participants were evaluated by an occupational therapist based on the specified criteria and gross motor function classification system (GMFCS), which included the assessments of balance, muscle strength, range of motion, and pain. Data analysis was done using the SPSS software, version 16. Results The results revealed a statistically significant difference between the mean range of motion of ankle dorsiflexion and knee extension between the two limbs (P&lt;0.001). The mean muscle strength of the quadriceps and ankle plantar flexors indicated a statistically significant difference in the affected limb (P&lt;0.001). Additionally, the mean displacement of the center of pressure of the foot also demonstrated a statistically significant difference regarding topographical involvement (P&lt;0.001). Conclusion Planovalgus deformity is one of the most common ankle deformities, which is of great concern for children with cerebral palsy. The results obtained from the assessments of the child’s balance and motor function demonstrated the importance of assessment strategies and early interventions to achieve better rehabilitation outcomes for children with CP and planovalgus deformity.

Effects of muscle fatigue on quadriceps muscle performance in healthy amateur soccer players

IntroductionQuadriceps femoris muscle (QFM) fatigue has a detrimental impact on athlete performance. Therefore, it is crucial to evaluate various performance parameters under fatigued conditions. This study aimed to assess the performance of the QFM during both concentric and eccentric contractions before and after fatigue in the lower extremities of healthy amateur soccer players. MethodTwenty-four healthy amateur soccer players performed three consecutive knee extension and flexion movements concentrically and eccentrically at a velocity of 120°/s with maximum effort, using a Biodex dynamometer. Fatigue was induced by a protocol involving repetitive concentric knee extension and flexion movements at 120°/s, with a load of 50% of maximal voluntary isometric contraction (MVIC) of the QFM until its moment declined to 50% of MVIC. Separate 2-way analyses of variance were conducted to assess the influence of contraction and fatigue on various isokinetic parameters. ResultsNo significant interaction effect between contraction and fatigue was observed for any of the parameters. There was a significant main effect of fatigue on average power for both lower extremities. However, no significant main effect of fatigue was observed for normalized peak moment, angle of peak moment, moment at 0.2s, total work, acceleration, and deceleration times. In contrast, significant main effects of contraction were noted for normalized peak moment, moment at 0.2s, average power, acceleration, and deceleration times in both lower extremities. ConclusionAverage power appeared as the most sensitive performance parameter to fatigue. To enhance QFM performance, emphasizing eccentric exercises during training and conditioning programs could be beneficial for athletes.

Single-Joint Type Hybrid Assistive Limb for Knee Training in the Acute Postoperative Phase After Opening Wedge High Tibial Osteotomy: A Feasibility and Safety Trial.

Opening wedge high tibial osteotomy (OWHTO) influences the knee extensor mechanism, the range of passive motion of knee extension and persistent quadriceps, and anterior knee pain and weakness. Rehabilitation should focus on quadriceps strength and improving joint mobility. The single-joint hybrid assistive limb device (HAL-SJ) is a wearable exoskeleton cyborg. In this study, we investigated the feasibility and safety of HAL-SJ training after the early postoperative period following OWHTO and whether the use of this device can improve functional outcomes, including knee muscle extensor strength and knee extension range of motion without knee pain. Patients who had been diagnosed with knee osteoarthritis and had undergone OWHTO were assessed for eligibility in this prospective trial conducted at our institution between June 2015 and November 2020. The participants were split into two groups, i.e., 10 patients in the hybrid assistive limb (HAL) group and eight patients in the control group. We initiated HAL-SJ therapy on postoperative day 8 and continued it until the patient's discharge. During the hospitalization period, patients engaged in HAL-SJ-assisted knee extension exercises. This exercise routine encompassed five sets, each comprising 10 repetitions, and was conducted twice a week. We conducted assessments aimed at detecting any potential adverse events that could be linked to HAL training. Assessment of the knee extension angle via the visual analog scale (VAS) and strength assessments using a hand-held dynamometer (HHD) were conducted. To compare clinical outcomes before and after OWHTO, knee extension angle, the VAS, HHD, Japanese Orthopaedics Association (JOA) score, and the Japanese Knee Osteoarthritis Measure (JKOM) were assessed at four distinct time points. No adverse events were observed during the study. The assessment of clinical outcomes before and after OWHTO demonstrated a gradual improvement in outcomes. The single-joint hybrid assistive limb device in patients who underwent OWHTO appears to be potentially safe. It contributed to enhanced muscle activity efficiency by reducing knee pain and improving knee extension angles in the early postoperative phase.

TELEREHABILITATION ASSESSMENT OF KNEE RANGE OF MOVEMENT; COMPARISON OF HUMAN POSE ESTIMATION TOOL, PHYSIOROM, VS 3D MOTION CAPTURE SYSTEM

INTRODUCTION AND AIMS Telerehabilitation is increasingly acknowledged, though uptake remains limited by an inability to accurately undertake objective measurement. This study sought to determine the validity of a human pose estimation tool (PhysioROM, Coviu) assessed via two-dimensional (2D) video to measure active knee flexion and extension movement during common rehabilitation exercises, versus gold-standard three-dimensional (3D) motion capture. METHODS Fifty participants were recruited (aged 18 to 30), each performing three common knee rehabilitation exercises; sit-to-stand, seated and reclined active knee flexion. Movements were recorded using the 12-camera, 3D Vicon motion capture system simultaneously with 2D video simulating a home telehealth consultation. Joint kinematics were calculated using the Vicon Plug-in Gait model (3D Vicon) or the human pose estimation tool within the PhysioROM algorithm (2D PhysioROM). RESULTS Mean peak knee flexion was 3.1°, 9.9° and 24.8° (p&amp;lt;0.001) greater for 3D Vicon versus 2D PhysioROM (sit-to-stand, seated flexion and reclined flexion, respectively). For peak knee extension, Vicon 3D was 2.4° and 1.93° greater than 2D PhysioROM in sit-to-stand (p=0.020) and seated flexion (p&amp;lt; 0.001), whilst 3.6° less than PhysioROM for reclined knee flexion (p=0.030). Statistical parametric mapping revealed significant differences between Vicon 3D and PhysioROM for 71% and 42% of timepoints (p&amp;lt;0.001) for seated and reclined movements, clustered around full knee flexion. Significant differences were also found at an additional 37% (p&amp;lt;0.001) of timepoints clustered around knee extension for reclined postures. Overall mean absolute deviation was 8.7°, 7.6° and 16.5° for sit-to-stand, seated flexion and reclined flexion, respectively. CONCLUSION Validity of PhysioROM to accurately measure knee flexion was high, less so in extension, during sit-to stand movements in a seated posture. Measurement in a reclined position were less accurate. PhysioROM may provide an effective method of accurately and objectively quantifying knee movement during a telerehabilitation session using 2D video.

Importance of modifiable non-radiographic functional parameters for adult spinal deformity

We clarified non-radiographic physical parameters associated with the severity of adult spinal deformity (ASD) using community-dwelling adult volunteers. They were subjected to upright entire spine radiographs for standard radiographic parameters and the number of sagittal modifiers of SRS-Schwab ASD classification (Schwab-SM). Clinical evaluations included isometric muscle strength of trunk extensor (TEX), trunk flexor (TFL), quadriceps femoris (QF), gluteus maximus, and iliopsoas; range of motion (ROM) of hip, knee, ankle, and active back extension (BET); SF36 physical component score (PCS), VAS for back and knee pain, and the degree of ambulatory kyphosis (dTIA). Each muscle strength was calibrated by body weight (BW) and expressed as BW ratio. According to our previous study, dTIA ≥ 7.6° was defined as pathological and dTIA ≤ 3.5° as normal. A final total of 409 female volunteers were included, and their demographics were; age 67.0 ± 5.5 years, Schwab-SM 2.1 ± 1.8, TEX 0.90 ± 0.33BW, TFL 0.48 ± 0.15BW, QF 0.45 ± 0.19BW, PCS 33.5 ± 6.5. Subjects were classified as clinical ASD group (cASD, n = 10) with PCS ≤ 27(mean-1SD) and pathological dTIA, robust group (n = 19) with PCS ≥ 40 (mean + 1SD) and normal dTIA, and the rest (non-cASD, n = 338). Statistical analyses showed significant differences in TEX, TFL, QF, knee extension (KEX), and BET between robust and cASD, and the mean values of robust group (TEX ≥ 1.1BW, TFL ≥ 0.5BW, QF ≥ 0.5BW, KEX ≥ 0° and BET ≥ 14 cm) were used as ‘ASD-MJ’ index. Subjects with fully achieving ASD-MJ goals showed significantly better radiographic and clinical outcomes than those with unmet goals. In conclusion, upon prescribing conservative or physical therapies for ASD patients, modifiable clinical goals should be clarified, and ASD-MJ could be a benchmark.

Number of intra-operative cyclic knee motion required to achieve stable graft tension in anterior cruciate ligament reconstruction; a prospective clinical study.

Applying pretension by cyclic knee motion immediately before graft fixation in anterior cruciate ligament (ACL) reconstruction surgery decreases graft elongation during the postoperative course. However, the expected change in graft tension caused by cyclic knee motion remains unclear. We measured graft tension changes caused by cyclic knee motion during double-bundle ACL reconstruction. We included 39 patients undergoing primary anatomical double-bundle ACL reconstruction with autologous hamstrings as graft sources, at multiple centers between February 2021 and August 2022. After securing the anteromedial (AM) and posterolateral (PL) bundle grafts to the femoral cortex, they were initially tensioned to 40 N per bundle. After 10 cycles of knee extension and flexion motion, ranging from 0 to 90-110°, tension was re-measured and re-tensioned to 40 N if the graft tension had decreased. This was repeated thrice for 10 cycles on each graft. Every 10 cycles, we recorded graft tension changes (ΔGT) and compared the mean ΔGT in the AM and PL bundles. Furthermore, we assessed relationships between total ΔGT in each bundle, age, sex, and graft diameter. Twenty-five women and 14 men with a mean age of 27.4 ± 12.4 years were included. The mean ΔGT in AM and PL bundles after every 10 cycles were 6.6 ± 3.7 N, 3.0 ± 2.3 N, 1.4 ± 1.5 N, and 9.9 ± 3.8 N, 4.9 ± 2.6 N, and 2.5 ± 1.9 N, respectively. There were significant differences in ΔGT in both bundles after every 10 cycles (p < 0.01). ΔGT in the AM bundle was significantly lower than in the PM bundle at the same number of cycles (p < 0.01). No correlation was observed between ΔGT in either bundle and age, sex, or graft diameter. The initially applied graft tension decreased by intra-operative cyclic knee movement, and the changes in graft tension decreased after retention and repeated cycles. Three sets of 10 cycles knee motion may avoid initial tension loss of the hamstring autograft in the early phase after double-bundle ACL reconstruction.

Conventional Ratio of Knee Flexors and Extensors Obtained Using an Isokinetic Dynamometer and Isoinertial Devices

This study aimed to analyze the conventional ratio values of knee flexors and extensors obtained using an isokinetic dynamometer (IsoRatio), an adjusted torque test of 5RM (Ratio5RM), and absolute values of 5RM (Ratio5RML). Fifteen male volunteers (28.47 ± 5.78 years; 78.30 ± 6.59kg; 1.79 ± 0.65m) performed a 5RM test on leg extension and leg curl machines. The volunteers executed knee flexion and extension movements at 60°/s angle speed without significant differences between protocols. Regression analysis showed that the Ratio5RML correlates with the isokinetic reference ratio (r=0.649; p=0.009). The result of the paired t-test showed no significant difference between the means of the isokinetic ratio and the ratio predicted by the equation. The results of the present study suggest that the 5RM test performed with isoinertial machines can be used to estimate conventional ratio and identify imbalance between the knee flexors and extensors muscles.

Late Stage Hoffa Disease

A 50-year-old man consulted in March 2019 for left anterior gonalgia that had been evolving for several years. During the interrogation, a notion of old trauma was found. On clinical examination, an anterolateral mass was palpated, the patient had active and passive limitation of knee flexion and extension movements. A standard radiological assessment revealed opacity in the infrapatellar adipose body. MRI showed ossification of the subpatellar fat as well as infiltration of the latter.

Toward a Better Understanding of Walking Speed in Ataxia of Charlevoix-Saguenay: a Factor Exploratory Study.

Mobility limitations, including a decrease in walking speed, are major issues for people with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). Improving our understanding of factors influencing walking speed in ARSACS may inform the development of future interventions for gait rehabilitation and contribute to better clinical practices. The objective of the study was to identify the factors influencing the self-selected walking speed in adults with ARSACS. The dependent variable of this cross-sectional study was the self-selected speed and the factors (independent variables) were age, sex, balance, balance confidence, knee flexion and extension cocontraction indexes, lower limb coordination, passive range of motion of ankle dorsiflexion, knee and hip extension, and global spasticity. Multiple regression models were used to assess the relationships between walking speed and each factor individually. Six factors were significantly associated with walking speed and thus included in regression models. The models explained between 42.4 and 66.5% of the total variance of the self-selected walking speed. The factors that most influence self-selected walking speed are balance and lower limb coordination. In order of importance, the other factors that also significantly influence self-selected walking speed are ankle dorsiflexion range of motion, lower limb spasticity, knee extension range of motion, and confidence in balance. Balance and lower limb coordination should be targeted in rehabilitation interventions to maintain walking ability and functional independence as long as possible. The six factors identified should also be included in future studies to deepen our understanding of walking speed.

Functional popliteal angle tests improve identification of short hamstring muscle–tendon length in patients with a central neurological lesion

This study introduces a functional exercise protocol to improve the identification for short hamstring muscle–tendon length (HMTL), a common contributor to crouch gait in patients with central neurological lesions (CNL). The functional exercise protocol incorporates a knee extension movement with hip in a flexed position, while standing on one leg (functional popliteal angle test) and walking with large steps to the current standard protocol (walking at comfortable speed and as fast as possible). The main aim was to establish whether the new protocol allows better determination of maximum HMTLs and diagnostics of short HMTL in patients with a CNL. Lower limb 3D marker position data from 39 patient limbs and 10 healthy limbs performing the exercises were processed in OpenSim to extract HMTLs. The new protocol provoked significantly larger HMTLs compared to the current standard protocol. The total number of limbs classified as having too short HMTLs reduced from 16 to 4 out of a total of 30 limbs walking in crouch. The new protocol improves determination of maximum HMTL, thereby improving short HMTL diagnostics and identification of patients in need of lengthening treatment. Inter-individual variability observed among patients, indicating the need to include all exercises for comprehensive diagnosis.

Predictors indicating the continuous need for a knee-ankle-foot orthosis in stroke patients at 1 month after onset

ObjectivesTo investigate predictors indicating the continuous need for a knee-ankle-foot orthosis (KAFO) at 1 month after stroke onset in patients who cannot walk without a KAFO in the acute period. Materials and methodsWe enrolled patients with severe hemiplegia (n = 139) who were unable to walk without a KAFO on day 10 from stroke onset. The patients were divided into two groups depending on the need for a KAFO at 1 month after the onset: the KAFO group and non-KAFO group. Logistic regression analysis was used to identify predictors of the continuous need for a KAFO at 1 month after stroke onset. In addition, significant predictors were analyzed using receiver operating characteristic curves. ResultsThe number of patients in the KAFO group and non-KAFO group was 72 (51.8 %) and 67 (48.2 %), respectively. Motor deficit, sensation disorder, severity of pusher syndrome, and body mass index were identified as predictors of the continuous need for a KAFO. Moreover, active range of motion of knee extension on the affected side was found to have the highest predictive ability, with an area under the receiver operating characteristic curve of 0.89 (95 % confidence interval, 0.83–0.94). ConclusionsIn this study, multiple factors were associated with the continuous need for a KAFO at 1 month after stroke onset. In particular, active range of motion of knee extension on the affected side is suggested to be a highly accurate predictor for the need for a KAFO in the subacute phase.

Physiotherapy Management In Reducing Hamstring Muscle Contracture Post Debridement: A Case Study

Contracture is a shortening of the musculotendinous tissue that surrounds or is around a joint and creates significant resistance to passive or active stretching as well as limitations in the range of motion of the joint which can interfere with functional ability. This study aims to find out and explain the physiotherapy management in cases of hamstring muscle contracture et cause post surgical debridement. This research method uses a case study method with 1 respondent involved in this study. Providing interventions in the form of Ultrasound, Infrared, Electrical Stimulation, Hold Relax Stretching and ROM, strengthening exercises and Gait Training in 5 meetings during therapy. The research instruments used by researchers were Range of motion, Manual Muscle Testing, Barthel Index, Limb Length Examination, Upper Limb Segment Circumference, and Trendelenburg Test. As a result of providing physiotherapy intervention, the patient experienced an increase in ROM in knee extension and hip extension movements by 5° each.

Use of Xbox Kinect 360 Videogame for Rehabilitation of Sports Specific ACL Sprain During Lockdown Period Due to COVID-19 Pandemic

Background: Anterior cruciate ligament is one of the two ligaments inside the middle section of the knee joint that forms an “X” shape. Its main function is to prevent the tibia from sliding forward relative to the femur. The ACL also assists with preventing excessive knee extension, knee varus and valgus movements, and tibial rotation. Kinect works in almost all room lighting conditions and can simultaneously track two active users. For full-body, head-to-feet tracking, the recommended user distance from the sensor is approximately 1.8 m for a single user; when two people are to track simultaneously, they should stand approximately 2.5 m away from the device. Kinect requires a minimum user height of 1 m. With the players themselves becoming the ‘game controller’ via their body movements and gestures, Kinect-enabled game titles lend themselves comfortably to the class of exergames (‘exercise games’), although the amount of physical activity involved and calories burned can vary significantly from title to title Materials and method: Twenty-six participated in the study. These subjects were divided into two groups, 13 subjects in each. Group A was administrated with the traditional training, and Group B was administrated with the X BOX Kinect training. Results: Comparison of mean and standard deviation of subjects aged (18-25) between Group A (Traditional Training) and Group B (X box Kinect 360 Training). The mean age of Group A was 20.7143±1.98278, and Group Bs was 20.6571±2.21711, respectively. The paired t-test value was 15.728. There was no significant difference between age groups. But in both Kujala score and muscle girth scores with p-value &lt;0.001** (i.e., p &lt;0.05 at 95 % confidence interval), the pre and post-values of Kujala score and muscle girth were statistically significant. Conclusion: Comparing traditional treatments with or without adding extra Kinect 360 training sessions would be very interesting, being that it may be a good addition to the treatment for post-operative ACL rehab, ACL sprains conservative management, and maintaining Knee joint fitness when sports players in a home without exposure of COVID -19. KEYWORDS: Xbox Kinect-360, ACL Sprain, Home-Based Exercises, Kujala Scale, COVID-19, Remote Rehabilitation.

Influence of time from injury to surgery on knee biomechanics during walking in patients with anterior cruciate ligament reconstruction

ABSTRACT The pilot study aimed to determine whether the time from injury to surgery influences on postoperative knee biomechanics during walking in patients with anterior cruciate ligament reconstruction (ACLR). Thirty-two patients with unilateral ACLR (early, 10 patients; delayed, 22 patients) and 30 control subjects participated in this study. All examinations for patients with ACLR were performed preoperatively and at 12 months postoperatively and comprised passive knee joint laxity, knee muscle strength, and knee kinematics and kinetics during walking. At both time points, there were no significant differences in passive knee joint laxity and knee muscle strength between the early ACLR and delayed ACLR groups. Preoperatively, both the early ACLR and delayed ACLR patients exhibited significantly reduced knee extension movement from midstance to terminal stance compared to the control subjects. Moreover, the delayed ACLR patients exhibited significantly decreased peak external knee flexion moment compared to the control subjects. At 12 months postoperatively, the early ACLR patients showed significant improvement in knee extension movement from midstance to terminal stance compared to pre-ACLR, while the delayed ACLR patients did not show significant improvement in this knee extension movement. It can be concluded that early ACLR may be more beneficial to improve knee biomechanics during walking.

Poster 356: Injury patterns of Achilles tendon ruptures: a systematic video analysis of 80 cases in professional male football

Objectives: Achilles tendon ruptures are injuries with a high severity. Analyses of underlying biomechanical and situational patterns may promote a better understanding of Achilles tendon ruptures and aid in their management and prevention. However, a systematic biomechanical and situational video analysis of real-life Achilles tendon ruptures has not been performed to date. Methods: Professional male football players with an acute Achilles tendon rupture were identified by using an online database (Transfermarkt.com, Hamburg, Germany). For every in-competition injury, the coinciding football match leading to injury was detected. Video files of the injuries were accessed using Wyscout.com (Wyscout.com, Genova, Italy). Situational patterns and injury biomechanics of the injury frame were independently analyzed by two reviewers using a standardized checklist and a motion analysis software (Kinovea v.0.8.15, www.kinovea.org). Finally, consensus was reached to describe the main injury patterns of Achilles tendon ruptures in professional male football. Results: Overall, 80 injuries were included for video analysis. Most injuries (94%) were indirect or non- contact injuries. The kinematic analysis revealed a knee extension movement and an ankle dorsiflexion movement in most cases. Typical joint positions at the assumed injury frame were hip extension, knee extension and ankle dorsiflexion. Player actions identified as main injury patterns were stepping back, landing, running/sprinting, starting, and jumping. All main patterns were closed-chain movements (that is, fixation of the affected leg to the ground). Conclusions: Most Achilles tendon ruptures share characteristic injury features, that is, Achilles tendon elongation, closed-chain movements, and sudden loading. The findings of this study allow insight into injury mechanisms of Achilles tendon ruptures in professional male football and may support translation towards future development of prevention programs.