Knee Extensor Moment Research Articles

Biomechanical Markers of Forward Hop-Landing After ACL-Reconstruction: A Pattern Recognition Approach

Biomechanical changes after anterior cruciate ligament reconstruction (ACLR) may be detrimental to long-term knee-joint health. We used pattern recognition to characterise biomechanical differences during the landing phase of a single-leg forward hop after ACLR. Experimental data from 66 individuals 12-24 months post-ACLR (28.2 ± 6.3 years) and 32 controls (25.2 ± 4.8 years old) were input into a musculoskeletal modelling pipeline to calculate joint angles, joint moments and muscle forces. These waveforms were transformed into principal components (features), and input into a pattern recognition pipeline, which found 10 main distinguishing features (and 8 associated features) between ACLR and control landing biomechanics at significance alpha =0.05. Our process identified known biomechanical characteristics post-ACLR: smaller knee flexion angle; less knee extensor moment; lower vasti, rectus femoris and hamstrings forces. Importantly, we found more novel and less well-understood adaptations: smaller ankle plantar flexor moment; lower soleus forces; and altered patterns of knee rotation angle, hip rotator moment and knee abduction moment. Crucially, we identified, with high certainty, subtle aberrations indicating landing instability in the ACLR group for: knee flexion and internal rotation angles and moments; hip rotation angles and moments; and lumbar rotator and bending moments. Our findings may benefit rehabilitation and assessment for return-to-sport 12–24 months post-ACLR.

Gait Biomechanics and Balance Associate with Talar and Subtalar T1ρ Relaxation Times in Those with Chronic Ankle Instability.

This study aimed to determine associations between T1ρ relaxation times of talar and subtalar articular cartilage and commonly altered gait biomechanics and postural control outcomes in those with chronic ankle instability (CAI). Fifteen individuals with CAI (21.13 ± 1.81 yr) completed a T1ρ magnetic resonance imaging as well as a postural control and an overground gait assessment. Talocrural and subtalar cartilage was segmented manually to calculate T1ρ relaxation times. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Pearson product-moment bivariate correlations examined the relationships between T1ρ relaxation times and the gait biomechanics and postural control outcomes. Across multiple variables, worse postural control demonstrated moderate to strong associations (range, 0.433-0.642 and -0.713) with greater talar T1ρ relaxation times. At the subtalar joint, greater T1ρ relaxation times were associated with lower peak vertical ground reaction forces, lower average vertical ground reaction force loading rates, and lower peak loading rates (range, -0.438 to -0.622). At the talar dome, greater talar T1ρ relaxation times were associated with increased knee extensor moments (r = 0.457), as well as greater knee flexion (r = 0.482) and knee adduction (r = 0.407) at initial contact. Larger step spatiotemporal gait parameters also associated with greater talar and subtalar T1ρ relaxation times (range, 0.434-0.697). In individuals with CAI, worse postural control and altered kinematic, kinetic, and spatiotemporal outcomes demonstrate moderate to strong associations with greater talar T1ρ and/or subtalar relaxation times (i.e., less proteoglycan content). Associations between modifiable neuromechanical variables and greater T1ρ relaxation times may represent potential therapeutic interventions to mitigate ankle joint degeneration in those with CAI.

A test of the effort equalization hypothesis in children with cerebral palsy who have an asymmetric gait.

Healthy people can walk nearly effortlessly thanks to their instinctively adaptive gait patterns that tend to minimize metabolic energy consumption. However, the economy of gait is severely impaired in many neurological disorders such as stroke or cerebral palsy (CP). Moreover, self-selected asymmetry of impaired gait does not seem to unequivocally coincide with the minimal energy cost, suggesting the presence of other adaptive origins. Here, we used hemiparetic CP gait as a model to test the hypothesis that pathological asymmetric gait patterns are chosen to equalize the relative muscle efforts between the affected and unaffected limbs. We determined the relative muscle efforts for the ankle and knee extensors by relating extensor joint moments during gait to maximum moments obtained from all-out hopping reference test. During asymmetric CP gait, the unaffected limb generated greater ankle (1.36±0.15 vs 1.17±0.16 Nm/kg, p = 0.002) and knee (0.74±0.33 vs 0.44±0.19 Nm/kg, p = 0.007) extensor moments compared with the affected limb. Similarly, the maximum moment generation capacity was greater in the unaffected limb versus the affected limb (ankle extensors: 1.81±0.39 Nm/kg vs 1.51±0.34 Nm/kg, p = 0.033; knee extensors: 1.83±0.37 Nm/kg vs 1.34±0.38 Nm/kg, p = 0.021) in our force reference test. As a consequence, no differences were found in the relative efforts between unaffected and affected limb ankle extensors (77±12% vs 80±16%, p = 0.69) and knee extensors (41±17% vs 38±23%, p = 0.54). In conclusion, asymmetric CP gait resulted in similar relative muscle efforts between affected and unaffected limbs. The tendency for effort equalization may thus be an important driver of self-selected gait asymmetry patterns, and consequently advantageous for preventing fatigue of the weaker affected side musculature.

Stride Length Impacts on Sagittal Knee Biomechanics in Flat Ground Baseball Pitching

Coordinated lower extremity biomechanics are altered in response to changes in stride length, influencing the kinetic chain that potentially induces compensatory throwing mechanics throughout the baseball pitching cycle. The respective sagittal knee dynamic profiles, for both the stride (lead) and drive (trail) leg, were analyzed during flat ground baseball pitching to determine whether the stride length variation elicits compensatory drive and stride leg knee joint kinematics, kinetics, and joint powers. Using a randomized cross-over design, a cohort of 19 healthy skilled competitive pitchers from collegiate and high school travel programs from across Western New York were assigned to throw 2 simulated 80 pitch games at ±25% of their desired stride length. An integrated motion capture system with two force plates and a radar gun tracked each throw. Pairwise comparisons at hallmark events and phases identified significantly different sagittal knee dynamics for both the drive and stride leg between the stride length conditions. During the acceleration phase, the drive knee moments between the stride length conditions demonstrated differences in power generation and absorption. Longer strides allowed for greater knee propulsion dynamics, exemplified by eccentric drive knee extensor moments with a concomitant power absorption that slowed the rate of drive knee flexion (p ≤ 0.001). Conversely, shorter strides generated power through concentric knee flexor moments that increased the rate of drive knee flexion (p ≤ 0.001). Stride knee extensor moments and power generation during the acceleration phase were also significantly higher with shorter strides (p ≤ 0.05). Adapted knee joint dynamics may offer insights into stride length optimization, training, and injury prevention strategies.

Training History-Dependent Functional Role of EMG Model-Predicted Antagonist Moments in Knee Extensor Moment Generation in Healthy Young Adults

Resistance training (RT) improves the skeletal muscle’s ability to generate maximal voluntary force and is accompanied by changes in the activation of the antagonist muscle which is not targeted primarily by RT. However, the nature and role of neural adaptation to RT in the antagonist muscle is paradoxical and not well understood. We compared moments, agonist muscle activation, antagonist activation, agonist-antagonist coactivation, and electromyographic (EMG) model-predicted moments generated by antagonist hamstring muscle coactivation during isokinetic knee extension in leg strength-trained (n = 10) and untrained (n = 11) healthy, younger adults. Trained vs. untrained adults were up to 58% stronger. During knee extension, hamstring activation was 1.6-fold greater in trained vs. untrained adults (p = 0.022). This hamstring activation produced 2.6-fold greater model-predicted antagonist moments during knee extension in the trained (42.7 ± 19.55 Nm) vs. untrained group (16.4 ± 12.18 Nm; p = 0.004), which counteracted (reduced) quadriceps knee extensor moments ~43 Nm (0.54 Nm·kg−1) and by ~16 Nm (0.25 Nm·kg−1) in trained vs. untrained. Antagonist hamstring coactivation correlated with decreases and increases, respectively, in quadriceps moments in trained and untrained. The EMG model-predicted antagonist moments revealed training history-dependent functional roles in knee extensor moment generation.

Relationship between vastus medialis Hoffmann reflex excitability and knee extension biomechanics during different tasks in women with patellofemoral pain

BackgroundImpaired knee extension biomechanics and spinal excitability have been reported in women with patellofemoral pain, but their relationship has not been explored. A significant relationship between them could indicate the need for investigating the potential benefits of disinhibitory interventions for women with patellofemoral pain. Thus, this study aimed to investigate the relationship between vastus medialis Hoffmann reflex and (1) maximal isometric, concentric and eccentric knee extensor strength and rate of torque development; (2) knee extensor torque steadiness; and (3) knee extensor moment during functional tasks; in women with patellofemoral pain. MethodsSpinal excitability of twenty-four participants was assessed by the amplitude of maximal vastus medialis Hoffmann reflex. Knee extensor strength, rate of torque development and torque steadiness were assessed using an isokinetic dynamometer. Knee extensor moment during step-down and stair descent tasks were obtained using a three-dimensional motion analysis system. FindingsA moderate negative relationship was found between vastus medialis Hoffmann reflex and knee extensor torque steadiness (r = −0.35; p = 0.05); whereas a moderate positive relationship was found with maximal isometric knee extensor strength (r = 0.37; p = 0.044). No significant relationships were found between vastus medialis Hoffmann reflex and the other variables. InterpretationOur findings provide insight on the relationship between spinal excitability and neuromuscular control of maximal and submaximal isometric torque production in women with patellofemoral pain. Conversely, spinal excitability does not seem to be related with dynamic torques and moments of the knee extensors in women with patellofemoral pain.

Regulation of Forward Angular Impulse in Tasks With Backward Translation.

Studying how elite athletes satisfy multiple mechanical objectives when initiating well-practiced, goal-directed tasks provides insights into the control and dynamics of whole-body movements. This study investigated the coordination of multiple body segments and the reaction force (RF) generated during foot contact when regulating forward angular impulse in backward translating tasks. Six highly skilled divers performed inward somersaults (upward and backward jump with forward rotation) and inward timers (upward and backward jump without rotation) from a stationary platform. Sagittal plane kinematics and RFs were recorded simultaneously during the takeoff phase. Regulation of the forward angular impulse was achieved by redirecting the RF about the total body center of mass. Significantly more backward-directed RF was observed during the first and second peak horizontal RF of the inward somersaults than the inward timers. Modulation of the horizontal RF altered the RF direction about the center of mass and the lower-extremity segments. Backward leg and forward trunk orientation and a set of relatively large knee extensor and small hip flexor net joint moments were required for forward angular impulse generation. Understanding how the forward angular impulse is regulated in trained individuals provides insights for clinicians to consider when exploring interventions related to fall prevention.

Altered lower extremity biomechanics following anterior cruciate ligament reconstruction during single-leg and double-leg stop-jump tasks: A bilateral total support moment analysis

BackgroundInjury to the anterior cruciate ligament (ACL) can lead to long-lasting biomechanical alterations that put individuals at risk of a second ACL injury. Examining the total support moment may reveal between- and within-limb compensatory strategies. MethodsTwenty-six participants who were cleared to return to sport following ACL reconstruction were recruited. Each participant completed the single-leg and double-leg stop jump tasks. These tasks were analyzed using force plates and a 3D motion analysis system. The total support moment was calculated by summing the internal moments of the hip, knee and ankle at peak vertical ground reaction force. FindingsInternal knee extensor moment was lower in the involved limb compared to the uninvolved for both tasks (17.6%, P = 0.022; 18.4%, P = 0.008). No significant between-limb differences were found for the total support moment. The involved limb exhibited an 18.2% decrease in knee joint contribution (P = 0.01) and a 21.6% increase in ankle joint contribution (P = 0.016) to the total support moment compared to the uninvolved limb in the single-leg stop jump task. InterpretationCompensation for the involved knee is likely due to altered biomechanics that redistributes load to the uninvolved knee or to adjacent joints of the same limb. A partial shift in joint contribution from the knee to the ankle during the single-leg stop jump task demonstrates a tendency to decrease load to the knee. Further studies are needed to investigate how these adaptations impact the prevalence of subsequent injury and poor joint health.

Effect of Assistance Timing in Knee Extensor Muscle Activation During Sit-to-Stand Using a Bilateral Robotic Knee Exoskeleton.

The population of older adults experiences a significant degradation in musculoskeletal structure, which hinders daily physical activities. Standing up from a seated position is difficult for mobility-challenged individuals since a significant amount of knee extensor moment is required to lift the body's center of mass. One solution to reduce the required muscle work during sit-to-stand is to utilize a powered exoskeleton system that can provide relevant knee extension assistance. However, the optimal exoskeleton assistance strategy for maximal biomechanical benefit is unknown for sit-to-stand tasks. To answer this, we explored the effect of assistance timing using a bilateral robotic exoskeleton on the user's knee extensor muscle activation. Assistance was provided at both knee joints from 0% to 65% of the sit-to-stand movement, with a maximum torque occurring at four different timings (10%, 25%, 40%, and 55%). Our experiment with five able-bodied subjects showed that the maximal benefit in knee extensor activation, 19.3% reduction, occurred when the assistance timing was delayed relative to the user's biological joint moment. Among four assistance conditions, two conditions with each peak occurring at 25% and 40% significantly reduced the muscle activation relative to the no assistance condition (p < 0.05). Additionally, our study results showed a U-shaped trend (R2= 0.93) in the user's muscle activation where the global optimum occurred between 25% and 40% peak timing conditions, indicating that there is an optimal level of assistance timing in maximizing the exoskeleton benefit.

Knee Extensor Morphology and Sprint Performance in Preadolescent Sprinters

ABSTRACT Purpose: We previously reported that the cross-sectional area of the quadriceps femoris is correlated with the sprint performance of preadolescent sprinters. This finding suggests a close relationship between knee extensor torque-enhancing morphology and sprint performance in this young population. To further clarify this issue, in this study, we examined the relationships of the quadriceps femoris muscle volume (MV) and knee extensor moment arm (MA) with sprint performance in preadolescent sprinters. Methods: The quadriceps femoris MV and knee extensor MA in 15 sprint-trained preadolescent boys were measured using magnetic resonance imaging. Sprint performance was evaluated using a personal best 100-m sprint time and the higher 50-m sprint velocity of two 50-m sprint tests. Results: The quadriceps femoris MV and knee extensor MA were significantly correlated with personal best 100-m sprint time (r = −0.810 and −0.752, P ≤ 0.001 for both) and 50-m sprint velocity (r = 0.814 and 0.702, P < .01 for both). Furthermore, the relative quadriceps femoris MV normalized to body mass was significantly correlated with both the personal best 100-m sprint time (r = −0.620, P = .014) and 50-m sprint velocity (r = 0.686, P = .005). In contrast, no significant correlations were observed between the relative knee extensor MA normalized to body height and both sprint performance parameters. Conclusions: These findings suggest that the quadriceps femoris size, rather than the knee extensor MA dimension, is a more important morphological factor for achieving superior sprint performance in preadolescent sprinters.

Isometric, Eccentric, and Concentric Strength in Trained and Untrained Older Adults: A Pilot Study

Background: Despite an overall decrease in muscular strength, older adults maintain eccentric (ECC) strength in greater proportions compared to isometric (ISO) and concentric (CON) strength. While resistance training is promoted for older adults, the impact of resistance training on ISO, ECC, and CON strength is relatively unknown. Objective: The purpose of this study was to compare peak ISO, ECC and CON knee extensor moments between trained and untrained older individuals. Methods: A quasi-experimental design with a two-group comparison, ex post facto, was conducted. Twenty older adults (8 females, 69.6 ± 6.1 years, 80.5 ± 16.4 kg, 1.7 ± 0.1 m) were allocated to two groups, one undergoing resistance training (n =10) and one not (n = 10). An isokinetic dynamometer measured ISO, ECC, and CON knee extensor moments. Peak knee extensor moments (Nm) and ECC: ISO ratio were analyzed using a Kruskal-Wallis test (α = 0.05). Spearman Rank-Order Correlations were run on paired combinations of peak ISO, ECC, and CON moments for both groups. Results: The trained group had significantly greater peak ISO moment (183.8 vs 137.1 Nm, p = 0.013, d = 1.3) but significantly lower ECC: ISO ratio (p = 0.028, d = 1.1). The trained group exhibited stronger correlations for ECC-ISO (rs = 0.79 vs. 0.65), ECC-CON (rs = 0.93 vs. 0.59), and CON-ISO (rs = 0.93 vs. 0.78) compared to the untrained group. Conclusions: The findings demonstrate older adults maintain eccentric and concentric strength, regardless of training status. However, trained participants had a more balanced ECC: ISO ratio, due to their increased peak ISO strength possibly due to their resistance training.

Immediate Effect of Anterior Cruciate Ligament Protective Knee Taping on Knee Landing Mechanics and Muscle Activations during Side Hops.

Athletic taping is widely used in sports to prevent injury. However, the effect of anterior cruciate ligament (ACL) protective taping on neuromuscular control during dynamic tasks remains unclear. Therefore, this study aimed to investigate the immediate effect of ACL protective taping on landing mechanics and muscle activations during side hops in healthy individuals. Fifteen healthy individuals (11 males and 4 females; age, 23.1 ± 1.4 years; height, 175.1 ± 10.4 cm; weight, 66.3 ± 11.2 kg) volunteered to participate in this study. Landing mechanics and muscle activations were measured while each participant performed single-leg hops side-to-side for ten repetitions with and without taping. An optical motion capture system and two force plates were used to collect the kinematic and kinetic data during the side hops. Surface electromyogram recordings were performed using a wireless electromyography system. Paired t-tests were performed to determine the differences in landing mechanics and muscle activations between the two conditions (taping and non-taping). The level of significance was set at p < 0.05. Compared with the non-taping condition, participants landed with a smaller knee abduction angle, greater knee external rotation angle, and smaller knee extensor moment in the taping condition. Given that greater knee abduction, internal rotation, and knee extension moment are associated with a greater risk of ACL injury, our findings suggest that ACL protective taping can have an immediate effect on dynamic knee stability. Clinicians should consider using ACL protective taping to facilitate the use of favorable landing mechanics for ACL injuries.

Biomechanical Mechanisms of Improved Balance Recovery to Repeated Backward Slips Simulated by Treadmill Belt Accelerations in Young and Older Adults.

Aim: Exposure to repeated gait perturbations improves the balance of older adults (OAs) and decreases their risks of falling, but little is known about the underpinning mechanical adjustments. We aimed to quantify the changing temporo-spatial and kinetic characteristics of balance recovery following repeated backward slips to better understand the mechanical adjustments responsible for improved balance.Methods: We exposed 17 young adults (YAs) (25.2 ± 3.7 years) and 17 OAs (62.4 ± 6.6 years) to 10 backward slips simulated on an instrumented treadmill by unilateral backward belt accelerations. We measured the balance of the participants (margin of stability: MoS), balance recovery (nsteps: number of steps necessary to return to a steady gait for at least three consecutive steps), temporo-spatial (step length), and kinetics [ground reaction force (GRF) angle, lower limb joint moments] for 15 steps following each slip. The results were compared with baseline.Results: Participants in both groups improved their MoS and nsteps with repeated exposure to the slips, but no significant effect of age was detected. During the perturbed step, the GRF vector was directed more posteriorly during mid-stance and more anteriorly during push-off than baseline, which resulted in a longer step. These adjustments were maintained from the first (Slip01) to the last (Slip10) slip, and by Slip10 were correlated with better balance (MoS) on the second recovery step. During the first recovery step following Slip01, participants developed lower plantarflexor and larger knee extensor moments whilst taking a shorter step, these adjustments were correlated with poorer balance and were not maintained with repeated slips. Joint moments and step length of the first recovery step returned to normal levels by Slip10.Conclusion: Young adults and OAs improved their balance with repeated slips. The adjustments that were positively correlated with balance (changes in step length, GRF angle) were maintained whilst those that were not (changes in joint moments) were discarded. All the responses observed in Slip10 were observed in Slip01. The observed balance improvements were achieved by refining the initial strategy rather than by developing a new one. The underlying mechanics were correlated with step length of the first recovery steps, which was associated with balance and should be monitored in fall prevention interventions.

The Impact of Patellar Tendon Advancement on Knee Joint Moment and Muscle Forces in Patients with Cerebral Palsy.

Background: Patellar tendon advancement (PTA) is performed for the treatment of crouch gait in patients with cerebral palsy (CP). In this study, we aimed to determine the influence of PTA in the context of single-event multilevel surgery (SEMLS) on knee joint moment and muscle forces through musculoskeletal modeling; Methods: Gait data of children with CP and crouch gait were retrospectively analyzed. Patients were included if they had a SEMLS with a PTA (PTA group, n = 18) and a SEMLS without a PTA (NoPTA group, n = 18). A musculoskeletal model was used to calculate the pre- and postoperative knee joint moments and muscle forces; Results: Knee extensor moment increased in the PTA group postoperatively (p = 0.016), but there was no statistically significant change in the NoPTA group (p > 0.05). The quadriceps muscle forces increased for the PTA group (p = 0.034), while there was no difference in the NoPTA group (p > 0.05). The hamstring muscle forces increased in the PTA group (p = 0.039), while there was no difference in the NoPTA group (p > 0.05); Conclusions: PTA was found to be an effective surgery for the treatment of crouch gait. It contributes to improving knee extensor moment, decreasing knee flexor moment, and enhancing the quadriceps and hamstring muscle forces postoperatively.

Trunk Inclination During Squatting is a Better Predictor of the Knee-Extensor Moment Than Shank Inclination.

A limitation of previous studies on squatting mechanics is that the influence of trunk and shank inclination on the knee-extensor moment (KEM) has been studied in isolation. The purpose of the current study was to determine the influence of segment orientation on the KEM during freestanding barbell squatting. Repeated-measures cross sectional. University research laboratory. Sixteen healthy individuals (8 males and 8 females). Each participant performed 8 squat conditions in which shank and trunk inclinations were manipulated. 3D kinematic and kinetic data were collected at 250 and 1500Hz, respectively. Regression analysis was conducted to identify the individual relationships between the KEM and the trunk and shank inclination at 60° and 90° of knee flexion. To identify the best predictor(s) of the KEM, stepwise regression was implemented. Increased shank inclination increased the KEM (P < .001, R2 = .21-.25). Conversely, increased trunk inclination decreased the KEM (P < .001, R2 = .49-.50). For the stepwise regression, trunk inclination entered first and explained the greatest variance in the KEM (all P < .001, R2 = .49-.50). Shank inclination entered second (all P < .010, R2 = .53-.54) and explained an additional 3% to 5% of the variance. Our results confirm that inclination of the trunk and shank have an opposing relationship with the KEM. Increased forward shank posture increases the KEM, while increased forward trunk posture decreases the KEM. However, when viewed in combination, the trunk was the superior predictor of the KEM, highlighting the fact that increased quadriceps demand created by a forward shank can be offset by trunk inclination.

Instructed Squat Improves Limb But Not Knee Extensor Moment Symmetry In Individuals Following ACLr.

Recent work found that individuals in early recovery post-ACL reconstruction (ACLr) spontaneously underload the surgical (Sx) limb and knee extensors in double limb tasks. With instructions to focus on equalizing weight under the feet, they are able to improve limb loading symmetry during a squat exercise. However, it is not known if these instructions can also improve knee extensor moment (kEXTmmt) symmetry. PURPOSE: To determine if instructions to equalize between limb loading improve kEXTmmt. METHODS: 14 subjects (6 male; 27 (11) yrs; 116.4 (16.6) days post-ACLr) performed bilateral squats to self-selected depths under natural (N) and instructed (I) conditions. In I condition, subjects were asked to concentrate on equalizing weight under both feet; no instructions were given in N condition. 3-D kinematics (250 Hz), ground reaction forces (1500 Hz), anthropometrics were used to calculate kEXTmmt (inverse dynamics). Vertical ground reaction force (vGRF) and kEXTmmt were averaged across the squat cycle for surgical (Sx) and non-surgical (NSx) limbs; 3 trials. The effect of instruction on vGRF and kEXTmmt was assessed using a (condition x limb) repeated measures ANOVA; post hoc paired t-test (p < 0.05). RESULTS: Condition x limb interaction was found (vGRF p = 0.007, kEXTmmt p = 0.002). Sx limb vGRF (Sx 335.29 (52.78) vs NSx 376.95 (67.75) N; p = 0.015) and kEXTmmt (Sx -0.33 (0.15) vs NSx -0.63 (0.17)Nm/kg; p < 0.001) were smaller in N condition. Sx limb kEXTmmt (Sx -0.35 (0.16) vs NSx -0.53 (0.15) Nm/kg; p = 0.002) was smaller in I condition; no difference was observed between limbs in vGRF. CONCLUSIONS: Individuals following ACLr adopt strategies that shift mechanical demands away from the knee of the surgical limb in early recovery. These strategies persist long term. Instruction to distribute weight symmetrically during squatting restored limb loading but did not restore kEXTmmt symmetry. These data suggest that these commonly employed corrective instructions are not adequate to retrain sagittal plane knee loading in early recovery post-ACLr.

Injury risk-factor differences between two golf swing styles: a biomechanical analysis of the lumbar spine, hip and knee

ABSTRACT The golf swing has been associated with mechanical injury risk factors at many joints. One swing, the Minimalist Golf Swing, was hypothesised to reduce lumbar spine, lead hip, and lead knee ranges of motion and peak net joint moments, while affecting swing performance, compared to golfers’ existing swings. Existing and MGS swings of 15 golfers with handicaps ranging from +2 to −20 were compared. During MGS downswing, golfers had 18.3% less lumbar spine transverse plane ROM, 40.7 and 41.8% less lead hip sagittal and frontal plane ROM, and 39.2% less lead knee sagittal plane ROM. MGS reduced lead hip extensor, abductor, and internal rotator moments by 17.8, 19.7 and 43%, while lead knee extensor, abductor, adductor and external rotator moments were reduced by 24.1, 26.6, 37 and 68.8% respectively. With MGS, club approach was 2° shallower, path 4° more in-to-out and speed 2 m/s slower. MGS reduced certain joint ROM and moments that are linked to injury risk factors, while influencing club impact factors with varying effect. Most golf injuries are from overuse, so reduced loads per cycle with MGS may extend the healthy life of joints, and permit golfers to play injury-free for more years.

Iliotibial Band Autograft Provides the Fastest Recovery of Knee Extensor Mechanism Function in Pediatric Anterior Cruciate Ligament Reconstruction.

Iliotibial band autograft is an increasingly popular option for pediatric anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare recovery of knee extensor mechanism function among pediatric patients who underwent ACLR using iliotibial band (IT), hamstring tendon (HT), quadriceps tendon (QT), and patellar tendon (PT) autografts. One hundred forty-five pediatric athletes (76 female; age 15.0, range 7–21 years) with recent (3–18 months) unilateral ACLR performed drop-jump landing and 45° cutting with 3D motion capture. Knee extensor mechanism function (maximum knee flexion angle, maximum internal knee extensor moment, energy absorption at knee) during the loading phase (foot contact to peak knee flexion) was compared among graft types (20 IT, 29 HT, 39 QT, 57 PT) and sides (ACLR or contralateral) using linear mixed models with sex, age, and time since surgery as covariates. Overall, knee flexion was significantly lower on the operated vs. contralateral side for HT, QT, and PT during both tasks (p < 0.03). All graft types exhibited lower knee extensor moments and energy absorption on the operated side during both movements (p ≤ 0.001). Kinetic asymmetry was significantly lower for IT compared with QT and PT during both movements (p ≤ 0.005), and similar patterns were observed for HT vs. QT and PT (p ≤ 0.07). Asymmetry was similar between IT and HT and between QT and PT. This study found that knee extensor mechanism function recovers fastest in pediatric ACLR patients with IT autografts, followed by HT, in comparison to QT and PT, suggesting that IT is a viable option for returning young athletes to play after ACLR.

EFFECT OF AUTOGRAFT TYPE ON RECOVERY OF KNEE EXTENSOR MECHANISM FUNCTION FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Background:While multiple studies have shown clear benefits of autograft over allograft for anterior cruciate ligament reconstruction (ACLR) in young athletes, disagreement remains regarding the optimal autograft choice. Recovery from ACLR may be influenced by autograft type, which can include iliotibial band (IT), hamstring tendon (HT), quadriceps tendon (QT), or patellar tendon (PT) depending on skeletal maturity and surgeon preference.Hypothesis/Purpose:This study compared knee joint function among pediatric athletes with different types of ACLR autografts. We hypothesized that knee extensor function would recover faster for graft types that did not disrupt the knee extensor mechanism (i.e., IT and HT vs. PT and QT).Methods:This retrospective study examined 138 pediatric athletes (73 female; mean age 15.5, SD 2.2, range 8-21 years) who had undergone sports biomechanical testing in our motion analysis laboratory following recent unilateral ACLR (mean 7.7, range 3-18 months post-surgery). All reconstructions used autografts including 20 IT, 26 HT, 37 QT, and 55 PT. Lower extremity sagittal plane kinematics and kinetics were measured during vertical drop jump landing (41 cm height) and 45° cutting. Maximum knee flexion angles, internal knee extensor moments, and energy absorption during the landing phase (initial contact to peak knee flexion) of each movement were compared among graft types and sides (ACLR vs. contralateral) using linear mixed models with sex, age, and time since surgery as covariates.Results:Knee flexion was significantly lower on the operated vs. contralateral side for HT, QT, and PT during drop jump and for QT and PT during cutting (p<0.001). All graft types exhibited lower knee extensor moments and energy absorption on the operated side (p<0.05). This asymmetry was most pronounced for QT and PT and least pronounced for IT (Figure 1.1). Loading on the operated limb decreased from IT to HT to QT and PT, while loading on the contralateral limb increased similarly. Asymmetry of kinetics was significantly lower for IT compared with both QT and PT during both movements (p<0.01). Similar patterns were observed for HT but were not always statistically significant. No differences in asymmetry were observed between IT and HT or between QT and PT.Conclusion:Young athletes with IT and HT autografts exhibit greater engagement of the knee extensors during dynamic loading than peers with PT or QT autografts in the 18 months following ACLR. This may be due to extensor mechanism donor site morbidity associated with PT and QT grafts.Tables/Figures:Figure 1.1:.Comparison of operated (red) and contralateral (blue) limbs by graft type (model predicted average and 95% confidence interval)

Gait outcomes following proximal tibial tumor resection and endoprosthetic reconstruction.

Despite the proximal tibia being a common site of primary malignant bone tumors, there is limited information about gait function following proximal tibial tumor resection and endoprosthetic reconstruction (PTR). What is the impact of PTR on gait and quality of life? This was a cross-sectional study of patients ≥18 years old who were ≥2 years post-PTR compared to a control group of similar age and sex distribution. Eighteen participants (9 PTR, 9 Control) were recruited. Gait spatial-temporal data, joint kinematics and kinetics were collected at preferred and fast walking speeds. Community walking cadence, health-related quality of life (SF-36) and knee joint torque were assessed. Comparisons were performed using one-way ANOVAs with Bonferroni corrections for multiple comparisons. Nonparametric tests were used for data not normally distributed. Mean age was 31 years for each group (PTR range = 18-42 yrs, Control range = 18-44 yrs). Compared to both control and nonsurgical limbs, the surgical limb exhibited significantly decreased % single limb support time, reduced heel rise during terminal stance and an absence of normally occurring knee flexion angles, extensor moments and power generation during initial double limb support. Additionally, a reduced peak plantar flexor moment was found for the surgical as compared to the control limb. The number of gait abnormalities increased during fast walking. Significantly reduced surgical knee extensor torque on isokinetic testing and weakness of the knee and ankle on clinical examination support gait findings. During community walking, the number of low frequency strides was an average of 5.3 % greater for the PTR group (p < 0.05). Norm-based PTR group SF-36 component scores were within normal values (53.4 physical, 56.5 mental). Gait abnormalities were consistent with ankle muscle resection and transposition and knee extensor mechanism disruption. Despite these deficits, walking speed and quality of life were relatively normal.