Intra-articular (IA) corticosteroid injections are commonly used for pain relief and improved function in patients with knee osteoarthritis (OA). However, the optimal corticosteroid preparation remains controversial. The aim of this study was to compare the efficacy of single-shot long-acting corticosteroid (betamethasone) and intermediate-acting corticosteroid (triamcinolone acetonide) injections in knee OA. This single-center, double-blinded, randomized controlled trial included 120 patients with symptomatic knee OA who were randomized to receive either a betamethasone (7-mg) or triamcinolone acetonide (40-mg) IA injection and were followed for 6 months. The primary outcomes were the visual analog scale (VAS) pain scores (0 to 100) at rest and during movement at 6 months. The secondary outcomes were the VAS pain during movement, knee flexion angle, modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, University of California Los Angeles (UCLA) activity score, Timed Up-and-Go test (TUG), 2-minute walk test (2MWT), and side effects. The analysis focused on between-group comparisons using multilevel regression models. The study population consisted of 120 Thai individuals. Both the betamethasone and triamcinolone groups demonstrated significant reductions in VAS pain at rest starting from day 1 and lasting for up to 6 months. At 6 months, the between-group mean difference in VAS pain at rest was -1 (95% confidence interval [CI], -11 to 8; p = 0.77), indicating no significant difference. Similarly, at 6 months, no significant between-group differences were observed in VAS pain during movement (-3 [95% CI, -13 to 7]; p = 0.51), flexion angle (6 [95% CI, 1 to 10]; p = 0.20), WOMAC score (-4 [95% CI, -11 to 4]; p = 0.91), UCLA activity score (0 [95% CI, -0.5 to 0.6]; p = 0.46), TUG (-1 second [95% CI, -3 to 1]; p = 0.88), or 2MWT (9 meters [95% CI, -1 to 19]; p = 0.47). Acetaminophen and tramadol use were numerically, but not significantly, lower in the betamethasone group (p > 0.05). No serious adverse events occurred. No significant differences were observed between IA betamethasone and triamcinolone acetonide with respect to VAS pain, functional scores, or performance-based outcomes at 6 months. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

ABSTRACT In soccer, anterior cruciate ligament (ACL) injuries frequently occur during sidestep cutting (SSC) in pressing situations. This study examined the effects of soccer-specific pressing tasks on SSC kinematics and kinetics. Twenty male recreational soccer players performed a 90° SSC followed by three task conditions: the Normal condition, in which participants simply continued running; the Pressing 70% condition, in which they reached for a ball placed at 70% of maximal straddle width; and the Pressing 100% condition, in which they reached for a ball at 100%. Maximal straddle width was defined as the distance between the toes during maximally hip-abducted. Both pressing conditions simulated defensive pressing. Three-dimensional peak knee and trunk angles, ground reaction forces, and knee moments of the supporting leg during the first 50 ms of the stance phase were compared. Results showed that peak knee valgus and trunk lateral inclination angles, as well as peak knee flexion, valgus, and internal rotation moments, were greater in both pressing conditions. These findings indicate that simulating pressing tasks altered SSC kinematic and kinetic characteristics. Notably, variables associated with ACL injury risk increased under pressing tasks, suggesting that pressing situations themselves may represent a biomechanical ACL injury risk.

ABSTRACTBACKGROUND:Anterior cruciate ligament (ACL) tears are common knee injuries with a known but vague association with secondary joint injuries. The extent to which these injuries are preventable remains unclear. OBJECTIVE:This study aimed to assess the functional differences in knee and ankle dorsiflexion biomechanics with full loading on one leg and to understand whether it could be a key point as a progressive method in ACL reconstruction, considering both legs and three different groups.DESIGN AND SETTING:A quasi-experimental study of Medical Centers in an outpatient clinic in PortugalMETHODS:The Y balance test (YBT) was used to evaluate and analyze the association between ankle dorsiflexion range of motion (DF-ROM) and knee flexion. DF-ROM and knee flexion were used to compare the deficits between the operated and uninvolved limbs in all three groups (ACL-I, ACL-II, and ACL-III).RESULTS:Ankle DF-ROM and knee flexion assessed during the YBT were associated with higher knee flexion ROM, identifying individuals who were better prepared for the next phase of the guideline. The study results provide preliminary data for future studies that use prospective longitudinal research and involve large patient populations to establish prognostic biomechanical markers for determining long-term dynamic stability after ACL reconstruction.CONCLUSIONS:In the three groups with a history of ACL injury, compensations and kinematic asymmetries in dorsal flexion and knee flexion were observed in the operated and control legs both at 6 and 8 weeks of treatment.

The contribution of lower limbs to Pelvic Tilt: A baseline and postoperative full-body analysis.

Anterior cruciate ligament reconstruction (ACLR) is a common surgical procedure after injury. However, ACLR contributes to aberrant biomechanical movement patterns that influence secondary injury or joint degeneration. Higher body size may influence gait and landing biomechanics differently between males and females. The purpose of this study was to investigate the influence of sex on the association between body mass index (BMI) and knee biomechanics long-term after ACLR recovery. Sixteen female (BMI: 27.7 [5.4]) and 14 male (BMI: 24.2 [5.5]) participants who had a history of ACLR performed walking and drop vertical jump tasks. The knee-flexion angle (KFA), external knee flexion moment, knee abduction moment (landing), and knee adduction moment (gait) were measured using 3D motion capture. Body fat percentage was assessed using a BOD POD. Moderated regression evaluated the influence of sex on the association between BMI and biomechanical outcomes after adjusting for body fat percentage. There was a significant interaction between sex and BMI on the KFA at heel contact (P = .01), peak KFA (P = .04), and peak external knee flexion moment (P = .05) during gait and on the KFA at ground contact during landing (P = .04). Higher BMI was associated with smaller KFAs at heel contact (P = .03), smaller peak KFAs during gait (P = .02), and smaller external knee flexion moments (P = .01) but only in females. Similarly, a higher BMI was associated with a smaller KFA at ground contact during landing (P = .03) but only in females. There was no sex by BMI interaction on the knee adduction moment during gait (P = .657) or on the knee abduction moment during landing (P = .643). Moreover, sex and BMI were not independent predictors of the knee adduction moment during gait or the knee abduction moment during landing (all P > .05). The association between sex and BMI may have implications for posttraumatic knee osteoarthritis and ACL reinjury, and female sex and high BMI should be considered when designing individualized rehabilitation programs. These findings suggest that females with high BMI may benefit from interventions to improve knee flexion during landing and gait.

Impact of hybrid closed-wedge high tibial osteotomy on mechanical loading during gait in patients with medial knee osteoarthritis.

The landing error scoring system (LESS) was developed to screen healthy individuals for anterior cruciate ligament (ACL) injury risk factors using a jump landing task. The purpose of this study was to evaluate unique landing error components of a modified LESS scoring criteria to determine its clinical utility in patients following ACL reconstruction (ACLR). An observational cross-sectional study design was implemented to determine if each individual error component of the modified LESS provided unique information in an ACLR patient population. Post-ACLR patients (N = 194 [47.9% female]) completed the LESS 7.91 (1.80)months after surgery. To complete the LESS, patients stood on a 30-cm plyometric box and jumped down to a ground target, at 50% of their height in front of the box, then completed a maximal vertical jump. The LESS was repeated 3 times. Two video cameras positioned 3m from the landing area at a height of 1m above the floor (frontal and sagittal) recorded all trials. Video analysis of landing kinematics was performed to determine scores for each error item using the modified LESS. Itemized error scores for each patient were evaluated using an exploratory factor analysis, and factors were retained if eigenvalues were greater than 1. Our exploratory factor analysis yielded 2 factor groupings. The first factor (λ = 1.61) was comprised of 4 biplanar error items (ie,errors that occur in both the frontal and sagittal plane) that evaluated body segment positioning (eg,hip and knee flexion during landing). The second factor (λ = 1.02) was comprised of 2 errors occurring in the frontal plane that evaluated knee valgus and the overall impression of their landing strategy. Reducing the modified LESS errors to 6-items could improve the efficiency and clinical utilization of the LESS in ACLR patients. An abbreviated version of the modified LESS may guide clinicians' decision making in gauging patients' readiness to return to play after ACLR.

Time to normalization of gait following ACL reconstruction compared with healthy controls: A systematic review and meta-analysis.

The passive stretching response of the human biceps femoris long head muscle varies regionally.

Correlation of sit-to-walk and sit-to-stand performance with gait kinematic outcomes and self-reported pain and function in end-stage knee osteoarthritis.

Biomechanical and neuromuscular differences between the snatch and clean in elite weightlifters.

Patient outcomes following bone-patellar tendon-bone ACL reconstruction: Influence of graft size relative to tendon width.

To evaluate the safety and efficacy of a novel three-dimensional triangular external fixator (3D-TEF) in combination with proximal femoral derotational osteotomy (PFDO) for the treatment of symptomatic excessive femoral anteversion (EFA). A retrospective analysis was conducted on data from 12 patients (23 limbs) who underwent PFDO with 3D-TEF from July 2018 to 2024. The preoperative and postoperative femoral neck anteversion angle (FNA) was measured using computed tomography scans, quality of life was assessed using the Pediatric Outcomes Data Collection Instrument (PODCI), and complications and bone healing time were recorded. Twelve patients underwent surgery on a total of 23 limbs, with a mean age of 10.4 years (7.00-17.00). The mean follow-up duration was 23.25 months (5.00-44.00). The preoperative FNA was 42.58 ± 7.57°, which significantly decreased to 17.99 ± 2.14° postoperatively ( t = 15.34, P < 0.001). The mean femoral neck-shaft angle measured 136 .25° ± 4. 26° preoperatively and 136.80° ± 4.24° postoperatively (t = -0.77, P > 0.05), indicating no statistically significant change. Postoperative PODCI scores approached normative levels. All patients showed improvement in symptoms of tripping and falling, as well as in the degree of FNA. Two complications were observed: one superficial pin tract infection and one knee flexion contracture, neither of which impacted final outcomes. All osteotomies achieved union without evidence of nonunion, malunion, delayed union, hardware loosening, or avascular necrosis. PFDO stabilized with the 3D-TEF yielded satisfactory outcomes in correcting EFA. The 3D-TEF may present itself as a viable alternative for treating EFA, offering positive clinical outcomes.

Knee joint biomechanics under external focus instructions promoting a quiet, safe and soft landing.

Occupational activities that require high knee flexion, such as kneeling and squatting, are associated with a higher prevalence of knee osteoarthritis (OA). It is generally accepted that excessive contact pressures in the joint may cause degeneration of healthy knee joints. Ailments in the patellofemoral (PF) joint were a common cause for knee pain in clinical observations. Knee savers have been used in sports and occupational activities to protect the knee joints during tasks involving high knee flexion. The biomechanics of the effects of knee savers on musculoskeletal loading have not been investigated. The purpose of the current study was two-fold: first was to develop a biomechanical model that accounts for the effects of the interface contact forces between thigh and shank, or between thigh-shank and knee savers; and second was to evaluate, using the biomechanical modeling, the effects of knee savers on musculoskeletal loading in the knee joint in high knee-flexion tasks. Five healthy male subjects (age years, body mass kg, height m) participated in the study. The subjects started from a standing posture, squatted down to a working posture, and returned to the standing posture, while subjects' heels remained on the ground during the tasks. The tasks were repeated without and with knee savers. The musculoskeletal loadings in the knees were calculated using inverse dynamic modeling. Our results indicated that the wearing of knee savers in the high knee-flexion tasks helped to reduce the contact forces in the PF joint by about 20%. Our findings suggest that wearing knee savers may help reduce the risks of the knee OA for workers who are frequently required to perform high knee-flexion tasks for extended time.

Bio-inspired auto-adaptive framework for optimized movement of passive knee prosthesis.

Gait assessment of osteosarcoma patients undergoing total knee arthroplasty: Influence of abduction-adduction angles in knee prostheses.

To assess the effect of the knee flexion on the tibial tuberosity-trochlear groove (TT-TG) distance measurement by comparing conventional and whole-leg rotational magnetic resonance imaging (MRI). This retrospective cohort study included 45 patients with patellar dislocations who had undergone both conventional knee MRI with the knee in slight knee flexion (20°-30°) and full-length rotational MRI in extension (0°-5°). TT-TG distances were determined by two independent observers using standardised landmarks. Measurement reproducibility was evaluated using intraclass correlation coefficients (ICCs) for both intra and interrater reliability (3-month interval). TT-TG distance values derived from conventional MRI were significantly smaller (13.4 ± 4.0 mm, 95% confidence interval [CI]: 12.2-14.6) compared to those from whole-leg rotational MRI (18.3 ± 4.4 mm [95% CI: 16.9-19.6]), yielding a mean difference of 4.8 ± 3.0 mm (95% CI: 3.9-5.8; p < 0.001). Both interrater (conventional MRI: ICC = 0.946 [95% CI: 0.901 - 0.971]; rotational MRI: ICC = 0.949 [95% CI: 0.899-0.973]) and intrarater reliability (conventional MRI: ICC = 0.995 [95% CI: 0.992-0.997]; rotational MRI: ICC = 0.991 [95% CI: 0.983-0.995]) were excellent across modalities. Conventional knee MRIs, performed with knee in slight flexion, are consistently smaller compared to those acquired in full extension whole-leg rotational MRI. Knee flexion, therefore, leads to a systematic underestimation of the TT-TG distance. Standardising knee position during imaging is essential to ensure accurate and comparable TT-TG assessments. Level II, cohort study (diagnosis).

Knee flexion refers to the relative motion between the tibia and femur including rolling and sliding (rollback motion). Notwithstanding the individual variations in knee motion, conventional wearable knee-assistive devices use hinge joints—resulting in nonnegligible mismatched movements, particularly during deep flexion. Therefore, we proposed a biomimetic knee joint (BKJ) that adapts to individual knee motion. A polycentric BKJ, integrating two gears with different radii, was designed to match the trajectory of the rotational axes of the knee. In this study, we developed a semi-active polycentric BKJ (SA-BKJ) incorporating an adjustable reaction-force mechanism (ARFM). In the ARFM, the combined spring constant can be adjusted using a shape-memory alloy actuator owing to its compact size, lightweight nature, and low energy consumption. In addition, the geared joint of the SA-BKJ (which integrates two gears with different radii) was designed to match the average trajectory of the rotational axes of the knee (of 22 healthy men). Applying the genetic algorithm, the radius of the femur and tibia gears were determined to be 25.5 and 40.0 mm. Misalignments of the designed SA-BKJ were measured in three healthy male participants. The error measurements averaged 20 degrees in the control device and 10 degrees in the optimized device. These results indicated that the optimized gears of the SA-BKJ totally reduced the misalignment.

Soft exoskeletons (SE) show promise for restoring ambulation after stroke, but evidence remains limited. This study evaluated the efficacy of bilateral SE-assisted gait training in subacute stroke. In this single-blind randomized controlled trial, 60 participants with subacute stroke were randomly assigned to either the bilateral SE group or the conventional training (CT) group. Both groups received 30-min conventional physical therapy per day for 20 days. Additionally, the SE group performed 30-min bilateral SE-assisted treadmill walking training once daily, while the CT group underwent unassisted treadmill walking training with the same frequency and duration. The primary outcome was the Functional Ambulation Category (FAC). Secondary outcomes were Fugl-Meyer Assessment for Lower Extremity (FMA-LE), Berg Balance Scale (BBS), spatiotemporal parameters, gait symmetry, and lower-limb kinematics. Within-group improvements from baseline to post-intervention were assessed using paired t-tests or Wilcoxon signed-rank tests. Between-group comparisons were performed using analysis of covariance (ANCOVA), with post-intervention scores as the dependent variable and baseline values as the covariate. After 20-session interventions, both groups showed significant within-group improvements in clinical scores, gait speed, gait symmetry, and paretic lower-limb joint peak angles (p < 0.05). Between-group analysis showed that the SE group achieved significantly greater post-intervention scores in FAC (adjusted mean difference [AMD] = 0.37, p = 0.022, partial η²=0.089), FMA-LE (AMD = 2.21, p = 0.001, partial η² = 0.178), BBS (AMD = 1.84, p = 0.019, partial η² = 0.093 ), and faster gait speed (AMD = 0.07, p = 0.013 partial η² = 0.103) than the CT group. For Spatiotemporal analysis, the SE group demonstrated significantly longer paretic step length (AMD = 0.10, p = 0.001, partial η² = 0.145) and shorter paretic swing time (AMD = - 0.06, p = 0.014, partial η² = 0.102) than the CT group, whereas no significant between-group differences were observed for cadence and stance time (p > 0.05). In terms of gait symmetry, the SE group exhibited significantly lower temporal symmetry ratio (AMD = - 0.14, p < 0.001, partial η² = 0.215) and spatial symmetry ratio (AMD = - 0.30, p < 0.001, partial η² = 0.260) than the CT group, indicating improved symmetry. Kinematic analysis revealed that the SE group achieved greater peak angles in paretic knee flexion (AMD = 3.29°, p = 0.019, partial η² = 0.092), paretic ankle dorsiflexion (AMD = 2.10°, p = 0.001, partial η² = 0.166), less-affected ankle plantarflexion (AMD = 2.74°, p < 0.001, partial η² = 0.194) than the CT group. However, the SE group showed a smaller peak knee flexion in the less-affected (AMD= - 1.46, p = 0.037, partial η² = 0.074) than the CT group. No other joint angles showed significant between-group differences (p > 0.05), and no serious adverse events were reported throughout the study. Bilateral SE-assisted gait training is a safe and effective approach to improving motor function and gait performance in people with subacute stroke. Further studies with larger cohorts and longer follow-up are needed to investigate long-term benefits and neural mechanisms.