Knee Joint Motion Research Articles

Discrete Takagi-Sugeno Fuzzy Models Applied to Control the Knee Joint Movement of Paraplegic Patients

In this manuscript, a method for designing Takagi-Sugeno (T-S) fuzzy discrete-time regulators based on linear matrix inequalities (LMIs) is proposed to control the variation of the knee joint angle movement of paraplegic patients through electrical stimulation. A simple method for discretizing nonlinear systems described by T-S fuzzy models is used. The control strategy is applied for a paraplegic volunteer and a healthy one. The results and analysis show that the controlled system attended the design specifications for small values of the sample time considered for the discretization.

THE ROLE OF QUADRICEPSPLASTY IN TREATMENT OF POST-TRAUMATIC STIFF KNEE USING JUDET PROCEDURE

The lack of knee flexion is an increasingly recognized complication especially after trauma. This is a significant challenge for both surgeon and patients. In 1956, Judet proposed a quadricepsplasty technique that allow a graded release without the disruption of the vastus medialis, vastus lateralis, or rectus femoris. The aim of this study is to evaluate the beneficial outcome of the Judet quadricepsplasty in improving the range of movement of knee joint in those patients complaining from post-traumatic stiffness. This research was done for evaluating the clinical outcome of 15 patients who underwent a Judet's quadricepsplasty, they were 12 men and 3 women. The definitive flexion gain was classified according to Judet's criteria; excellent, if flexion was greater than 100°; good, from 80° to 99°, fair result are from 50° to 79°; and poor flexion degree is less than 50°. Patients were operated upon after an average of 19.40±17.63 months (range, 6-72 months) after first initial surgery. Average follow-up period was 6.5±3.6 months (range, 3-15 months). According to Judet criteria, 7 patients (47%) achieved excellent, 5 patients (33%) good, 2 patients (13%) fair, with zero poor results. Final average flexion arc improvement was 97.67±18.6 degrees with a range of 60-120 degrees. The noticed complications included; one case of extension lag excluded from the study and one case of small area of skin necrosis. In conclusion, even though it was proposed in 1956, the Judet procedure seems to give a reproducible amount of good results today and still holds its leading role in the treatment of extra-articular knee stiffness. Key words: Quadricepsplasty, Post-traumatic, Stiff joint, Knee joint, Judet procedure, Surgery

Clinical results of arthroscopic anterior cruciate ligament reconstruction with short femoral tunnel

To evaluate the clinical outcome of arthroscopic reconstruction of anterior cruciate ligament (ACL) with short femoral tunnel. From May 2013 to June 2017, 128 patients with anterior cruciate ligament reconstruction were performed with Transportal technique. Among them, 32 cases had short femoral tunnel were included, including 13 males and 19 females, aged 25.8 (17 to 43) years old, with a mean history of (4.5±1.1) months. The tibial tunnels were drilled in the middle of the footprint of the ACL, and femoral tunnels were drilled by transportal technique. Grafts were fixed with Endobutton at the femoral side and with interference screw at the tibial side. The changes of symptoms and signs were observed and the anterior tibial displacement was measured. The function of knee joint was evaluated by Lysholm score and Tegner score. All patients were followed up for over 2 years. At the latest follow-up, 30 patients were negative and 2 patients were positive in knee shift test; 28 patients were negative in Lachman sign, 4 patients were positive in degree I; 30 patients were negative in anterior drawer test, 1 patient was positive in degree I and 1 patient was positive in degree II. The anterior displacement of the tibia increased by (2.6±1.8) mm compared with the healthy side, which was significantly different from that before operation (t=19.77, P<0.05). Lysholm score of 82.2±6.1 was significantly higher than that before operation (t=17.33, P=0.001). According to Lysholm score evaluation, 15 cases got an excellent result, 10 were good, 7 were fair, and no bad results, with a significant difference compared with that before operation (z=-7.151, P<0.05). Tegner motor function score of (7.4±0.6) was significantly different from that before operation (t=9.11, P=0.000 5). After operation, the knee joint movement ability of the patients improved significantly. Twelve patients could participate in antagonistic sports and 15 patients could participate in non-antagonistic sports. Fifteen patients were very satisfied with the curative effect, 13 patients were satisfied with the curative effect. The incidence of short femoral tunnel in anterior cruciate ligament reconstruction with transportal technique is 25%. At present, the clinical effect of patients with short tunnel is acceptable. However, due to the lack of comparative study, the effect of short tunnel on the curative effect is still unclear.

Analysis of challenging reconstruction of soft tissue defects around the knee joint and evolving a treatment algorithm

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The soft tissue defects around knee joint give a challenging experience to reconstruct. There are various ways to reconstruct soft tissue defects around knee joint. In this study, a reconstructive algorithm is formed for soft tissue defect around knee joint using pedicled flaps.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Reconstructive procedures were done for 15 cases of soft tissue defects around knee joints following different etiologies during the tenure of January 2017 to December 2018 in the Department of Burns, Plastic and Reconstructive Surgery, Kilpauk Medical College, Chennai.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Soft tissue defects around knee joint need flap to have a durable cover, to protect the underlying structures – bones, vessels, tendon, and to enable ease of free movement of knee joint without producing contracture. There are various etiologies for soft tissue defects around knee joint-post traumatic injuries, post total knee replacement, post electric burn injuries, post burn scar contracture release of knee joint. 15 cases of soft tissue defects around knee joint were reconstructed using various pedicled flaps-medial thigh rotation flap, gastrocnemius muscle and myocutaneous flap, reverse anterolateral thigh flap, propeller flap. In this retrospective study, reconstructive algorithm for soft tissue defects around knee joint is provided.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The reconstruction of soft tissue defects around knee joint is difficult one. In this study, a simple reconstructive algorithm is provided based on the experience in Department of Burns, Plastic, and Reconstructive Surgery, Kilpauk Medical College, Chennai.&lt;/p&gt;

Comparison of the Post-Total Knee Arthroplasty Analgesic Effect of Intraoperative Periarticular Injection of Different Analgesics

To compare post-TKA (total knee arthroplasty) analgesic effect of periarticular injection of different analgesics during surgery. Experimental study. Tianjin People's Hospital, from December 2016 to July 2018. Patients undergoing unilateral TKA were randomly divided into Group A and Group B, with 67 patients in each group. In Group A, compound analgesics of ropivacaine, ketorolac, adrenaline, morphine and normal saline were injected periarticularly during surgery. While in Group B, compound analgesics of bupivacaine, methylprednisolone, adrenalin, morphine and normal saline were injected periarticularly during surgery. Visual analogue scale (VAS), range of motion (ROM) of knee joint, and rehabilitation of knee joint of both groups were compared. VAS scores of Group A at 6-hour, 24-hour, 48-hour and 72-hour after surgery was lower than those of Group B (p=0.046, p<0.001, p<0.001 and p<0.001, respectively). ROM of knee joint of Group A on the 3rd, 7th, 10th and 14th day after surgery was superior to that of Group B (all p<0.001). On the 14th day after surgery, excellent and good rate of rehabilitation of knee joint of Group A was higher than that of Group B (p=0.032). Compared with periarticular injection of compound analgesics of bupivacaine, methylprednisolone, adrenaline, morphine and normal saline during surgery, periarticular injection of compound analgesics of ropivacaine, ketorolac, adrenaline, morphine and normal saline during surgery can alleviate post-TKA pain more effectively, improve early ROM of joint knee after surgery, increase rehabilitation effect of knee joint.

Monofilament Cerclage Wiring Fixation with Locking Plates for Distal Femoral Fracture: Is it Appropriate?

Purpose:We aimed to determine the efficacy of cerclage wiring by comparing the clinical and radiological results between internal fixation with locking plates after distal femoral fracture reduction with or without cerclage wiring.Materials and Methods:One hundred and one patients who received open reduction internal fixation for distal femoral fractures of oblique, spiral, and spiral wedge type between 2007 and 2014 were reviewed retrospectively. Only locking plate fixation was performed in 46 patients, and locking plate fixation with additional cerclage wiring was performed in 55 patients (Group CW). Demographic, clinical, and radiologic factors were evaluated in both the groups. Age, gender, bone mineral density, bone graft, and the presence of concomitant fractures were measured as demographic factors. The range of motion of knee joint, Lysholm knee score, visual analog scale score, procedure time, and C-arm time were measured as clinical factors preoperatively and at the final followup. We also evaluated the duration of bone union and knee joint alignment radiologically.Results:There were no demographic differences between the two groups. Furthermore, there were no statistically significant differences between the two groups in terms of clinical and radiological parameters. However, the procedure time used was significantly longer in Group LP than in Group CW (108.4 vs. 95.2 min; P = 0.027). The C-arm time was longer in Group LP (2.8 vs. 1.2 s; P = 0.017).Conclusions:Open reduction and locking plate fixation with additional cerclage wiring is a useful method for the reduction of complicated distal femoral fractures, without increased complications such as nonunion.Level of Evidence:Level III, retrospective cohort design, treatment study.

Real-Time Intended Knee Joint Motion Prediction by Deep-Recurrent Neural Networks

Human-assisting intelligent systems demand certain methods to precisely predict motorized limb joint angles. This paper presents the application of deep-recurrent neural networks (RNNs), which is a type of neural network for processing sequential data, for predicting the knee joint angle in real-time. This model is created based on a combination of electromyographic (EMG) signals, (with electrodes being placed on three leg muscles), and inertial measurements of the upper and lower legs. The data collected from different subjects when they performed different gaits were used to construct the model, which was evaluated in a real-time setting. The proposed RNN model based on fusion information contains a balance between computational complexity and prediction accuracy. Results on a microcontroller show that, within a predicted horizon of 50 ms, the model has a low prediction error of ±2.93 degrees.

Regional modulation of the ankle plantarflexor muscles associated with standing external perturbations across different directions.

Maintenance of upright standing posture has often been explained using the inverted pendulum model. This model considers the ankle plantarflexors to act as a single synergistic group. There are differences in muscle properties among the medial and lateral gastrocnemius (MG and LG, respectively) and the soleus that may affect their activation. Twelve volunteers participated in an investigation to determine whether the activation of the ankle plantarflexor muscles was modulated according to perturbation direction during unilateral standing perturbations of 1% body mass. High-density surface electromyography (HDS-EMG) was used to determine the amplitude and barycenter of the muscle activation and kinematic analysis was used to evaluate ankle, knee, and hip joint movement. The HDS-EMG amplitude and barycenter of MG and LG were modulated with the perturbation direction (MG p < 0.05; LG p < 0.01; one-way repeated-measures ANOVA). In soleus, the HDS-EMG barycenter modulated across the perturbation direction (p < 0.01 for X&Y coordinates), but the HDS-EMG amplitude did not change. A repeated-measures correlation was used to interpret the HDS-EMG pattern in the context of the kinematics. The relative contribution of MG activation compared to the total gastrocnemii activation was significantly associated with ankle dorsi/plantarflexion (rrm = 0.620), knee flexion/extension and abduction/adduction (rrm = 0.622 and rrm = 0.547, respectively), and hip flexion/extension and abduction/adduction (rrm = 0.653 and rrm = 0.432, respectively). The findings suggest that the central nervous system activates motor units within different regions of MG, LG and SOL in response to standing perturbations in different directions.

Influence of Pain on Knee Joint Movement and Moment during the Stance Phase in Patients with Severe Bilateral Knee Osteoarthritis: A Pilot Study

Background and Objectives: The purpose of this study was to compare the side-to-side differences in knee joint movement and moment for the degree of pain in the walking stance phase in patients with bilateral knee osteoarthritis (KOA) of comparable severity. We hypothesized that knee joint movement and moment on the side with strong pain were lower compared with the side with weak pain. Materials and Methods: We included 11 patients diagnosed with bilateral severe KOA. In all patients’ left and right knees, the Kellgren–Lawrence radiographic scoring system grade was level 4, and the femorotibial angle and knee range of motion were equivalent. Following patients’ interviews with an orthopedic surgeon, we performed a comparative study with KOA with strong pain (KOAs) as the strong painful side and KOA with weak pain (KOAw) as the weak painful side. Data for changes in bilateral knee joint angles in three dimensions during the stance phase and bilateral knee sagittal and frontal moments exerted in the early and late stance phases were extracted from kinematics and kinetics analyses. Results: Three-dimensional joint movements in the knee joint were not significantly different in all phases between KOAs and KOAw. Knee extensor moment in the early stance phase in KOAs was significantly smaller than that in KOAw. Knee abductor moment in the early and late stance phase was not significantly different between KOAs and KOAw. Conclusions: Although we found no difference in joint motion in bilateral knee joints, knee extensor moment on the side with strong pain was decreased. In patients with bilateral severe KOA, it was suggested that the magnitude of knee pain contributed to the decrease in knee joint function.

Identification of Gait Motion Patterns Using Wearable Inertial Sensor Network.

Gait signifies the walking pattern of an individual. It may be normal or abnormal, depending on the health condition of the individual. This paper considers the development of a gait sensor network system that uses a pair of wireless inertial measurement unit (IMU) sensors to monitor the gait cycle of a user. The sensor information is used for determining the normality of movement of the leg. The sensor system places the IMU sensors on one of the legs to extract the three-dimensional angular motions of the hip and knee joints while walking. The wearable sensor is custom-made at San Diego State University with wireless data transmission capability. The system enables the user to collect gait data at any site, including in a non-laboratory environment. The paper also presents the mathematical calculations to decompose movements experienced by a pair of IMUs into individual and relative three directional hip and knee joint motions. Further, a new approach of gait pattern classification based on the phase difference angles between hip and knee joints is presented. The experimental results show a potential application of the classification method in the areas of smart detection of abnormal gait patterns.

Subjects With COPD Walk With Less Consistent Organization of Movement Patterns of the Lower Extremity.

The inherent stride-to-stride fluctuations during walking are altered in the aging population and could provide insight into gait impairments and falls in patients with COPD. Stride-to-stride fluctuations are quantified two ways: variability of the fluctuations (eg, standard deviation), and movement patterns within the fluctuations. Our objective was to investigate stride-to-stride fluctuations by evaluating the variability and movement patterns of lower limb joints in subjects with COPD compared to subjects without COPD as control subjects. In this cross-sectional study, 22 subjects with COPD (age 63 ± 9 y; FEV1 54 ± 19% predicted) and 22 control subjects (age 62 ± 9 y; FEV1 95 ± 18% predicted) walked for 3 min on a treadmill while their gait was recorded. The amount of variability (ie, standard deviation and coefficient of variation) and movement patterns (ie, predictability and consistency in organization) were quantified for the range of motion and joint angle of the hip, knee, and ankle, at 3 walking speeds (ie, self-selected, fast, and slow). General linear mixed models were used for analysis. Control subjects had more consistent organization of the hip and knee joint movement patterns compared to subjects with COPD (P = .02 and P = .02, respectively). Further, control subjects adapted to speed changes by demonstrating more consistent organization of movement patterns with faster speeds, whereas subjects with COPD did not. At the fast walking speed, subjects with COPD demonstrated less consistent organization of knee and hip joint movement patterns as compared to control subjects without COPD (P = .03 and P = .005, respectively). The amount of variability did not differ between groups. Although subjects with COPD did not demonstrate decreased amount of variability, their hip and knee joint movement patterns were less consistent in organization during walking. Reduced consistency in organization of movement patterns may be a contributing factor to falls and mobility problems experienced by patients with COPD.

Knee Health Monitoring Through Emg using Ni-Data Acquisition

Knee joint is prominent joint, giving support to the entire body. Problems related to the knee joint such as fracture, genetic disorders, Ligament tear, and diseases like osteoarthritis etc. leads to Knee joint health problems. The adopted methodologies are X-Ray, CT, and MRI etc .This all requires periodical checkup and evaluated only when the person is having problem with the Knee joint. Continuous monitoring knee health is important and helpful for the needy. This papers aims to develop knee health monitoring device with the help of EMG signal which is acquired through vastus medialis and gastrocnemius muscles. These two are important muscles which are giving support to the knee joint. The two major skeletal muscles are investigated on the basis of their muscle reflection by giving different dynamic motions. This study includes adults, age ranging from 18-30 and aged adult from 50-60 .The EMG signals are taken from both the legs by using Muscle V3 sensor.NI-DAQ are used to acquire the signals. The result shows that there is a significant variance in the amplitude of the EMG signals with respect to the increasing age, the strength of the muscle signals which is the base for stability of the knee joint movement have been focussed in the results.

Flexible knitted sensing device for identifying knee joint motion patterns

A knitted fabric strain sensor made from silver-plated conductive yarn and nylon spandex covered yarn is presented. Ten sensing zones are embedded into the fabricated running tights throughweft knitting technology. Physical activity tests are conducted to establish the linear relationship between the angle of the knee joint and the change in resistance of the sensing zones. A corresponding change in resistance relative knee joint movement is applied to identify three kinds of knee joint dynamics, namely, walking, sitting, and squatting, as well as four kinds of movement modes under the walking state of knee joint, including running, walking, climbing, and descending steps. The middle sensor region of the knee joint also has an obvious influence on the sensing performance of knee joint movement. Four modes of motion are extracted. Maximum resistance, average resistance, variance resistance, and median resistance are the main resistance characteristic values. Two kinds of motion cycles, namely, stand phase and swing phase, are the main time characteristic values. This thesis cites the decision tree algorithm and describes the method of realizing gait recognition.

Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study.

This study aimed to identify the relationships between clinical impairments and gait deviations in children with cerebral palsy (CP). A retrospective convenience sample of 367 children with CP was selected (3–18 years old) and divided in two groups based on clinical symptomatology [unilateral (uCP) / bilateral CP (bCP), (n = 167/200)]. All children underwent a three-dimensional gait analysis and a standardized clinical examination. Gait was inspected on a vector level (all sagittal motions combined), and an individual joint level (pelvis, hip, knee and ankle joint motions). Statistical non-parametric mapping was applied to identify specific parts of the gait cycle displaying relationships between the gait deviations of both groups and the impairment scores of spasticity, weakness, selectivity, and passive range of motion. Impairment scores were summarized in two ways: a) composite impairment scores (e.g. combined spasticity of all assessed muscles acting around the hip, knee and ankle joints) and b) joint specific impairment scores (e.g. spasticity of the muscles acting around the knee joint). Results showed that the vector and most of the individual motions were related to the composite scores. Direct and carry-over relationships were found between certain individual motions and joint impairment scores (around the same or neighboring joints, respectively). All correlations were more prominent for children with bCP compared to uCP, especially regarding the relationships of gait deviations with weakness and reduced selectivity. In conclusion, this study enabled the mapping of relationships between clinical impairments and gait deviations in children with CP, by identifying specific parts of the gait cycle that are related to each of these impairments. These results provide a comprehensive description of these relationships, while simultaneously highlighting the differences between the two CP groups. Integration of these findings could lead to a better understanding of the pathophysiology of gait deviations and, eventually, support individualized treatment planning.

Development and Examination of a Knee Prosthesis Geometry

Abstract The necessity for the knee prosthesis is confirmed by the large increase in the number of patients suffering from arthrosis, which is a present-day disease. Despite this need, there doesn’t exist an optimal knee prosthesis. Nowadays the development of the knee prostheses is progressing. It is very difficult to define the required geometry with traditional methods, because the movement conditions to be created by the prostheses should be similar to the movements of the human knee. During previous research the biomechanical research team of the Szent István University occupied with experimental measurements of the healthy human knee joint movement. In this paper I would like to introduce a method of prosthesis geometry development. As a result, a knee prosthesis geometry has been created which is approaching the movement form of the real human knee joint.

Variable Impedance Control of Powered Knee Prostheses Using Human-Inspired Algebraic Curves.

Achieving coordinated motion between transfemoral amputee patients and powered prosthetic joints is of paramount importance for powered prostheses control. In this article, we propose employing an algebraic curve representation of nominal human walking data for a powered knee prosthesis controller design. The proposed algebraic curve representation encodes the desired holonomic relationship between the human and the powered prosthetic joints with no dependence on joint velocities. For an impedance model of the knee joint motion driven by the hip angle signal, we create a continuum of equilibria along the gait cycle using a variable impedance scheme. Our variable impedance-based control law, which is designed using the parameter-dependent Lyapunov function framework, realizes the coordinated hip-knee motion with a family of spring and damper behaviors that continuously change along the human-inspired algebraic curve. In order to accommodate variability in the user's hip motion, we propose a computationally efficient radial projection-based algorithm onto the human-inspired algebraic curve in the hip-knee plane.

Special Issue: Nonlinear and Computational Dynamics in Biomedical Applications

Special Issue: Nonlinear and Computational Dynamics in Biomedical Applications

SOLUTE TRANSPORT IN ARTICULAR CARTILAGE UNDER ROLLING-COMPRESSION LOAD

Solute transport is one of the important aspects involved in maintaining the physiological activity of tissues. The mechanical environment drives nutrition in and waste out in articular cartilage due to its avascularity, which plays a key role in the biological activity of articular cartilage. The human knee joint motion is a complex interaction between different bones including relative rolling and/or sliding movements. Rolling-compression process is a typical physiological load in knee joint motion. To investigate solute transport behavior in articular cartilage under rolling-compression load, fluorescence tracers with molecular weights of 40kDa and 0.43kDa were used respectively to mark the transport in fresh articular cartilage of mature pigs. Solute fluorescence intensity changing with time and depth of cartilage layer was measured under rolling-compression load and static state, respectively, and the distribution of corresponding relative concentration was calculated by the fluorescence microscope imaging method. The experiment results show that the solute relative concentration in articular cartilage under rolling-compression load increases significantly, even up to 62.4%, comparing with that under static state, and the changes of concentration vary in different layers and that small molecular weight solute is easier to transport than relatively large molecular weight solute in articular cartilage. Therefore, rolling-compression load can promote the solute transport in cartilage, and the mechanical loading may have application in functional cartilage tissue engineering.

SEMG-based multifeatures and predictive model for knee-joint-angle estimation

Surface electromyography (sEMG) signals are commonly used in activity monitoring and rehabilitation training as they reflect effectively the motor intentions of users. This study proposed a new sEMG-based multifeature extraction and predictive model to predict knee-joint angle from multichannel sEMG. Six channels of sEMG from relevant muscles were recorded, and knee-joint angles were sampled simultaneously for six kinds of knee-joint movement models. The root–mean–square (RMS), wavelet coefficients (WC), and permutation entropy (PE) as features of sEMG were extracted. The back propagation neural network, generalized regression neural network, and least-square support vector regression machine (LS-SVR) were used as predictive models. To validate the effectiveness of the sEMG features and predictive models, twelve subjects without neural or musculoskeletal deficits participated in the experiment. Six kinds of knee-joint movement models at different speeds and different loads were respectively conducted by the subjects. Results revealed that the combination of the three features (RMS, WC, and PE) and LS-SVR performed well for the knee-joint-angle of all kinds of leg motions. The RMS error for all kinds of leg motions was &amp;lt;7.7°. The estimation results of joint motion state would be used to rehabilitation robot or functional electrical stimulation for active rehabilitation of spinal cord injury patients or stroke patients.

Effects of Treadmill Gait Training According to Obstacle Crossing on the Hip, Knee and Ankle Joint Motion during Gait Cycle in Patients with Post Stroke Hemiplegia

Effects of Treadmill Gait Training According to Obstacle Crossing on the Hip, Knee and Ankle Joint Motion during Gait Cycle in Patients with Post Stroke Hemiplegia