Knee Joint Motion Research Articles

GS2203 足の上下運動における股関節及び膝関節まわりの筋骨格解析

In recent years, elderly persons who are needed a care are increasing. This main reasons are "disease of joints" or "bone fracture・fall down". In order to prevent these, it is necessary to training effectively muscles of the lower limbs. There for, it is important to clearly "the motion performance of joints" and "the intensity of the motion in muscles". In this paper, for the extension and flexion motion of knee joint, we quantified the motion performance of joints by using the driving power. And we quantified the intensity of the motion in muscles by using the angular momentum. Also, the 3D musculoskeletal model of lower limbs used for the analysis. And, Hill type model is used to muscle model. As those results, we could quantitatively consider "the motion performance of joints" and "the intensity of the motion in muscles".

Knee-Extension Training with a Single-Joint Hybrid Assistive Limb during the Early Postoperative Period after Total Knee Arthroplasty in a Patient with Osteoarthritis.

The knee range of motion is an important outcome of total knee arthroplasty (TKA). According to previous studies, the knee range of motion temporarily decreases for approximately 1 month after TKA due to postoperative pain and quadriceps dysfunction following surgical invasion into the knee extensor mechanism. We describe our experience with a knee-extension training program based on a single-joint hybrid assistive limb (HAL-SJ, Cyberdyne Inc., Tsukuba, Japan) during the acute recovery phase after TKA. HAL-SJ is a wearable robot suit that facilitates the voluntary control of knee joint motion. A 76-year-old man underwent HAL-SJ-based knee-extension training, which enabled him to perform knee function training during the acute phase after TKA without causing increased pain. Thus, he regained the ability to fully extend his knee postoperatively. HAL-SJ-based knee-extension training can be used as a novel post-TKA rehabilitation modality.

199 IMUを用いた膝関節動作計測の精度検証

199 IMUを用いた膝関節動作計測の精度検証

Comparisons of knee and ankle joint angles and ground reaction force according to functional differences during single-leg drop landing.

[Purpose] The purpose of this study was to determine potential predictors of functional instability of the knee and ankle joints during single-leg drop landing based on the prior history of injury. [Subjects and Methods] The subjects were 24 collegiate soccer players without pain or dysfunction. To compare the differences between the stable and unstable sides during single-leg drop landing, 8 motion analysis cameras and a force plate were used. The Cortex 4 software was used for a biomechanical analysis of 3 events. An independent t-test was used for statistical comparison between both sides; p<0.05 indicated significance. [Results] The knee joint movements showed gradual flexion in the sagittal plane. The unstable-side ankle joint showed plantar flexion of approximately 2° relative to the stable side. In the coronal plane, the unstable-side knee joint differed from the stable side in its tendency for valgus movement. The unstable-side ankle joint showed contrasting movement compared with the stable side, and the difference was significant. Regarding the vertical ground reaction force, the stable side showed maximum knee flexion that was approximately 0.1 BW lower than that of the unstable side. [Conclusion] Increasing the flexion angle of the knee joint can help prevent injury during landing.

Two-dimensional knee valgus displacement as a predictor of patellofemoral pain in adolescent females.

Patellofemoral pain (PFP) is a prevalent lower limb musculo-skeletal injury in adolescent females. Female athletes with PFP display increased frontal plane knee joint motion in comparison to control subjects. The current investigation aimed to determine prospectively whether two-dimensional knee valgus displacement during landing could predict the risk of developing PFP. Seventy-six injury-free adolescent female athletes (age=12.9±0.35years) participated. At baseline participants performed three drop vertical jump trials from a 31-cm box. A standard video camera was used to record frontal plane knee joint kinematics. Over the 24-month follow-up, eight participants developed PFP, as diagnosed by a Chartered Physiotherapist. Knee valgus displacement was significantly increased in those who developed PFP compared to those who did not (mean difference=7.79°; P=0.002; partial eta squared=0.07). Knee valgus displacement ≥10.6° predicted PFP with a sensitivity of 0.75 and specificity of 0.85. The associated positive likelihood ratio was 5. These results have clinical utility suggesting that two-dimensional analysis could be implemented to screen for increased risk of PFP in adolescent female athletes.

Neuromuscular Activation of the Vastus Intermedius Muscle during Isometric Hip Flexion.

Although activity of the rectus femoris (RF) differs from that of the other synergists in quadriceps femoris muscle group during physical activities in humans, it has been suggested that the activation pattern of the vastus intermedius (VI) is similar to that of the RF. The purpose of present study was to examine activation of the VI during isometric hip flexion. Ten healthy men performed isometric hip flexion contractions at 25%, 50%, 75%, and 100% of maximal voluntary contraction at hip joint angles of 90°, 110° and 130°. Surface electromyography (EMG) was used to record activity of the four quadriceps femoris muscles and EMG signals were root mean square processed and normalized to EMG amplitude during an isometric knee extension with maximal voluntary contraction. The normalized EMG was significantly higher for the VI than for the vastus medialis during hip flexion at 100% of maximal voluntary contraction at hip joint angles of 110° and 130° (P < 0.05). The onset of VI activation was 230–240 ms later than the onset of RF activation during hip flexion at each hip joint angle, which was significantly later than during knee extension at 100% of maximal voluntary contraction (P < 0.05). These results suggest that the VI is activated later than the RF during hip flexion. Activity of the VI during hip flexion might contribute to stabilize the knee joint as an antagonist and might help to smooth knee joint motion, such as in the transition from hip flexion to knee extension during walking, running and pedaling.

Mechano growth factor-C24E, a potential promoting biochemical factor for ligament tissue engineering

Ligaments play an important role in stabilizing and balancing knee joint movement. Anterior cruciate ligament (ACL) injuries remain a challenge in clinical and experimental settings due to the poor healing potential of ACL injuries. This study investigates whether the short peptide Mechano growth factor-C24E (MGF-C24E) is an efficient biochemical factor to promote repair of ACL injuries. We found that MGF-C24E-treated (5–30ng/ml) synovial fibroblasts (SFs) subjected to the static stretching (12% strain) were experienced significant lower oxidative stress, endoplasmic reticulum stress, and the activity of matrix metalloproteinases (MMPs) by SFs was also decreased. In addition, when ACL fibroblasts (ACLFs) were injured and then cultured in SFs culture medium after the SFs had been treated with MGF-C24E, the ACLFs exhibited increased proliferation, migration, collagen synthesis and enhanced mechanical recovery. These results indicate that MGF-C24E can interact with injured SFs and affect the injury microenvironment of the knee to promote ACLFs mechanical injury repair.

Pediatric femoral shaft fractures treated by flexible intramedullary nailing

BackgroundNowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5–13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age. MethodsThere were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture. ResultsWe were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening. ConclusionPatients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.

Dynamic Three-Dimensional Analysis of Lachman Test for Anterior Cruciate Ligament Insufficiency: Analysis of Anteroposterior Motion of the Medial and Lateral Femoral Epicondyles.

PurposeTo evaluate dynamic three-dimensional (3D) kinematic properties of the anterior cruciate ligament (ACL)-insufficient knees and healthy contralateral knees in awake patients during the Lachman test using biplane fluoroscopy.Materials and MethodsTen patients with unilateral ACL-insufficient knees and healthy contralateral knees were enrolled in this study. Each patient underwent the Lachman test three times in the awake state. The knee joint motions were captured using biplane fluoroscopy. After manual registration of 3D surface data from 3D-computed tomography to biplane images, dynamic 3D kinematic data were analyzed.ResultsThe average anteroposterior (AP) translation of the medial femoral epicondyle of the ACL-insufficient knees (11.5±4.2 mm) was significantly greater than that of the contralateral knees (7.7±3.5 mm) (p<0.05). However, there was no statistically significant side-to-side difference in the average AP translation of the lateral femoral epicondyle. During the Lachman test, the distal femur was more externally rotated than the proximal tibia, which showed significant difference between both sides.ConclusionsDuring the Lachman test, the medial femoral epicondyle of the ACL-insufficient knee exhibited greater AP motion than that of the contralateral knee, whereas there was no significant side-to-side difference with regard to the AP motion of the lateral femoral epicondyle.

Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis

ObjectiveThe objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). MethodsDynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. ResultsPatients with knee OA demonstrated larger medial/lateral joint contact point excursions (p<0.02) and greater heel-strike joint contact point velocities (p<0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p=0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p<0.01) and greater quadriceps and hip abductor muscle weakness (p=0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p<0.04) but not with quadriceps or hip abductor strength. ConclusionAltered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.

The effect of aging on vertical postural control during the forward and backward shift of the center of pressure

Preventing fall-related injuries is becoming a priority as the world population ages. This study's purpose was to examine the effect of aging on vertical postural control in the community-dwelling elderly. Thirty-six elderly individuals and twenty-two healthy young adults were asked to shift their centers of pressure (COPs) as far as possible while standing. The COP position, angle of each lower leg joint, and postural muscle activities were measured using a force plate, three-dimensional motion analyzer, and electromyogram, respectively. The vertical position of the center of mass (COM) was also measured to assess the change in vertical postural control. The backward COP shift in the elderly group was significantly smaller than that in the young group, and both the forward and backward COM shifts were significantly smaller in elders relative to those in youths. The COM position in the elderly group during the backward COP shift was also significantly lower than that in the young group. Knee and ankle joint movements differed between the two groups during the backward COP shift. Factor analysis indicated that dorsal and ventral muscle groups were involved in the COP shift. Specifically, the relationship between the biceps femoris muscle and the voluntary COP shift was reinforced in the elderly group. These findings suggest that the vertical postural strategy changes in the elderly during the backward COP shift.

The use of intramedullary telescopic fixateur for osteosynthesis of long bones of the lower limbs in children with osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a heterogeneous pathology which is accompanied by the development of multiple fractures and deformi­ties of the long bones of the extremities. Objective: to present out­comes of surgical treatment in patients with OI using intramedullary telescopic fixateur (ITF). Methods: 9 patients with bone deformities of the extremities due to OI were operated (4 boys, 5 girls aged 1,5–11 years). Correction was performed with using of percuta­neous semi-open osteoclasia on top of deformity. Bone fragments were fixed by means of ITF developed by authors which provides bone elongation during growth. After surgery we used an orthosis for external fixation. Rehabilitation envisaged work out active and passive movements in joints of the operated extremity, exercises for increasing of muscle strength, and hydrokynesiotherapy. Control checkups (clinical and radiological examination, determination of active movements in joints and muscle strength of the lower limbs) were performed every 3–4 months. Outcomes were assessed by FAQ Ambulation Scale. In all patients there were found consolidation of fragments in the area of osteotomy, preservation of achieved axial correction of parameters in lower extremities, increasing of active movements in hip and knee joints. Bearing-kinematic function of the lower extremities grew on 5 classes, and in two cases — on 7 ones. Improvement of functional class according to FAQ Ambula­tion Scale was found in 4 patients. In 6 patients which were not able to walk before surgery an ability for vertical standing and walking appeared. Conclusion: The proposed ITF provides restoration of anatomical axis of a limb, function of walk and bearing capacity in lower extremities, early start of the rehabilitation period, reduction of the percentage of complications, and also reduces the need for repeated surgeries, prevents the progression of deformation and a nascence of secondary fractures of long bones.

Comparison of Efficacy and Tolerability of Aceclofenac and Diclofenac in Osteoarthritis of Knee Joint

Background: Osteoarthritis is a slowly progressive disorder associated with a hyaline cartilage loss. Non-steroidal anti-inflammatory drugs play a pertinent role in management of osteoarthritis. Objectives: The study was carried out for the comparison of efficacy and tolerability of Aceclofenac and Diclofenac in patients of osteoarthritis of knee joint. Material and Methods: It is a randomised parallel group double blinded study. The study included 60 patients of confirmed osteoarthritis of knee joint, 30 patients were given Aceclofenac and 30 patients were given Diclofenac after food for 8 weeks and the patients were evaluated and compared statistically for pain intensity by VAS Score, Joint tenderness, Swelling, Erythema, Pain on movement, Functional capacity and Overall Assessment on LIKERT Scale. Results: Both the drugs caused marked improvements in the parameters of - Pain intensity, Joint tenderness, Swelling, Erythema, Pain on movement of OA knee joint but there was increased improvement in all the parameters with aceclofenac. Conclusion: Aceclofenac is the NSAID of choice in the osteoarthritis of knee joint as compare to Diclofenac.

보행과 한발·두발 수직점프 수행 시 내측비복근 근-건 복합체와 근섬유다발의 길이 변화 패턴의 차이

Objective : The purpose of this study was to investigate difference in fascicle behavior of the medial gastrocnemius during the locomotion with varying intensities, such as gait and one-legged and two-legged vertical jumping. Methods : Six subjects (3 males and 3 females; age: <TEX>$27.2{\pm}1.6yrs.$</TEX>, body mass: <TEX>$62.8{\pm}9.8kg$</TEX>, height: <TEX>$169.6{\pm}8.5cm$</TEX>) performed normal gait (G) at preferred speed and maximum vertical jumping with one (OJ) and two (TJ) legs. While subjects were performing the given tasks, the hip, knee and ankle joint motion and ground reaction force was monitored using a 8-infrared camera motion analysis system with two forceplates. Simultaneously, electromyography of the triceps surae muscles, and the fascicle length of the medial gastrocnemius were recorded using a real-time ultrasound imaging machine. Results : Comparing to gait, the kinematic and kinetic parameters of TJ and OJ were found to be significantly different. Along with those parameters, change in the medial gastrocnemius (MG) muscle-tendon complex (MTC) length (<TEX>$50.57{\pm}6.20mm$</TEX> for TJ and <TEX>$44.14{\pm}5.39mm$</TEX> for OJ) and changes in the fascicle length of the MG (<TEX>$18.97{\pm}3.58mm$</TEX> for TJ and <TEX>$20.31{\pm}4.59mm$</TEX> for OJ) were observed. Although the total excursion of the MTC and the MG fascicle length during the two types of jump were not significantly different, however the pattern of length changes were found to be different. For TJ, the fascicle length maintained isometric longer during the propulsive phase than OJ. Conclusion : One-legged and two-legged vertical jumping use different muscle-tendon interaction strategies.

The influence of task complexity on knee joint kinetics following ACL reconstruction

BackgroundPrevious research indicates that subjects with anterior cruciate ligament reconstruction exhibit abnormal knee joint movement patterns during functional activities like walking. While the sagittal plane mechanics have been studied extensively, less is known about the secondary planes, specifically with regard to more demanding tasks. This study explored the influence of task complexity on functional joint mechanics in the context of graft-specific surgeries. MethodsIn 25 participants (10 hamstring tendon graft, 6 patellar tendon graft, 9 matched controls), three-dimensional joint torques were calculated using a standard inverse dynamics approach during level walking and stair descent. The stair descent task was separated into two functionally different sub-tasks—step-to-floor and step-to-step. The differences in external knee moment profiles were compared between groups; paired differences between the reconstructed and non-reconstructed knees were also assessed. FindingsThe reconstructed knees, irrespective of graft type, typically exhibited significantly lower peak knee flexion moments compared to control knees during stair descent, with the differences more pronounced in the step-to-step task. Frontal plane adduction torque deficits were graft specific and limited to the hamstring tendon knees during the step-to-step task. Internal rotation torque deficits were also primarily limited to the hamstring tendon graft group during stair descent. Collectively, these results suggest that task complexity was a primary driver of differences in joint mechanics between anterior cruciate ligament reconstructed individuals and controls, and such differences were more pronounced in individuals with hamstring tendon grafts. InterpretationThe mechanical environment experienced in the cartilage during repetitive, cyclical tasks such as walking and other activities of daily living has been argued to contribute to the development of degenerative changes to the joint and ultimately osteoarthritis. Given the task-specific and graft-specific differences in joint mechanics detected in this study, care should be taken during the rehabilitation process to mitigate these changes.

The effects of knee joint kinematics on anterior cruciate ligament injury and articular cartilage damage

This study determined which knee joint motions lead to anterior cruciate ligament (ACL) rupture with the knee at 25° of flexion. The knee was subjected to internal and external rotations, as well as varus and valgus motions. A failure locus representing the relationship between these motions and ACL rupture was established using finite element simulations. This study also considered possible concomitant injuries to the tibial articular cartilage prior to ACL injury. The posterolateral bundle of the ACL demonstrated higher rupture susceptibility than the anteromedial bundle. The average varus angular displacement required for ACL failure was 46.6% lower compared to the average valgus angular displacement. Femoral external rotation decreased the frontal plane angle required for ACL failure by 27.5% compared to internal rotation. Tibial articular cartilage damage initiated prior to ACL failure in all valgus simulations. The results from this investigation agreed well with other experimental and analytical investigations. This study provides a greater understanding of the various knee joint motion combinations leading to ACL injury and articular cartilage damage.

EMG Signals for Co-Activations of Major Lower Limb Muscles in Knee Joint Dynamics

Integrity analysis of knee joint involves a detail study of several anatomical parts such as bones, cartilage, tendons etc. Any disorder or damage of these anatomical parts causes severe knee disease, like osteoarthritis (OA), which is generally found in an increasing tendency, particularly, in an aged society. Although, the reasoning of OA in knee joint is not concentrated to the present paper, however, the influences of related muscular co-activities to knee flexor-extensor actions are figured out in the present research. Particularly, the muscle reflection actions of two major skeletal muscles at knee are investigated with aging functions of participants. EMG signals have been collected from the vastus lateralis and the gastrocnemius for the dynamic movements (standing and sitting) of knee joint. Aged participants (over 60 years old) and young participants (20 -25 years old) joined the experiments. Data have been collected from both legs, however, analysis is shown only for left leg in this paper. EMG sensors and the related devices of the present sensing technique have been installed based on the instructions of Biometric Co. Ltd. Result show that the voltage amplitudes of EMG signals fluctuate largely with increasing ages and thus, the result focuses on the postural effectiveness in muscular activities for the stability challenges of knee joints in their movements.

Comparison Of Biomechanics And Metabolic Cost Among Elliptical Exercises And Running In Runners

Standard elliptical devices are a popular cross-training modality as they have similar metabolic cost as running with minimal lower extremity impact. A modified elliptical device produces lateral movement of the lower extremities and yields knee and hip joint motion that may have positive clinical implications for injured runners. PURPOSE: Compare acute differences in joint kinematics and metabolic cost between treadmill running (TR), standard elliptical (SE), and lateral elliptical (LE) in runners. METHODS: 16 non-injured runners (8 men) completed ten minutes of randomized exercise on TR, SE and LE on separate days. 3D knee and hip joint kinematics for the right limb were collected using a motion capture system (Qualisys). Oxygen consumption (VO2; ml/kg/min) was collected using a metabolic system (Parvo Medics). Motion data were analyzed using Visual3D (C-Motion). One-way repeated measures ANOVA to assess exercise type main effects (p<0.05) and cohen’s d effect sizes (ES) to assess mean differences were used. RESULTS: The knee ROM were different in LE (69.2±9.4°; extension) compared to SE (32.4±6.5°; ES=4.70; extension) and TR (-17.9±3.2°; ES=12.81; flexion) and, different between SE and TR (ES=10.14). The transverse plane hip ROM were different in LE (-8.9±8.1°; ES=2.94; external rotation) and TR (-3.3±4.9°; ES=3.07; external rotation) compared to SE (8.0±2.2°; internal rotation) and different between LE and SE (ES=0.86). Frontal plane hip ROM were different in LE (-16.4±5.5°; ES=5.32; abduction) and SE (2.7±1.9°; ES=1.27; adduction) compared to TR (5.3±2.3°; adduction) and, different between LE and SE (ES=4.79). Contralateral pelvic drop ROM were greater in LE (-5.3±4.8°; ES=0.83) and TR (-5.7±1.9°; ES=1.71) compared to SE (-2.3±2.2°). Finally, VO2 were greater in both TR (36.9±4.4; ES=2.65) and LE (36.8±8.3; ES=1.70) compared to SE (26.1±4.0). CONCLUSIONS: The LE yields joint motions that could have strengthening effects to help prevent knee and hip joint running injuries. However, greater pelvis drop in LE may have injurious consequences. The greater VO2 during LE suggests that LE may be more comparable to TR for metabolic activity than SE. The greater VO2 in LE may be due to greater frontal plane muscle control. Studies on chronic elliptical training effects are warranted in healthy and injured runners.

Selection of Drives for Prototype of Continuous Passive Motion Machine

The paper contains a description of a research into selecting drives for prototype of Continuous Passive Motion machine. Designing and constructing automated rehabilitation devices aims to increase effectiveness as well as shorten the time of a therapy. Information drew from literature, market researches and interviews in Krakow’s rehabilitation centers enabled the assessment of changes that are necessary to improve the ongoing process of automation. The article focuses on problem of designing and appropriate location of drives in accordance with durability calculations. Additionally, designing the universal machine that would allow conducting the ankle, knee and hip joint motion simultaneously, involved proper choice of drives and planning their placement, so they would not disturb the therapy.

Hip Rotation as a Crucial Risk Factor for Anterior Cruciate Ligament Injury in Female Athletes

Non-contact anterior cruciate ligament (ACL) injuries occurs with a higher incidence in female athletes compared with males after the onset of puberty. One anatomical factor with clinically observable differences between males and females is lower extremity alignment. The knee joint valgus in the coronal plane, which is associated with ACL injury risk, is composed of rotation of the tibia around the stationary femur and hip rotation combined with knee flexion. However, knee abduction measurements require expensive biomechanical laboratories. Therefore, it is important to develop simple measurement methods of the anatomical and structural factors to determine female athletes at increased risk for ACL injury. PURPOSE: The purpose of this study was to prove the difference of hip rotation between female and male handball players with or without history of ACL injury. METHODS: Elite collegiate athletes on the varsity handball team (17 females and 24 males) were recruited. Whereas 8 females and 1 male had a history of ACL injury, there were 9 females and 23 males with no history of ACL injury. The 6 measures of hip joint motion (flexion, extension, abduction, adduction, external rotation, and internal rotation) and the 2 measures of knee joint motion (flexion and extension) were measured with the standard procedure using a goniometer. RESULTS:Table: No title available.*p<0.05 vs. female players with no ACL injury COCLUSION: Female handball players with a history of ACL injury had greater hip internal rotation with smaller hip external rotation, compared with the counterpart without history of ACL injury. Hip rotation, which can be readily measured by coaches, athletic trainers, physical therapists, and athletes, may be a crucial risk factor for ACL injury in female athletes.