Lower Limb Flexion Research Articles

Evaluation of the Effectiveness of In-Hospital Exercise Rehabilitation in Middle-Aged and Elderly Patients with Type 2 Diabetes Mellitus Combined with Sarcopenia Effect of Lifestyle Management on Disease Status in Patients with Type 2 Diabetes Mellitus

ABSTRACT Objective The aim of this study was to explore the effects of in-hospital exercise rehabilitation on glucose and lipid metabolism and healthy physical fitness in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM) combined with sarcopenia, and to provide a reference for the effective implementation of exercise rehabilitation for middle-aged and elderly patients with T2DM combined with sarcopenia in healthcare institutions. Methods This study retrospectively included 122 patients with T2DM combined with sarcopenia treated at the General Hospital of Ningxia Medical University from August 2017 to August 2020 and randomly divided into a control group and an experimental group. The control group was given conventional treatment and the experimental group was given exercise rehabilitation in the hospital for 12 weeks to compare the indexes related to glucose and lipid metabolism and healthy fitness in the two groups. Results After the intervention, the experimental group showed significant decreases in fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin resistance index (HOMA-IR), triglycerides (TG), total cholesterol (TC), low-density cholesterol (LDL-C) and body fat percentage (p < 0.05), while high-density cholesterol (HDL-C), grip strength, lower limb extension, lower limb flexion, peak oxygen uptake were significantly higher (p < 0.05) and were more significant at 12 weeks compared to the 6-week intervention (p < 0.05). However, there were no significant changes in any of the glucose metabolism indicators in the control group before and after the intervention. A two-way repeated measures ANOVA showed that at control baseline levels, HbA1c decreased significantly in the experimental group after both 6 and 12 weeks of intervention compared to the control group (p < 0.05). After 6 weeks of intervention, the experimental group showed a significant decrease in body fat percentage and a significant increase in grip strength. After 12 weeks of intervention, the experimental group showed an increase in glycemic control from 33.3% to 73.3%, a significant decrease in body fat percentage and a significant increase in grip strength, lower limb extension and lower limb flexion strength and peak oxygen uptake. Conclusion In-hospital exercise rehabilitation can effectively improve the glycemic and lipid profiles of patients with T2DM combined with sarcopenia and enhance their health fitness, with good clinical rehabilitation effects.

Effects of Low Intensity Blood Flow Restriction Training on Muscle Volume, Strength and Power in Healthy Middle-Aged Females

OBJECTIVES The purpose of this study is to investigate the efficacy of weight training with controlled blood flow occlusion compared to conventional resistance training, in the ageing population.METHODS Twenty-three healthy female subjects (aged 40-55) were randomly assigned to one of three groups; low intensity blood flow restriction training (LI-BFRT) (n = 9), conventional resistance training (RT) (n = 7) and control (CON) (n = 7). The RT group trained between 65-70% one repetition maximum (1RM) and the LI-BFRT group trained at 30% 1RM while wearing pressure cuffs inflated to 100-120% of brachial systolic blood pressure (bSBP). Relative appendicular skeletal muscle mass (ASM/weight), isokinetic strength and power were tested pre and post 8 weeks of training.RESULTS Upper limb ASM/weight increased significantly in the LI-BFRT and RT groups (both p &lt; 0.001). Only LI-BFRT showed significant difference compared with the CON group (p &lt; 0.01). Lower limb ASM/weight improved in both the LI-BFRT (p &lt; 0.01) and CON (p &lt; 0.01) groups without group differences. Lower limb flexion strength increased in the LI-BFRT and RT groups (both p &lt; 0.01), with differences between groups (p &lt; 0.01, LI-BFRT &gt; RT &gt; CON). Only RT increased extension muscle strength (p &lt; 0.05). Lower limb flexion and extension power improved following LI-BFRT (p &lt; 0.05 and p &lt; 0.01, respectively), significantly greater than RT in both flexion (p &lt; 0.001) and extension (p &lt; 0.01).CONCLUSIONS LI-BFRT may be as, if not more effective than RT for increasing muscle volume, strength and power in middle-aged women.

Musculoskeletal adaptation of young and older adults in response to challenging surface conditions

Over 36 million adults over 65 years of age experience accidental falls each year. The underlying neuromechanics (whole-body function) and driving forces behind accidental falls, as well as the effects of aging on the ability of the musculoskeletal system to adapt, are poorly understood. We evaluated differences in kinematics (lower extremity joint angles and range of motion), kinetics (ground reaction force), and electromyography (muscle co-contraction), due to changes in surface conditions during gait in 14 older adults with a history of falling and 14 young adults. We investigated the impact of challenging surfaces on musculoskeletal adaptation and compared the mechanisms of adaptation between age-groups. Older adults displayed greater hip and knee flexion and range of motion during gait, reduced initial vertical loading, and 13 % greater knee muscle co-contraction during early stance compared to young adults. Across age groups, the presence of an uneven challenging surface increased lower-limb flexion compared to an even surface. On a slick surface, older adults displayed 30 % greater ankle muscle co-contraction during early stance as compared to young adults. Older adults respond to challenging surfaces differently than their younger counterparts, employing greater flexion during early stance. This study underscores the need for determining lower-limb musculoskeletal adaptation strategies during gait and assessing how these strategies change with age, risk of accidental falls, and environmental surfaces to reduce the risk of accidental falls.

Do healthy athletes exhibit at-risk biomechanics for anterior cruciate ligament injury during pivoting movements?

ABSTRACT A consistent injury mechanism involving multiple joints has been highlighted in athletes experiencing anterior cruciate ligament (ACL) rupture. However, if and to what extent healthy athletes incur an unsafe biomechanical profile during high-dynamics movements is unknown. The present study aimed to investigate the occurrence of the ACL risk profile in a competitive pivoting sports population.Thirty-four athletes (22.8 ± 4.1 y) performed a frontal deceleration and a change of direction at 90°. Full-body kinematics was collected through 15 wearable inertial sensors (Awinda, Xsens). Nine ACL risk factors were defined based on four categories: limited lower limb flexion, valgus collapse, foot rotation and trunk rotation. A movement trial was considered ‘at-risk’ in the presence of at least 5 simultaneous risk factors. The rate of athletes with at-risk movements was assessed and multivariate regression for associated outcomes was conducted.The overall rate of injury profile occurrence was 9–12%. The injury profile was identified at least in one trial in 24 athletes (71%) and three trials in 5 athletes (15%). Significant associations were found for higher approaching speed (OR = 4.3) and female sex (OR = 4.8). A large occurrence of the typical ACL injury biomechanical profile was noticed. Large screenings are advisable to identify at-risk athletes and promote preventative strategies.

Association Between Temporal Asymmetry and Muscle Synergy During Walking With Rhythmic Auditory Cueing in Survivors of Stroke Living With Impairments

ObjectiveTo examine the relationship between temporal asymmetry and complexity of muscle synergy during walking using rhythmic auditory cueing (RAC) and the factors related to changes in muscle synergy during walking with RAC in survivors of stroke. DesignCross-sectional study. SettingWards at 2 medical corporation hospitals. ParticipantsForty survivors of stroke (N=40; mean age, 70.4±10.3 years; time since stroke, 72.2±32.3 days) who could walk without physical assistance. InterventionsNot applicable. Main Outcome MeasuresThe participants were assessed in a random block design under 2 conditions: comfortable walking speed (CWS) and walking with RAC. Single-leg support time, kinematics, and electromyograms were measured. Factors related to the complexity of muscle synergy (variance accounted for by 1 synergy [VAF1]) between the walking conditions were examined using hierarchical multiple regression analysis. ResultsIn the RAC condition, lower limb flexion and knee flexion angles, single-leg support time on the paretic side, and the symmetry index of single-leg support time were increased compared with those in the CWS condition. VAF1 was decreased in the RAC condition (73.9±0.15) compared with that in the CWS condition (76.9±0.13, P=.002). Hierarchical multiple regression analysis revealed that the change in VAF1 was explained by change in single-leg support time (R2=0.43, P=.002). ConclusionsThe RAC condition demonstrated a more complex representation of muscle synergy than the CWS condition; the change in single-leg support time on the paretic side related to the changes in muscle synergy more than changes in lower limb angle. These findings can help in the walking-training concept to improve muscle synergy deficits in survivors of stroke.

Merged swing-muscle synergies and their relation to walking characteristics in subacute post-stroke patients: An observational study.

In post-stroke patients, muscle synergy (the coordination of motor modules during walking) is impaired. In some patients, the muscle synergy termed module 1 (hip/knee extensors) is merged with module 2 (ankle plantar flexors), and in other cases, module 1 is merged with module 4 (knee flexors). However, post-stroke individuals with a merging pattern of module 3 (hip flexor and ankle dorsiflexor) and module 4, which is the swing-muscle synergy, have not been reported. This study aimed to determine the muscle-synergy merging subtypes of post-stroke during comfortable walking speed (cws). We also examined the effect of experimental lower-limb angle modulation on the muscle synergy patterns of walking in each subtype. Forty-one participants were assessed under three conditions: cws, long stepping on the paretic side (p-long), and long stepping on the non-paretic side (np-long). Lower-limb flexion and extension angles and the electromyogram were measured during walking. Subtype classification was based on the merging pattern of the muscle synergies, and we examined the effect of different lower-limb angles on the muscle synergies. We identified three merging subtypes: module 1 with module 2 (subtype 1), module 1 with module 4 (subtype 2), and module 3 with module 4 (subtype 3). In the cws condition, the lower-limb flexion angle was reduced in subtype 3, and the lower-limb extension angle was decreased in subtype 1. A more complex muscle synergy was observed only in subtype 3 in the p-long condition versus cws (p = 0.036). This subtype classification of walking impairments based on the merging pattern of the muscle synergies could be useful for the selection of a rehabilitation strategy according to the individual’s particular neurological condition. Rehabilitation with increased lower-limb flexion may be effective for the training of patients with merging of modules 3 and 4 in comfortable walking.

Effects of Transcutaneous Spinal Direct Current Stimulation (tsDCS) in Patients With Chronic Pain: A Clinical and Neurophysiological Study.

Background and Aims: Chronic pain is a complex clinical condition, often devastating for patients and unmanageable with pharmacological treatments. Converging evidence suggests that transcutaneous spinal Direct Current Stimulation (tsDCS) might represent a complementary therapy in managing chronic pain. In this randomized, double-blind and sham-controlled crossover study, we assessed tsDCS effects in chronic pain patients.Methods: Sixteen patients (aged 65.06 ± 16.16 years, eight women) with chronic pain of different etiology underwent sham and anodal tsDCS (anode over the tenth thoracic vertebra, cathode over the somatosensory cortical area: 2.5 mA, 20 min, 5 days for 1 week). As outcomes, we considered the Visual Analog Scale (VAS), the Neuropathic Pain Symptom Inventory (NPSI), and the components of the lower limb flexion reflex (LLFR), i.e., RIII threshold, RII latency and area, RIII latency and area, and flexion reflex (FR) total area. Assessments were conducted before (T0), immediately at the end of the treatment (T1), after 1 week (T2) and 1 month (T3).Results: Compared to sham, anodal tsDCS reduced RIII area at T2 (p = 0.0043) and T3 (p = 0.0012); similarly, FR total area was reduced at T3 (p = 0.03). Clinically, anodal tsDCS dampened VAS at T3 (p = 0.015), and NPSI scores at T1 (p = 0.0012), and T3 (p = 0.0015), whereas sham condition left them unchanged. Changes in VAS and NPSI scores linearly correlated with the reduction in LLFR areas (p = 0.0004).Conclusions: Our findings suggest that tsDCS could modulate nociceptive processing and pain perception in chronic pain syndromes.

Single-session training on an ascending treadmill slope: effects on gait parameters in persons with stroke. A pilot study.

Treadmill training with an upward incline could improve gait parameters altered in persons with stroke, especially lower limb flexion. This study aimed to determine the effects of a treadmill single-session training with a 10% upward incline on biomechanical gait parameters in persons with stroke. Fifteen persons with stroke-related hemiparesis performed a 20-min treadmill training session with a 10% ascending incline in this interventional pilot study. Spatiotemporal, kinematic and kinetic parameters were evaluated, overground, with a tridimensional optoelectronic system, before the session, immediately after and after a 20-min rest period. The single-session training on a treadmill with a 10% incline has significantly increased hip flexion peak on the paretic side (39.8°± 8.1 in baseline to 42.7°± 8.6 after the session, P < 0.001, large effect size) and knee flexion peak on the paretic side (39.9°± 11.6 in baseline to 43.1°± 11.7 after the session, P = 0.004, large effect size). Gait speed, other spatiotemporal gait parameters and propulsion on the paretic side were also significantly increased (P < 0.05, all large effects size). These short-term changes were maintained after the break. A treadmill single-session training with a 10% upward incline induces biomechanical changes in people with stroke. The environmental constraints of this training could explain these biomechanical adaptations, concerning especially paretic hip and knee flexion.

Duty Factor Reflects Lower Limb Kinematics of Running

The aim was to identify the differences in lower limb kinematics used by high (DFhigh) and low (DFlow) duty factor (DF) runners, particularly their sagittal plane (hip, knee, and ankle) joint angles and pelvis and foot segment angles during stance. Fifty-nine runners were divided in two DF groups based on their mean DF measured across a range of speeds. Temporal characteristics and whole-body three-dimensional kinematics of the running step were recorded from treadmill runs at 8, 10, 12, 14, 16, and 18 km/h. Across speeds, DFhigh runners, which limit vertical displacement of the COM and promote forward propulsion, exhibited more lower limb flexion than DFlow during the ground contact time and were rearfoot strikers. On the contrary, DFlow runners used a more extended lower limb than DFhigh due to a stiffer leg and were midfoot and forefoot strikers. Therefore, two different lower limb kinematic mechanisms are involved in running and the one of an individual is reflected by the DF.

Spinal Cord Imaging Markers and Recovery of Volitional Leg Movement With Spinal Cord Epidural Stimulation in Individuals With Clinically Motor Complete Spinal Cord Injury.

Previous studies have shown that epidural stimulation of the lumbosacral spinal cord (scES) can re-enable lower limb volitional motor control in individuals with chronic, clinically motor complete spinal cord injury (SCI). This observation entails that residual supraspinal connectivity to the lumbosacral spinal circuitry still persisted after SCI, although it was non-detectable when scES was not provided. In the present study, we aimed at exploring further the mechanisms underlying scES-promoted recovery of volitional lower limb motor control by investigating neuroimaging markers at the spinal cord lesion site via magnetic resonance imaging (MRI). Spinal cord MRI was collected prior to epidural stimulator implantation in 13 individuals with chronic, clinically motor complete SCI, and the spared tissue of specific regions of the spinal cord (anterior, posterior, right, left, and total cord) was assessed. After epidural stimulator implantation, and prior to any training, volitional motor control was evaluated during left and right lower limb flexion and ankle dorsiflexion attempts. The ability to generate force exertion and movement was not correlated to any neuroimaging marker. On the other hand, spared tissue of specific cord regions significantly and importantly correlated with some aspects of motor control that include activation amplitude of antagonist (negative correlation) muscles during left ankle dorsiflexion, and electromyographic coordination patterns during right lower limb flexion. The fact that amount and location of spared spinal cord tissue at the lesion site were not related to the ability to generate volitional lower limb movements may suggest that supraspinal inputs through spared spinal cord regions that differ across individuals can result in the generation of lower limb volitional motor output prior to any training when epidural stimulation is provided.

Asymmetry in children with unilateral cerebral palsy during sit-to-stand movement: Cross-sectional, repeated-measures and comparative study

BackgroundWe aimed to compare motor strategies adopted by children with unilateral Cerebral Palsy and typically developing children during the performance of sit-to-stand. MethodsEleven children with unilateral cerebral palsy and 20 typically developing children were evaluated. Kinematic and kinetic analysis of the sit-to-stand movement was performed. Three seat heights were evaluated: neutral (90° of hip-knee-ankle flexion), elevated to 120% of the neutral height, and lowered to 80% of the neutral height. As outcome variables, we considered sit-to-stand duration (temporal); initial, final and maximal sagittal angles and range of motion of trunk, pelvis, hip, knee, and ankle (kinematics); the peak of vertical ground reaction force (kinetics), and asymmetric index. Effect size is represented by η2p. FindingsWe found that for the lowered seat, all groups presented increased flexion of lower limbs and trunk to initiate sit-to-stand (p≤0.012; η2p = 0.41–0.84), increased peak flexion of trunk, hip and knee (p≤0.01; η2p = 0.39–0.88), increased range of motion of knee and trunk (p≤0.01; η2p = 0.45–0.85) and the duration of sit-to-stand (p≤0.05 η2p = 0.23–0.56). Children with unilateral cerebral palsy presented increased posterior pelvic tilt (p≤0.01) and decreased hip flexion of both lower limbs (p≤0.01) for all seat heights and moved their non-affected limb backward in the lowered seat (p≤0.01). Asymmetry was observed for the final and the maximal angles of the ankle in neutral and lowered seats in unilateral cerebral palsy (asymmetry index = 3.3–5.8%). InterpretationThe lowered seat height led to adaptive motor strategies in children with unilateral cerebral palsy, which should be considered in clinical practice.

Full-Body Radiographic Analysis of Postoperative Deviations From Age-Adjusted Alignment Goals in Adult Spinal Deformity Correction and Related Compensatory Recruitment.

Full-body stereographs for adult spinal deformity (ASD) have enhanced global deformity and lower-limb compensation associations. The advent of age-adjusted goals for classic ASD parameters (sagittal vertical axis, pelvic tilt, spino-pelvic mismatch [PI-LL]) has enabled individualized evaluation of successful versus failed realignment, though these remain to be radiographically assessed postoperatively. This study analyzes pre- and postoperative sagittal alignment to quantify patient-specific correction against age-adjusted goals, and presents differences in compensation in patients whose postoperative profile deviates from targets. Single-center retrospective review of ASD patients ≥ 18 years with biplanar full-body stereographic x-rays. Inclusion: ≥ 4 levels fused, complete baseline and early (≤ 6-month) follow-up imaging. Correction groups generated at postoperative visit for actual alignment compared to age-adjusted ideal values for pelvic tilt, PI-LL, and sagittal vertical axis derived from clinically relevant formulas. Patients that matched exact ± 10-year threshold for age-adjusted targets were compared to unmatched cases (undercorrected or overcorrected). Comparison of spinal alignment and compensatory mechanisms (thoracic kyphosis, hip extension, knee flexion, ankle flexion, pelvic shift) across correction groups were performed with ANOVA and paired t tests. The sagittal vertical axis, pelvic tilt, and PI-LL of 122 patients improved at early postoperative visits (P < .001). Of lower-extremity parameters, knee flexion and pelvic shift improved (P < .001), but hip extension and ankle flexion were similar (P > .170); global sagittal angle decreased overall, reflecting global postoperative correction (8.3° versus 4.4°, P < .001). Rates of undercorrection to age-adjusted targets for each spino-pelvic parameter were 30.3% (sagittal vertical axis), 41.0% (pelvic tilt), and 43.6% (PI-LL). Compared to matched/overcorrections, undercorrections recruited increased posterior pelvic shift to compensate (P < .001); knee flexion was recruited in undercorrections for sagittal vertical axis and pelvic tilt; thoracic hypokyphosis was observed in PI-LL undercorrections. All undercorrected groups displayed consequentially larger global sagittal angle (P < .001). Global alignment cohort improvements were observed, and when comparing actual to age-adjusted alignment, undercorrections recruited pelvic and lower-limb flexion to compensate. 3.

Effects of unilateral, bilateral movement and combined exercise using a ski simulator on lower limb joint and muscle activities

Summary Objectives This study was conducted to closely examine the effects of representative types of lower limb flexion and extension exercises (unilateral and bilateral exercises) and the combined exercise using a ski simulator on lower limb joint and muscle activities. Equipment and methods In the experiments of this study performed on 20 participants, lower limb joint angles and muscle activities were measured during unilateral (lunge), bilateral (squat), and combine (ski simulator) using a 3D motion capture and electromyography analysis system. Results Analysis of the measurement results revealed that unilateral exercises required more time and exhibited greater angular displacements of the lower limb joints (P Conclusion Research approaches adopted by such studies are easy to apply and may be applicable in many fields involving rehabilitation and improvement of muscle strength and balance.

Equine Sesamoiditis: Report on one case

Sesamoiditis is the inflammation of the proximal sesamoid bones. The aetiopathogenesis of sesamoiditis is still open to discussion, while several therapeutic protocols have been put forward. This study presents the case of a l6year-old Dutch Warmblood gelding with sesamoiditis of the right forelimb. A right forelimb lameness (3/10), with a positive lower limb flexion test (5/10) was noted, and enlargement of the soft tissues of the right fore fedock. Based on the positive low four point nerve block, radiographic examination of the fedock revealed the presence of numerous radiolucent areas along the palmar aspect of the sesamoidean bones, but only minimal new bone formation on its base. An ultrasonographic evaluation of the suspensory ligament and the distal sesamoidean ligaments was made, something which did not detect any abnormalities. Phenylobutazone (4mg/kg i.v. SID) was administered for five days and, also, local hydrotherapy with cold water was used and the horse was given a 15- day box rest. The horse was re-examined three months following the initial inspection. The radiographic examination of the fetlock showed the same lesions with the initial examination. The second ultrasonographic evaluation, though, showed enlargement by 50% of the lateral branch of the suspensory ligament with loss of the normal outline. Moreover, anechoic areas were noted within the branch with calcification at its insertion site. To address the inflammation phenylobutazone (4mg/kg i.v.) was administered for ten days and, also, local hydrotherapy with cold water was used. Box-rest for 30 days was recommended. In the end of this period there was no inflammation in the fetlock region. A blister (TWYDIL liquid blister®) was used in order to resolve the chronic inflammation of the suspensory apparatus. The horse was then given three weeks of box rest and received correcting shoeing (egg- bar shoe with elevated heels and rolled- toe). It was then put in a gradually increasingexercise program.

Analysis of Kinematics and Kinetics According to Skill Level and Sex in Double-under Jump Rope Technique

Objective: The purpose of this study was to perform a kinematic and kinetic analysis of double-under jump rope technique according to skill level and sex. Method: Participants comprised a skilled group of 16 (9 males, 7 females), and an unskilled group of 16 with 6 months or less of experience (9 males, 7 females). Five consecutive double-under successes were regarded as 1 trial, and all participants were asked to complete 3 successful trials. The data for these 3 trials were averaged and analyzed after collecting the stable third jump in each trial. The variables used in the analysis included phase duration, total duration, flight time, vertical toe height, stance width, vertical center of mass displacement, and right lower limb ankle, knee, and hip joint angles in the sagittal plane during all events. Results: The skilled group had a shorter phase and total duration and a shorter flight time than the unskilled group. The vertical center of mass displacement and ankle dorsiflexion angle were significantly smaller in the skilled group. The male group had a shorter phase duration than the female group. The vertical toe height was greater, the stance width was smaller, and the ankle and hip flexion angles were smaller in the male group. Conclusion: Variables that can be used to distinguish between skill levels are phase and total duration, flight time, vertical center of mass displacement, and ankle dorsiflexion angle. Differences between sexes in double-under jump rope technique may be related to lower limb flexion angle control.

Tibial osteotomy combined with arthroscopic condylar notch plasty to treat flexion deformity of knee varus osteoarthri-tis

Objective To explore the medial open wedge high tibial osteotomy (OWHTO) combined with arthroscopic condyle plasty with clinical flexion deformity in patients with osteoarthritis of knee varus. Methods From January 2014 to July 2015, 11 cases (11 knees) of varus knee joint flexion deformity were applied the procedure of OWHTO combined with arthroscopic condyle plasty, including 4 male and 7 female; the average age was 52.1 years old (ranged from 48 to 58 years). OWHTO could ad-just the line of force of the lower limbs in coronal plane (the connection line between femoral head center point and the center point of ankle joint) through lateral tibial plateau 62.5% position, and implant allogeneic bone to support posterior inclination an-gle, underwent arthroscopic condyle plasty to improve flexion deformity at the same time. Results 11 patients in this group were all followed up, and the follow-up time was 1-2.5 years, average 1.5 years. No case of fracture nonunion or delayed healing was found. Imaging data was measured to evaluate the mechanical axis of lower extremity by the relative position of tibial plateau, femo-ral tibial angle,femoral notch width index, tibial plateau posterior angle before operation and one year after the operation. The rela-tive position of the mechanical axis of the lower limb through the tibial plateau was 17.4% ± 4.9% preoperatively, and 58.9% ± 3.1% after operation, femoral tibial angle changed from 181.6°±1.2° to 170.3°±1.3°, tibial plateau posterior inclination angle: pre-operative 7.7°±2.2°, postoperative 7.9°±1.9°, femoral notch width index was increased from 0.221±0.007 to 0.272±0.009 after op-eration, flexion deformity angle of preoperative was 11.1°±3.1°, and 1.4°±1.5° one years after operation, VAS score was (6.5±1.1) points before surgery, and (2.5±0.8) points of postoperative, Lysholm score was (50.72±6.57) points before operation, and (75.72±7.41) points one year after operation, and the differences were all statistically significant. Conclusion OWHTO combined with arthroscopic condyle plasty can significantly improve the lower limb line and flexion deformity, and also maintain the posterior in-clination angle of tibial plateau,and can get a good short-term efficacy. Key words: Osteoarthritis, knee; Osteotomy; Genu varum; Treatment outcome

Effect of walking on sand on gait kinematics in individuals with multiple sclerosis

BackgroundWalking in the real-world involves negotiating challenging or uneven surfaces, including sand. This can be challenging for people with Multiple Sclerosis (PWMS) due to motor deficits affecting the lower extremities. The study objective was to characterise kinematic gait adaptations made by PWMS when walking on sand and describe any immediate post-adaptation effects. Methods17 PWMS (mean age 51.4 ± 5.5, Disease Steps 2.4 ± 1.0), and 14 age-and gender matched healthy adults (HA) took part in a case-control study. 3D gait analysis was conducted using an eight-camera Vicon motion capture system. Each participant completed walking trials over level ground (baseline), sand (gait adaptation response), and again level ground (post-adaptation). Spatiotemporal data and kinematic data for the hip knee and ankle were recorded. ResultsAt baseline PWMS showed significantly less total lower limb flexion (p<0.05) compared to HA. PWMS adapted to walking on sand by significantly increasing hip and knee flexion and ankle dorsiflexion (p<0.05) during swing, resulting in an overall 23° greater total lower limb flexion (p<0.05), reaching values within normal range. During the return to level ground walking values of temporal-spatial and kinematic parameters returned towards baseline values. ConclusionsPWMS adapted to walking on sand by increasing lower limb flexion during swing, and returned to their gait pattern to near baseline levels, in a manner similar to but with values not equalling HA. Further work is required to determine whether this mode of walking has potential to act as a gait retraining strategy to increase flexion of the lower limb.

Comparison of lower limb kinetics during vertical jumps in turnout and neutral foot positions by classical ballet dancers

The purpose of this study was to investigate the effect of hip external rotation (turnout) on lower limb kinetics during vertical jumps by classical ballet dancers. Vertical jumps in a turnout (TJ) and a neutral hip position (NJ) performed by 12 classical female ballet dancers were analysed through motion capture, recording of the ground reaction forces, and inverse dynamics analysis. At push-off, the lower trunk leaned forward 18.2° and 20.1° in the TJ and NJ, respectively. The dancers jumped lower in the TJ than in the NJ. The knee extensor and hip abductor torques were smaller, whereas the hip external rotator torque was larger in the TJ than in the NJ. The work done by the hip joint moments in the sagittal plane was 0.28 J/(Body mass*Height) and 0.33 J/(Body mass*Height) in the TJ and NJ, respectively. The joint work done by the lower limbs were not different between the two jumps. These differences resulted from different planes in which the lower limb flexion–extension occurred, i.e. in the sagittal or frontal plane. This would prevent the forward lean of the trunk by decreasing the hip joint work in the sagittal plane and reduce the knee extensor torque in the jump.

Osgood-Schlatter disease

Osgood-Schlatter disease is a specific disorder related to osteochondropathies that affects young subjects and is localized in the tuberositas tibiae. The disease frequently develops after injuries including loading ones. It is apparent as gradual swelling of the knee joint(s) that becomes painful. Pain increases during walking, lower limb flexion an extension or stair climbing but may die down at rest. Diagnostics is based on the clinical picture. Radiodiagnostic methods my be helpful but their efficacy is inferior to that of clinical examination. Anti-inflammatory and chondroprotective therapy, immobilization of the affected joint, controlled exercises, and balneotherapy are indicated.

Lower limb flexion posture relates to energy absorption during drop landings with soldier-relevant body borne loads

Fifteen military personnel performed 30-cm drop landings to quantify how body borne load (light, ∼6 kg, medium, ∼20 kg, and heavy, ∼40 kg) impacts lower limb kinematics and knee joint energy absorption during landing, and determine whether greater lower limb flexion increases energy absorption while landing with load. Participants decreased peak hip (P = 0.002), and knee flexion (P = 0.007) posture, but did not increase hip (P = 0.796), knee (P = 0.427) or ankle (P = 0.161) energy absorption, despite exhibiting greater peak hip (P = 0.003) and knee (P = 0.001) flexion, and ankle (P = 0.003) dorsiflexion angular impulse when landing with additional load. Yet, when landing with the light and medium loads, greater hip (R2 = 0.500, P = 0.003 and R2 = 0.314, P = 0.030) and knee (R2 = 0.431, P = 0.008 and R2 = 0.342, P = 0.022) flexion posture predicted larger knee joint energy absorption. Thus, military training that promotes hip and knee flexion, and subsequently greater energy absorption during landing, may potentially reduce risk of musculoskeletal injury and optimize soldier performance.