Maximum Knee Abduction Research Articles

Relationship between hip contact force during gait and patient-reported outcome measures 6 months after total hip arthroplasty

PurposeEvaluating the hip contact force (HCF) during gait is important for assessing treatment outcomes after total hip arthroplasty (THA). This study investigated the relationship between patient-reported outcome measures (PROMs) and HCF during gait after THA as well as gait biomechanical factors affecting HCF during gait in relation to PROMs. MethodsIn total, 29 female patients who underwent THA with a 6-month follow-up were included in this study. Musculoskeletal model analysis was performed to obtain the first and second peak values of the HCF during gait and the minimum value between both peaks. PROMs were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). The relationship between JHEQ and selected HCFs and between the HCF and gait biomechanical factors was examined. ResultsThe second peak value of HCF was positively related to the total JHEQ, movement, and mental health scores (r ​= ​−0.551, 0.410, and 0.495, respectively). A positive relationship was found between the second peak value of the HCF and hip flexion–extension range of motion (r ​= ​0.518), maximum hip abduction moment (r ​= ​0.432), and maximum knee extension moment (r ​= ​0.417). A negative relationship was found between the second peak value of the HCF and the maximum knee abduction moment (r ​= ​−0.458). ConclusionsThe second peak value of HCF during gait after THA was related to PROMs. The second peak value was related to the hip flexion–extension range of motion, maximum hip abduction moment, and maximum knee extension and abduction moment.

The effect of a knee brace in dynamic motion-An instrumented gait analysis.

BackgroundOsteoarthritis (OA) is a common problem in the older population. To reduce pain and stress in the affected knee joint compartment, a functional knee brace is often prescribed by physicians to protect it from high loads.ObjectivesAn instrumented gait analysis should evaluate how the 4-point knee orthosis for varus or valgus load relief (M.4s OA) changes the kinematics of the knee, especially in the frontal plane.Methods17 healthy participants took part and were analyzed with an inertial sensor system (MyoMotion) giving continuous, objective information on the anatomical angles. The measurements were made both without wearing a knee brace and with the brace in different settings.ResultsThe results show a significant reduction in the maximum knee abduction and raised knee adduction. The knee brace, with a strong adjustment in varus or valgus orientation, caused a shift of maximum ab-/adduction in the proposed direction in 69% and 75% of the dynamic tests, respectively. The knee motion in the frontal plane shows individual movement patterns.ConclusionThe use of the brace leads to significant changes in the knee’s movement. Patient-specific movement patterns may explain different effects of functional knee braces on individual persons. Inertial sensors have been shown to be a low-cost, easy-to-use option for individual movement analysis and further personalized therapy.

The long-term use of foot orthoses affects walking kinematics and kinetics of children with flexible flat feet: A randomized controlled trial.

BackgroundDue to inconclusive evidence on the effects of foot orthoses treatment on lower limb kinematics and kinetics in children, studies are needed that particularly evaluate the long-term use of foot orthoses on lower limb alignment during walking. Thus, the main objective of this study was to evaluate the effects of long-term treatment with arch support foot orthoses versus a sham condition on lower extremity kinematics and kinetics during walking in children with flexible flat feet.MethodsThirty boys aged 8–12 years with flexible flat feet participated in this study. While the experimental group (n = 15) used medial arch support foot orthoses during everyday activities over a period of four months, the control group (n = 15) received flat 2-mm-thick insoles (i.e., sham condition) for the same time period. Before and after the intervention period, walking kinematics and ground reaction forces were collected.ResultsSignificant group by time interactions were observed during walking at preferred gait speed for maximum ankle eversion, maximum ankle internal rotation angle, minimum knee abduction angle, maximum knee abduction angle, maximum knee external rotation angle, maximum knee internal rotation angle, maximum hip extension angle, and maximum hip external rotation angle in favor of the foot orthoses group. In addition, statistically significant group by time interactions were detected for maximum posterior, and vertical ground reaction forces in favor of the foot orthoses group.ConclusionsThe long-term use of arch support foot orthoses proved to be feasible and effective in boys with flexible flat feet to improve lower limb alignment during walking.

The effects of an unanticipated side-cut on lower extremity kinematics and ground reaction forces during a drop landing

Unanticipated direction to cut after landing may alter the lower extremity landing biomechanics when performing landing motions. These alterations may potentially increase the risk of ACL injury. The purpose of this study was to determine if an unanticipated side-cut affects lower extremity landing biomechanics in females. Eighteen recreational female athletes participated in two blocks of testing: the first block of testing consisted of three acceptable trials of anticipated dominant limb and non-dominant limb 45-degree diagonal cutting after landing, which were performed in a counterbalanced order. The second block of testing consisted of three acceptable trials of unanticipated dominant limb and non-dominant limb diagonal cutting after landing. Data analysis mainly focused on the dominant limb landing biomechanics. Unanticipated side-cut landing, compared (paired t-test, p < 0.05) to the anticipated landings, resulted in less hip abduction and tibial internal rotation angle at initial contact (IC) and a lower maximum ankle inversion angle and a greater maximum knee abduction angle, and knee and hip displacement. Also, greater posterior GRF and a longer time to peak medial GRF were exhibited. These outcomes indicate that athletes may adapt their landing mechanics to land unsafely when encountering an unanticipated event.

Differences and correlations in knee and hip mechanics during single-leg landing, single-leg squat, double-leg landing, and double-leg squat tasks

Landing and squat tasks have been utilized to assess lower extremity biomechanics associated with anterior cruciate ligament loading and injury risks. The purpose of this study was to identify the differences and correlations in knee and hip mechanics during a single-leg landing, a single-leg squat, a double-leg landing, and a double-leg squat. Seventeen male and 17 female recreational athletes performed landings and squats when kinematic and kinetic data were collected. ANOVAs showed significant differences (p < 0.00001) for maximum knee flexion angles, maximum hip flexion angles, maximum knee abduction angles, maximum hip adduction angles, and maximum external knee abduction moments among squats and landings. For maximum knee and hip flexion angles, significant correlations (r ≥ 0.5, p ≤ 0.003) were observed between the two landings and between the two squats. For maximum knee abduction and hip adduction angles and maximum external knee abduction moments, significant correlations were mostly found between the two landings, and between the single-leg squat and landings (r ≥ 0.54, p ≤ 0.001). Individuals are likely to demonstrate different profiles of injury risks when screened using different tasks. While a double-leg landing should be considered as a priority in screening, a single-leg squat may be used as a surrogate to assess frontal plane motion and loading.

Effects of menarcheal age on the anterior cruciate ligament injury risk factors during single-legged drop landing in female artistic elite gymnasts.

Although numerous studies have demonstrated the relationship between maturation and lower extremity biomechanics during landing in team sport athletes, we are presently uninformed of any research that examined the single-legged drop landing biomechanics of gymnasts. The purpose of this study is to investigate the effects of the menarcheal age on the lower extremity biomechanics during a single-legged drop landing in female artistic elite gymnasts. Twenty-two female artistic elite gymnasts, between 9 and 36years of age, participated in this study. The participants were divided into two groups pre- (n=11) and post- (n=11) menarche and asked to perform a single-legged drop landing on top of a 30cm platform and land on a force plate. The statistical analysis consisted of the multivariate analysis with the level of significance set at p<0.05. The post-menarche group showed a decrease in their maximum knee flexion angle and increase in their maximum knee abduction angle, maximum internal tibial rotation angle, maximum knee abduction moment, and hamstring-quadriceps muscle activity ratio compared with the pre-menarche group during the single-legged drop landing. The post-menarche group showed an increased noncontact anterior cruciate ligament injury risk, due to their greater knee loads, compared with the pre-menarche group.

Sidestep cutting technique and knee abduction loading: implications for ACL prevention exercises

BackgroundSidestep cutting technique is essential in programmes to prevent anterior cruciate ligament (ACL) injury. A better understanding of how technique affects potentially harmful joint loading may improve prevention programmes. The...

Longitudinal Sex Differences during Landing in Knee Abduction in Young Athletes

The objective of this study was to determine whether biomechanical and neuromuscular risk factors related to abnormal movement patterns increased in females, but not males, during the adolescent growth spurt. A total of 315 subjects participated in two testing sessions approximately 1 yr apart. Male and female subjects were classified on the basis of their maturation status as pubertal or postpubertal. Three trials of a drop vertical jump (DVJ) were collected. Maximum knee abduction angle and external moments were calculated during the DVJ deceleration phase using a three-dimensional motion analysis system. Changes in knee abduction from the first to second year were compared among four subject groups (female pubertal, female postpubertal, male pubertal, and male postpubertal). There were no sex differences in peak knee abduction angle or moment during DVJ between pubertal males and females (P > 0.05). However, pubertal females increased peak abduction angle from first to second year (P < 0.001), whereas males demonstrated no similar change (P = 0.90) in the matched developmental stages. After puberty, the peak abduction angle and moment were greater in females relative to males (angle: female -9.3° ± 5.7°, male -3.6° ± 4.6°, P < 0.001; moment: female -21.9 ± 13.5 N·m, male -13.0 ± 12.0 N·m, P = 0.017). This study identified, through longitudinal analyses, that knee abduction angle was significantly increased in pubertal females during rapid adolescent growth, whereas males showed no similar change. In addition, knee abduction motion and moments were significantly greater for the subsequent year in young female athletes, after rapid adolescent growth, compared with males. The combination of longitudinal, sex, and maturational group differences indicates that early puberty seems to be a critical phase related to the divergence of increased anterior cruciate ligament injury risk factors.

Effects of Sports Injury Prevention Training on the Biomechanical Risk Factors of Anterior Cruciate Ligament Injury in High School Female Basketball Players

Background Female athletes have a higher risk of anterior cruciate ligament injury than their male counterparts who play at similar levels in sports involving pivoting and landing. Hypothesis The competitive female basketball players who participated in a sports injury prevention training program would show better muscle strength and flexibility and improved biomechanical properties associated with anterior cruciate ligament injury than during the pretraining period and than posttraining parameters in a control group. Study Design Controlled laboratory study. Methods A total of 22 high school female basketball players were recruited and randomly divided into 2 groups (the experimental group and the control group, 11 participants each). The experimental group was instructed in the 6 parts of the sports injury prevention training program and performed it during the first 20 minutes of team practice for the next 8 weeks, while the control group performed their regular training program. Both groups were tested with a rebound-jump task before and after the 8-week period. A total of 21 reflective markers were placed in preassigned positions. In this controlled laboratory study, a 2-way analysis of variance (2 × 2) experimental design was used for the statistical analysis (P < .05) using the experimental group and a testing session as within and between factors, respectively. Post hoc tests with Sidak correction were used when significant factor effects and/or interactions were observed. Results A comparison of the experimental group's pretraining and posttraining results identified training effects on all strength parameters (P = .004 to .043) and on knee flexion, which reflects increased flexibility (P = .022). The experimental group showed higher knee flexion angles (P = .024), greater interknee distances (P = .004), lower hamstring-quadriceps ratios (P = .023), and lower maximum knee extension torques (P = .043) after training. In the control group, no statistical differences were observed between pretraining and posttraining findings (P = .084 to .873). At pretraining, no significant differences were observed between the 2 groups for any parameter (P = .067 to .784). However, a comparison of the 2 groups after training revealed that the experimental group had significantly higher knee flexion angles (P = .023), greater knee distances (P = .005), lower hamstring-quadriceps ratios (P = .021), lower maximum knee extension torques (P = .124), and higher maximum knee abduction torques (P = .043) than the control group. Conclusion The sports injury prevention training program improved the strength and flexibility of the competitive female basketball players tested and biomechanical properties associated with anterior cruciate ligament injury as compared with pretraining parameters and with posttraining parameters in the control group. Clinical Relevance This injury prevention program could potentially modify the flexibility, strength, and biomechanical properties associated with ACL injury and lower the athlete's risk for injury.

Fatigue-Induced Adaptations in Central Control Increases the Risk of Non-Contact ACL Injury

Dynamic sports landing execution in a combined fatigued and unanticipated state is proposed as a worst case scenario for non-contact ACL injury risk. To date, however, the extent to which this phenomenon stems from a compromise in central control remains unclear. Elucidating the link between central fatigue and ACL injury is crucial to prevention strategies that can successfully cater to the random and physically taxing nature of sports. PURPOSE: To determine the impact of fatigue on the central control of dynamic lower limb landing mechanics. METHODS: Eighteen female athletes (19.8 ± 1.2 yrs) performed anticipated (AT) and unanticipated (UT) single leg landing tasks both before and during a fatigue protocol. Jump direction was determined by random light stimuli activated prior to or during the pre landing phase of AT and UT respectively. For fatigue trials, subjects performed three single leg squats immediately followed by a randomly ordered landing, with this sequence repeated until squats were no longer possible. Subject-based initial contact (IC) and peak stance (0%-50%) lower limb joint mechanics were calculated across pre-fatigue trials, and for trials denoting 25%, 50%, 75% and 100% maximal fatigue. Data were submitted to a 3-way ANOVA to test for the main effects of and interactions between decision (AT and UT), limb (fatigued and non-fatigued) and fatigue level. RESULTS: UT promoted significant (p<0.05) increases in IC hip extension and internal rotation and knee flexion angles, maximum knee abduction and internal rotation angles and moments and maximum knee flexion moment. IC knee extension, peak knee abduction angle, and peak knee flexion and abduction moments all significantly (p<0.05) increased as fatigue progressed. Further, fatigue induced increases in peak knee abduction motions and loads were more pronounced (p<0.05) during UT compared to AT. Changes in joint mechanics due to decision and/or fatigue level conditions were similarly evident in both the fatigued and non-fatigued limb. CONCLUSIONS: Mechanical adaptations in the non-fatigued limb strongly suggest high risk movement strategies stem from fatigue induced central pathway degradation. Prevention strategies should thus target the interaction between fatigue and central (spinal and supraspinal) control within the training paradigm.

The Effects of Plyometric versus Dynamic Stabilization and Balance Training on Lower Extremity Biomechanics

Background Neuromuscular training that includes both plyometric and dynamic stabilization/balance exercises alters movement biomechanics and reduces ACL injury risk in female athletes. The biomechanical effects of plyometric and balance training utilized separately are unknown. Hypothesis A protocol that includes balance training without plyometric training will decrease coronal plane hip, knee, and ankle motions during landing, and plyometric training will not affect coronal plane measures. The corollary hypothesis was that plyometric and balance training effects on knee flexion are dependent on the movement task tested. Study Design Controlled laboratory study. Methods Eighteen high school female athletes participated in 18 training sessions during a 7-week period. The plyometric group (n= 8) performed maximum-effort jumping and cutting exercises, and the balance group (n = 10) used dynamic stabilization/ balance exercises during training. Lower extremity kinematics were measured during the drop vertical jump and the medial drop landing before and after training using 3D motion analysis techniques. Results During the drop vertical jump, both plyometric and balance training reduced initial contact (P= .002), maximum hip adduction angle (P= .015), and maximum ankle eversion angle (P= .020). During the medial drop landing, both groups decreased initial contact (P= .002) and maximum knee abduction angle (P= .038). Plyometric training increased initial contact knee flexion (P= .047) and maximum knee flexion (P= .031) during the drop vertical jump, whereas the balance training increased maximum knee flexion (P= .005) during the medial drop landing. Conclusion Both plyometric and balance training can reduce lower extremity valgus measures. Plyometric training affects sagittal plane kinematics primarily during a drop vertical jump, whereas balance training affects sagittal plane kinematics during single-legged drop landing. Clinical Relevance Both plyometric and dynamic stabilization/balance exercises should be included in injury-prevention protocols.