Maximum Knee Flexion Research Articles

Recurrence quantification analysis of isokinetic strength tests: A comparison of the anterior cruciate ligament reconstructed and the uninjured limb

BackgroundDespite widespread use of return to sport testing following anterior cruciate ligament reconstruction, studies suggest inadequacy in current testing criteria, such as limb symmetry index calculations, to determine athletes' readiness to return to play. Recurrence quantification analysis, an emerging non-linear data analysis tool, may reveal subtle neuromuscular differences between the injured and uninjured limb that are not captured by traditional testing. We hypothesized that isokinetic torque curve data of the injured limb would demonstrate lower determinism and entropy as compared to the uninjured limb. Methods102 patients (44 M, 58F, 10 ± 1 months post-anterior cruciate ligament reconstruction) underwent isokinetic quadriceps strength testing using a HumacNorm dynamometer. Patients completed maximum effort knee extension and flexion at 60°/sec. Data were post-processed with a MATLAB CRQA Graphical User Interface and determinism and entropy values were extracted. Paired-sample t-tests (α = 0.05) were used to compare data from the injured and uninjured limb. FindingsDeterminism and entropy values in the torque curves were lower in the injured limb than the uninjured limb (p < 0.001). Our findings indicate there is less predictability and complexity present in the torque signals of injured limbs. InterpretationRecurrence quantification analysis can be used to assess neuromuscular differences between limbs in patients who have undergone anterior cruciate ligament reconstruction. Our findings offer further evidence that there are changes to the neuromuscular system which persist following reconstruction. Further investigation is needed to establish thresholds of determinism and entropy values needed for safe return to sport and to evaluate the utility of recurrence quantification analysis as a return to sport criterion.

무릎 신전근 피로 수준이 외발 드롭 착지 시 무릎 관절 안정성에 미치는 영향

This study was to investigate the effect of experimentally induced knee extensor muscle fatigue on biomechanical variables related to knee stability during landing after a drop jump. Methods: A total of 14 young men participated voluntarily. As for the fatigue induction method, isokinetic equipment (Biodex System 4, Biodex Medical Systems, Inc. USA) was used, Kinematic data of the lower limbs were collected using a 3D Motion Analysis Eagle system (EVART 4.6, Santa Rosa, CA, USA) connected to 12 cameras at a sampling rate of 200 Hz, and ground reaction forces were obtained using an AMTI OR6-5 force platform (Watertown, MA, USA) was used to collect at a sampling rate of 1200 Hz. Results: The maximum knee flexion angle during one-leg drop landing was significantly increased after fatigue induction than before fatigue induction, but there was no significant difference among the fatigue induction conditions in knee valgus and varus, lateral rotation and medial rotation during one-leg drop landing. The shear stress in the tibia showed a tendency to increase according to the level of fatigue, but no significant difference was found. On the other hand, in the sagittal plane, the maximum knee joint moment was significantly decreased after fatigue induction, and the maximum ground reaction force was also found to be significantly decreased in the condition after fatigue induction compared to the condition before fatigue induction. Conclusion: Fatigue of the knee joint extensors following the fatigue protocol did not lead to significant changes in biomechanical variables related to knee stability. However, there was a significant decrease in maximum knee joint moment and maximum ground reaction force, and a significant increase in maximum knee joint angle during one-leg drop landing after fatigue induction. Therefore, the results of the study demonstrated that local fatigue (knee extensor fatigue exercise) according to the fatigue protocol did not affect biomechanical variables related to knee stability, but did affect biomechanical variables related to task performance.

The Effect of Muscles Fatigue on the Knee’s Kinetics and Kinematics Characteristics

Badminton is very popular on college campuses. In badminton, the anterior cruciate ligament of the players has a higher risk of injury. There are many studies investigating the impact of fatigue on the injury of professional athletes, but few studies focused on college students. We hypothesized that the knee joint would experience greater ground reaction forces, valgus moments, and flexion moments of lunge contact in amateur after fatigue than those indicators before fatigue. Ten male badminton amateurs were enrolled in this study. They performed a lunge to hit the shuttlecock at the designated position and then quickly returned to the starting position before and after fatigue. Fatigue was induced by repeated isokinetic flexion/extension of the knee. Lower body kinematics and ground reaction force (GRF) were collected and further used to calculate the lower body joint moments from initial contact to maximum knee flexion. Compared to the pre-fatigue condition, the peak flexion moment (p = 0.012) and peak abduction moment of knee joint (p = 0.01), and maximum horizontal ground reaction force (p = 0.027) increased significantly at the initial contact (p = 0.01). After muscle fatigue, the knee buckling moment and valgus moment increased significantly at initial contact, and the horizontal backward maximum GRF also increased significantly. These changes might increase the injury risk of anterior cruciate ligament (ACL). The fatigue of the muscles around the knee joint did not change the maximum GRF in the vertical direction at the moment of contact. Combined with the results of our study, badminton coaches and teachers should increase the training of lower extremity muscle strength and endurance in our daily class and training, and also should pay special attention to the coordinated development of muscles.

Relative contribution of neuromuscular activation, muscle size, and muscle quality to maximum strength output of the thigh muscles in young individuals.

This study aimed to investigate the relationship between maximal muscle strength and neuromuscular activation, muscle size, and quality of quadriceps (QF) and hamstring muscles (HM). The study included 24 young men and women. The neuromuscular activation parameter was recorded using a single-channel surface electromyography (EMG) with the root mean square (RMS) during maximal isometric knee extension and flexion from four muscles: rectus femoris and vastus lateralis for QF; biceps femoris and semitendinosus for HM. In addition, the peak torque was measured during the same session. B-mode ultrasonographic transverse images were obtained from the anterior, lateral, and posterior thighs. Furthermore, we calculated the muscle thickness (MT) and echo intensity (EI) of the four muscles as indicators of muscle size and quality. The averaged MT, EI, and absolute RMS of QF were calculated by averaging the values of the rectus femoris and vastus lateralis, and that of HM was calculated by averaging the values of the biceps femoris and semitendinosus. The knee extension peak torque was correlated with EI (r=-0.61, P < 0.01) and RMS (r=0.53, P < 0.01) in the QF. In contrast, the knee flexion peak torque was correlated with RMS (r=0.53, P < 0.05) but not with MT and EI in HM. In addition, EI and RMS in QF, and RMS in HM were selected as the major determinants of muscle strength in the stepwise regression analysis. These results suggest that muscle strength is moderately associated with different factors related to the thigh muscles in young individuals.

The Comparison between Pharmaceutical Method and Changes in Speed of Patients with Knee Osteoarthritis

Knee osteoarthritis is the most common degenerative bone and joint disease in the middle-aged and elderly. Here, we compared the diverse formulations of sports intensity and pharmaceutical selection for knee osteoarthritis patients. In this study, we compared and analyzed the differences and characteristics of lower limb joint kinematics, dynamics and muscle contraction function of knee osteoarthritis patients when walking at different speeds and the ones taking pharmaceutical selection including oral non-steroidal antiinflammatory drugs as well as topical capsaicin, so as to explore the impact of walking speed and drugs on the walking ability of knee osteoarthritis patients. 16 patients with left knee osteoarthritis and 16 patients with right knee osteoarthritis were selected and were grouped for different walking speed; 8 subjects were given oral non-steroidal anti-inflammatory drugs and 8 subjects were given topical capsaicin. Kistler threedimensional dynamometer, Noraxon surface electromyography and Qualisys infrared three-dimensional motion analysis were used to record the gait parameters. Compared with walking at low speed, normal walking speed significantly increased the knee maximum flexion angle. For dynamic parameters, the lowest value of first peak knee adduction moment presented in normal speed patients and there was also significant difference between groups for hip flexion torque (p=0.014), the first peak of knee adduction torque (p=0.043) and knee flexion torque (p=0.040). For the electromyographic parameters, in the early period of support, the speed of the lower extremity rectus femoris (p=0.001), anterior tibial muscle (p=0.016), lateral femur muscle (p=0.040) and the average amplitude of electromyography were not equal for distinct groups. We found that the outcome of kinematics parameters for oral non-steroidal anti-inflammatory drug was greatly higher than topical capsaicin. The research conclusion will provide important scientific basis and theoretical support for knee osteoarthritis population to conduct walking exercise scientifically and reasonably.

Estimation and Comparison of Knee Joint Contact Forces During Heel Contact and Heel Rise Deep Squatting.

Increased knee flexion is required for deep squatting in the daily life of the non-western population as well as in many sports activities. The purpose of this study was to estimate as well as to compare knee joint contact forces during heel contact (HC) and heel rise (HR) deep squatting in 10 healthy young Indian participants. Kinematic data were captured using a 12-camera Motion Analysis system. Kinetic data were collected using two Kistler force plates. EMG of 6 lower limb muscles was monitored by Noraxon wireless EMG. OpenSim musculoskeletal model was customized to increase the maximum knee flexion capability of the existing model and knee joint contact forces were estimated. A significant difference in tibiofemoral (p < 0.001) as well as patellofemoral (p = 0.006) knee joint contact force was observed between HC and HR squatting. The resultant maximum tibiofemoral KJCF was 5.9 (± 0.54) times body weight (BW) and 5.3 (± 0.6) BW for the HC and HR, respectively. The resultant maximum patellofemoral KJCF was 7.8 (± 0.57) BW and 7.1 (± 0.73) BW for the HC and HR, respectively. The findings can provide implications for physiotherapists to design rehabilitation exercise protocols, exercise professionals, and the development of high flexion knee implants. The online version contains supplementary material available at 10.1007/s43465-022-00798-y.

Post-game recovery of isometric hamstring strength in a high-risk hamstring strain injury group throughout an Australian Football League season

ABSTRACT This study sought to investigate post-game hamstring strength recovery of 26 Australian Football League (AFL) players with a previous hamstring strain injury (HSI) across an AFL season. Maximal unilateral isometric knee flexion strength was assessed using an externally fixed dynamometer, and inter-session reliability was measured during the pre-season period. Linear mixed effects models investigated the influence of numerous variables on post-game hamstring strength decrement (relative change between initial weekly test and individual baseline) and individual within-week strength change following gameplay. The test demonstrated good inter-tester reliability (ICC = 0.81–0.88; CV = 6.73–7.33), and an acceptable level of error (MAE = 5.77–7.14%). Player as a random effect strongly influenced post-game strength decrement and within-week strength change (marginal R2 = 0.185–0.407; conditional R2 = 0.455–0.654). Within-week hamstring strength change was strongly determined by post-game strength decrement alone (estimate = 0.51, 95% CI = -0.66- -0.36 ; η2 = 0.32; P=<0.001) and in interaction with number of days post-game (estimate = 0.43, 95% CI = 0.20–0.66; η2 = 0.096; P=<0.001). This study shows the importance of early individual assessment of post-game hamstring strength in players with prior hamstring injury and could be valuable to inform post-game hamstring recovery in future applications.

Optimal Drop Height in Prepubertal Boys Is Revealed by the Performance in Squat Jump.

Drop jump (DJ) performance gain with increasing drop height is well documented in adults, but there is still no clear evidence of such gain in children. This study aimed to examine the differences in DJ performance gain in male adults and prepubescent boys by comparing drop heights tailored to each individual's performance and expressed as a percentage of their squat jump (SJ) performance. Fifteen boys (9-11 y) and 15 men (19-27 y) executed DJs from drop heights that were set at 75%, 100%, 125%, and 150% of their best performance in SJ (DJ75, DJ100, DJ125, and DJ150, respectively). Vertical ground reaction force (vGRF), contact time and kinematics of the lower extremities were captured. The results showed that boys jumped significantly lower than adults in DJs, and both age groups presented jumping gain with increasing drop height, up to DJ125. Boys demonstrated longer total contact time, lower angular velocity and vGRF during the propulsive phase, as well as smaller knee flexion at touchdown and lower reactive strength index. vGRF in DJ75 and DJ100 was lower than in DJ125 and DJ150. The highest value for maximum knee flexion was also presented at DJ150. It is concluded that in prepubescent boys, the appropriate drop height for an effective DJ is linked to their performance in SJ and might be between 75% and 125% of their maximum SJ performance.

Neuromuscular characteristics of agonists and antagonists during maximal eccentric knee flexion in soccer players with a history of hamstring muscle injuries.

Muscle strain injuries (MSIs) in the hamstrings are among the most prevalent injuries in elite soccer. We aimed to examine the relation between biomechanical maladaptation in eccentric strength and neuromuscular factors separated by their time and frequency domains. 20 elite soccer players with a previous history of unilateral MSI in the M. biceps femoris (BF) long head and 20 without MSI participated. Knee flexion torques, rate of torque development (RTD) and electromyographic signals (EMG) of the BF, the M. semitendinosus (SMT) and knee extensors were obtained during unilateral maximal eccentric knee flexions performed at slow (30°/s) and fast (120°/s) angular speeds. Root mean squares and mean power frequency (MF) was calculated. In the group with a history of MSI, reduced maximal eccentric flexion torque (slow eccentrics -8±11, p<0.05; fast eccentrics -18±13 N*m, p<0.05) and RTD (-33±28 N*m/s, p<0.05; -95±47 N*m/s, p<0.05) concomitantly occurred with diminished agonistic myoelectrical activities (-4±5% of MVC, p<0.05; -10±7% of MVC, p<0.05) and MFs (-24±13 Hz, p<0.05; -24±18 Hz, p<0.05) in the BF. Simultaneously, antagonistic myoelectric activity was elevated (+4±3% of MVC, p<0.05; +3±3% of MVC, p<0.05) in MSI affected legs as compared to unaffected legs for both eccentric contractions. Deficits in myoelectrical activity (r2 = 0.715, p<0.05; r2 = 0.601, p<0.05) and MF (r2 = 0.484, p<0.05; r2 = 0.622, p<0.05) correlated with deficits in maximal torque in the affected leg in the MSI group. Analysis of SMT demonstrated no significant differences. Positive relationships between neuromuscular deficits and the reduced eccentric strength profile underpin neuronal inhibition after MSI. This persistent involvement of dysfunctional synergist and antagonist neural hamstring function in strength weakness is of clinical relevance in sports medicine for prevention and rehabilitation.

The Effect of Two Types of Foot Orthoses on the Knee Valgus Angle Within Single-Leg Landing: Implications for ACL Damage Hazard Decrease

Background: Non-contact anterior cruciate ligament (ACL) injuries commonly occur when athletes land in high risk positions such as knee valgus. The impact of foot orthoses during exercises that recreate a non-contact ACL harm system (i.e., landing) in any case will be obscured. Objectives: The purpose of the current study research was to evaluate the effect of two foot orthoses (semi-hard foot orthoses and hard foot orthoses) on knee valgus angle during single-leg drop landing. Methods: Twenty male leisure volleyball gamers performed landing in one-leg step from 30 cm height in 3 conditions (without foot orthoses, mid-hard foot orthoses, and hard foot orthoses). A motion capture system was used to measure lower extremity kinematics. Two risk factors of ACL injury, maximum knee valgus angle (KVA), and maximum knee flexion was measured. ANOVA was used for statistical analysis (P &lt; 0.05). Results: With mid-hard foot, orthoses provide the maximum level of knee flexion and the minimum level of knee valgus during single-leg drop landing. Conclusions: It may be concluded showed that foot orthoses affect knee kinematics. More knee flexion and less knee valgus brought about by mid-hard foot orthoses can reduce injuries of the anterior cruciate ligament (ACL).

Rectus femoris transfers with and without a hamstring lengthening will not change hip kinematics in children with cerebral palsy

BackgroundA rectus femoris transfer (RFT) surgery with and without a hamstring lengthening (HSL) is used to treat stiff-knee gait in children with cerebral palsy (CP). While current literature has reported that a RFT surgery improves the kinematics at the knee, little is known about the kinematic changes at the hip. Research questionDoes a RFT surgery change hip joint kinematics in children with CP? MethodsThis retrospective study included children (<18 years old) diagnosed with CP, who underwent a RFT procedure, and who were seen at our institution’s accredited clinical motion laboratory. Patients with both pre- and post-operative gait analysis were identified and comparison between those analyses were performed to identify kinematic differences at the hip and knee. A total of 66 legs from 46 children (mean age: 11.1 ± 3.6) met the inclusion criteria. ResultsOverall results revealed that a RFT did not change kinematics at the hip [p > 0.05], however, a RFT did increase the maximum knee flexion during the swing period [Mean Difference Post – Pre: 8.3°, 95% CI: 4.9–11.8, p < 0.0001]. Additionally, it was found that changes in hip extension during the terminal stance phase were significantly different between the combined RFT and HSL compared to solely an RFT. The results of this study also revealed that children whose stiff-knee gait did not improve, tended to have increased hip external rotation during terminal stance and swing and greater hip extension during terminal stance, compared to children whose stiff-knee gait did improve. SignificanceOverall, a RFT with and without a HSL surgery improves hip and knee kinematics in the sagittal plane, however, improvements at the hip were not clinically significant. As a result, a RFT or a combined RFT with HSL should not be used to change hip kinematics in children with CP.

Sofigait-A Wireless Inertial Sensor-Based Gait Sonification System.

In this study, a prototype of an inertial sensor-based gait sonification system was tested for the purpose of providing real-time gait feedback on the knee angle. The study consisted of two parts: (1) a comparison of the knee angle measurement to a marker-based 3D optical capturing system (Vicon, Oxford, UK) with N = 24 participants and (2) an evaluation four different sonification feedback versions in an accentuation × pitch (2 × 2) design on a sample of N = 28 participants. For the measurement system comparison, the RMSE was 7.6° ± 2.6° for the left and 6.9° ± 3.1° for the right side. Measurement agreement with bias up to -7.5° ± 6.2° (for maximum knee flexion) was indicated by the Bland-Altmann Method. The SPM revealed significant differences between both measurement systems for the area 45-90% (p &lt; 0.001) (left) and the area between 45% and 80% (p = 0.007) (right). For the sonification perception, the variation of pitch had a significant effect on the perception of pleasantness of the sound. No effect was found for the accentuation of the swing or stance phase.

Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy.

Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve patient outcomes as long as complications are not increased. To evaluate the safety and effectiveness of an accelerated weightbearing and early strengthening postoperative rehabilitation program for patients who undergo TTO. Case series; Level of evidence, 4. Included were patients who underwent unilateral/staged bilateral TTO performed by a single surgeon between August 2013 and February 2018 with ≥6 months of follow-up. The surgical indication was primarily for patients with recurrent patellar instability. In all cases, a diagnostic arthroscopy was performed to evaluate the cartilage surfaces and document patellar tracking. The TTO was performed using a freehand technique and two 3.5-mm fully threaded screws for fixation. Patients underwent an accelerated postoperative rehabilitation program that allowed for weightbearing and lower extremity strengthening starting at 4 weeks. Objective and subjective outcome measures included any postoperative complications, knee range of motion, and patient-reported outcome scores (Kujala Anterior Knee Pain Scale [AKPS] and Knee injury and Osteoarthritis Outcome Score composite [(KOOS5]). A total of 51 knees in 50 patients (38 female, 12 male) with a mean age of 31.24 ± 12.57 years were included in the final analysis. Compared with preoperative values, postoperative maximum knee flexion was significantly improved (117.67° ± 32.65° vs 131.12° ± 9.02°, respectively; P = .022). Postoperative complications included 6 patients with arthrofibrosis requiring manipulation under anesthesia, 4 with removal of symptomatic hardware, 1 tibial fracture (due to a fall), and 1 conversion to patellofemoral arthroplasty. The mean postoperative AKPS and KOOS5 scores were 72.98 ± 21.51 and 75.05 ± 16.02, respectively. Accelerated postoperative rehabilitation in TTO patients was an effective means of treatment with good subjective and objective outcomes and complication rates lower than traditional rehabilitation protocols.

Effects of auxetic shoe on lumbar spine kinematics and kinetics during gait and drop vertical jump by a combined in vivo and modeling investigation

The present study examined the effects of auxetic shoes on the biomechanics of the spine, as compared to barefoot and conventional shoe conditions, during gait and drop vertical jump (DVJ) activities using a combined in vivo and musculoskeletal modeling approach. Motion and force-plate data as well as electromyographic (EMG) activities of select trunk muscles of 11 individuals were collected during foregoing activities. In DVJ activity, two main phases of first landing (FL) and second landing (SL) were studied. In the FL phase of DVJ noticeable alternations were observed when auxetic shoes were used. That is, compared to the conventional footwear condition, smaller EMG activities in extensor muscles (by ~ 16–29%, p < 0.001), smaller anterior–posterior (AP) distance between the center of pressure of ground reaction force and heel (by ~ 19%, p = 0.002), generally larger maximal hip, knee, and ankle flexion angles (p < 0.005) and finally smaller maximal L5-S1 compression force and maximal external moment (by ~ 12 and 8%, respectively, p < 0.001) were obtained by wearing auxetic shoes. Our results, therefore, indicate that using auxetic shoes can reduce load on the lumbar spine during high-demanding activities such as vertical jump and thus may decrease the musculoskeletal risk of injuries during these activities.

Importance of Lower Extremity Muscle Performance and Knee Proprioception During First 60 Degrees of Knee Flexion at Three Months After Anterior Cruciate Ligament Reconstruction

Background: Knee proprioception and neuromuscular control may be important factors contributing to re-injury occurrences. Objectives: To examine lower extremity muscular performance and knee proprioception preoperatively and 3 months after anterior cruciate ligament (ACL) reconstruction. Methods: Twelve participants underwent ACL reconstruction using the hamstring tendon. All participants were assessed for knee proprioceptive sense using an isokinetic dynamometer at 15° and 60° of knee flexion. Lower extremity muscular performance was examined using the single-leg squat test (SLS) with two-dimensional motion analysis in frontal and sagittal planes. Results: Mean absolute error angle at a 15-degree-target angle was significantly lower at three months after ACL reconstruction compared with the preoperative state (P = 0.04). Maximal knee flexion angle of the injured The SLS test showed a lesser knee flexion angle of the injured knee at three months after ACL reconstruction (P = 0.01), and injured knee proprioception at 60 degree-flexion did not significantly improve at the three month-postoperative stage. Conclusions: At three months after ACL reconstruction by hamstring graft tendon, knee proprioceptive sense at an inner range of knee extension improved. However, proprioception at the middle range did not significantly develop. The range of hip and knee motions using SLS related to strength changes that the knee extensor needs to improve, especially in the middle range.

Reliability and criterion validity of two-dimensional movement assessments in those with patellofemoral pain

ObjectivesDetermine criterion validity and intra/inter-rater reliability of 2-dimensional (2D) knee frontal plane projection angle (kFPPA), hip frontal plane projection angle (hFPPA), and dynamic valgus index (DVI) during forward step-downs in those with patellofemoral pain (PFP). DesignCross-sectional. SettingUniversity research laboratory. Participants39 participants with PFP (34.18 ± 7.41years, 170± .1 cm, 81.03 ± 19.36 kg, duration of pain: 68.67 ± 85.08months, anterior knee pain scale: 80.49 ± 7.87, visual analog scale:2.08 ± 2.02) Main outcome measuresAverage 3D hip and knee sagittal, frontal, and transverse joint angles and 2D kFPPA, hFPPA, and DVI at maximum knee flexion were variables of interest. 3D DVI was calculated as the sum of hip and knee frontal and transverse angles. 2D kFPPA, hFPPA, and DVI were calculated by two raters independently on two occasions. ResultsIntra- and inter-rater reliability of all 2D angles were excellent. kFPPA was moderately correlated to 3D knee transverse angles. hFPPA was moderately correlated to 3D hip frontal and transverse angles and largely correlated to 3D DVI. 2D DVI was moderately correlated to hip transverse angles. ConclusionkFPPA, hFPPA, and DVI are reliable. hFPPA may be reflective of 3D hip and knee frontal and transverse motion during forward step-downs in those with PFP.

Comparison of Tibial Tubercle Landmark Technique and Range of Motion Technique in Primary Total Knee Arthroplasty: A Retrospective Cohort Study.

There is not a standard for rotational alignment of the tibial component in total knee arthroplasty (TKA). For now, the most commonly methods are tibial-tubercle -landmark technique (TTL) and range-of-motion technique (ROM). The study is aimed to compare clinical outcomes and radiographic data of patients who undergone primary TKA with TTL or ROM technique. This single-surgeon retrospective cohort study includes 60 patients with TTL technique and 60 with ROM technique from December 2017 to January 2019. All patients were evaluated clinically using Hospital for Special Surgery Knee Score (HSS), Feller patellar score, visual analogue scale (VAS) and maximum knee flexion and extension angle before and after surgery at both 6 months and 12months postoperatively. Radiographic data contain hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), posterior slope angle (PSA) on pre and postoperative X-ray and rotation angle of femoral component (relative to surgical trans-epicondylar axis) and tibial component (relative to surgical trans-epicondylar axis, tibial posterior condylar line and Akagi') on postoperative computed tomography (CT) scan. Clinical outcomes and radiological data were compared between the two groups. One hundred twenty patients (120 knees) were enrolled in this study, including 38 males and 82 females, aged from 58 to 78, with an average of 65.7 years. There was no significant difference in demographics and preoperative X-ray data between the two groups (P > 0. 05). Clinical scores of the TTL group were better than those in the ROM group at 6 and 12months after surgery, when comparing HSS (83.57 ± 5.00 vs 75.90 ± 4.89, F=59.004, P < 0.001; 90.53 ± 4.31 vs 82.83 ± 4.98, F=54.509, P < 0.001), Feller patellar score (21.43 ± 2.54 vs 19.10 ± 2.52, F=14.864, P=0.001; 26.27 ± 1.98 vs 23.20 ± 2.31, F=42.204, P < 0.001) and VAS (3.70 ± 0.62 vs 4.38 ± 0.92, F=14.508, P=0.001; 2.10 ± 0.90 vs 2.79 ± 0.80, F=11.554, P=0.002). But there was no significant difference in the flexion and extension angle between the two groups. In imaging evaluation, no statistical difference was found in pre- and postoperative HKA, mLDFA, mMPTA and PSA. Rotational angles of tibial component only did relative to Akagi' have statistical difference in two groups (2.33 ± 4.3 vs 4.41 ± 3.2, t=2.143, P < 0.05) (Positive value represented external rotation). The results of our study showed that both methods were reliable, and TTL technique provided better clinical scores and larger external angle of tibial component, compared to ROM technique.

Effects of Foam Rolling on Strength and Flexibility of Hamstring Muscles

Foam rolling is frequently implemented in warm-up prior to an exercise session. The purpose of this study was to evaluate the acute effects of a short bout of foam rolling on maximal knee flexion strength along with active and passive hamstring flexibility. Methods: Fourteen healthy young participants were included in this within-subject randomized controlled trial. After warm-up a short bout (two sets of 60 s) of foam rolling was performed on the intervention leg (counterbalanced leg dominance) while the contralateral leg was used as a control. Measurement of peak knee flexion torque and hamstring passive and active range of motion were performed on both sides in counterbalanced order. An analysis of variance was conducted to evaluate differences between the two groups. Results: Our results did not show significant differences between the intervention and control leg for any of the assessed parameters. Conclusion: The main findings are that a short bout of foam rolling does not affect maximal knee flexion strength and that the foam rolling intervention does not further affect flexibility although hamstring passive flexibility increases following a warm-up. Based on our results we conclude that short bouts of foam rolling can be used prior to exercise, as they have no deleterious effect on muscle performance. Foam rolling before exercise should be recommended solely based on individual preference.

Influence of Contoured Insoles with Different Materials on Kinematics and Kinetics Changes in Diabetic Elderly during Gait.

Background: Alterations in the lower limb kinematics and kinetics of diabetic patients have been reported in previous studies. Inappropriate choices of orthopedic insole materials, however, fail to prevent diabetic foot ulcers and modify abnormal gait. The aim of this study was to quantitatively compare the effects of contoured insoles with different materials on the kinematics of and kinetics changes in the diabetic elderly during gait. Methods: There were 21 diabetic patients who participated in this study. Three-dimensional (3D) experimental contoured insoles constructed of soft (i.e., Nora Lunalastik EVA and PORON® Medical 4708) and rigid (i.e., Nora Lunalight A fresh and Pe-Lite) materials with Langer Biomechanics longitudinal PPT® arch pads were adopted. An eight-camera motion capture system (VICON), two force plates, and an insole measurement system—Pedar® with 99 sensors—were utilized to obtain the kinematics and kinetics data. The plug-in lower body gait model landmarks were used for dynamic data acquisition during gait. The corresponding data from five gait cycles were selected and calculated. Results: The range of motions (ROMs) of the ankle joint (p = 0.001) and knee joint (p = 0.044) were significantly influenced when the contoured insoles were worn in comparison to the barefoot condition. The joint moments of the lower limbs with maximum ankle plantarflexion during the loading response and maximum knee and hip flexions were significantly influenced by the use of contoured insoles with different materials in the diabetic elderly. The peak plantar pressure (PPP) of the forefoot (p < 0.001), midfoot (p = 0.009), and rearfoot (p < 0.001) was significantly offloaded by the contoured insoles during the stance phase, whilst the PPP of the rearfoot (p < 0.001) was significantly offloaded during the swing phase. Conclusions: The contoured insoles, especially those constructed with soft materials, significantly offloaded the PPP during gait—hence accommodating certain abnormal gait patterns more effectively compared to going barefoot.

Passive Muscle Stiffness of Biceps Femoris is Acutely Reduced after Eccentric Knee Flexion.

Eccentric hamstring exercises reportedly prevent hamstring strain injury in the biceps femoris long head (BFlh). However, information on the favorable adaptive responses in the BFlh to eccentric hamstring exercises is limited. We aimed to examine the acute effect of maximal isokinetic eccentric knee flexion on passive BFlh stiffness as a potential risk factor for the hamstring strain injury using ultrasound shear wave elastography. Ten young participants randomly performed both tasks involving five consecutive repetitions of isokinetic concentric and eccentric knee flexion with maximal effort on different legs. Passive BFlh shear modulus was taken before and 30, 60, 90, and 120 s after each task. Passive BFlh shear modulus was significantly reduced at all time points after eccentric knee flexion, whereas there was no significant change in passive BFlh shear modulus after the concentric task. The present findings indicate that passive BFlh stiffness would reduce specifically after low-volume, slow-velocity eccentric knee flexion exercise. The findings may help provide practitioners with a basis to develop more effective exercise programs for preventing HSI.