Tibiofemoral Compressive Forces Research Articles

Hamstrings vibration reduces tibiofemoral compressive force following anterior cruciate ligament reconstruction.

Individuals who have undergone anterior cruciate ligament reconstruction (ACLR)are at greater risk of developing knee osteoarthritis (OA).This elevated risk of knee OA is associated with high tibiofemoral (TF) compressive force, due to a combination of low knee flexion angles and increased co-contraction of the hamstrings and quadriceps during limb loading. Prolonged vibration of the hamstrings fatigues the intrafusal muscle fibers, which reduces autonomic reflexive excitation of the hamstrings and alleviates reciprocal inhibition to the quadriceps. The aim of this study was to examine the effect of prolonged hamstrings vibration on TF compressive force in individuals who have undergone ACL reconstruction. Fourteen participants with unilateral ACLR and 14 participants without knee injury performed a single-leg drop-land task before and after prolonged (20 min) vibration of the hamstrings. Peak TF compressive force, knee flexion angle, and hamstrings/quadriceps co-contraction were calculated during the deceleration phase of the drop-land task before and after vibration. The ACLR group experienced an 18% decrease in TF compressive force, a 32% increase in knee flexion angle, and a 38% decrease in hamstrings/quadriceps co-contraction after hamstrings vibration. There was no difference in any of the parameters in the noninjured group after vibration. These data suggest that acute prolonged hamstrings vibration has the potential to mitigate TF compressive force, which may protect the knee joint in the long term.Clinical significance: The results of this research are expected to lead to improved clinical care for ACLR patients because it holds promise for mitigating altered joint mechanics and perhaps slowing down the onset of posttraumatic knee osteoarthritis.

Tibiofemoral compressive force during downhill walking in patients with primary total knee arthroplasty: A statistical parametric mapping approach

BackgroundDownhill walking is a necessary part of daily life and an effective activity in post-operative rehabilitation following total knee arthroplasty. The purpose of this study was to determine differences in the behavior of total, medial, and lateral tibiofemoral compressive forces as well as knee extensor and flexor muscle forces between different limbs of patients with total knee arthroplasty (replaced, non-replaced) during downhill and level walking. MethodsMusculoskeletal modeling and simulation were implemented to determine muscle forces and tibiofemoral compressive forces in 25 patients with total knee arthroplasty. A 2 × 2 [Limb (replaced, non-replaced) × Slope (0°, 10°)] Statistical parametric mapping repeated measures analysis of variance was conducted on selected variables. FindingsStatistical parametric mapping did not identify any between-limb differences for compressive or muscle forces. Differences in joint compressive and muscle forces persisted throughout different intervals of stance-phase between level and downhill walking. Knee extensor muscle forces were distinctly greater during level walking for nearly all of stance phase. Knee flexor muscle force was greater during downhill walking for >60% of stance. Statistical parametric mapping did identify regions of significance between level and downhill walking that coincided temporally (near loading response and push off) with peak joint moment and joint compressive forces traditionally reported using discrete variable analyses. InterpretationDownhill walking may be a safe and useful rehabilitation tool for post-knee arthroplasty rehabilitation that will not disproportionally load either the replaced or the non-replaced joint and where the quadriceps muscles can be strengthened during a gait-specific task.

Estimation of Tibiofemoral Joint Contact Forces Using Foot Loads during Continuous Passive Motions.

Continuous passive motion (CPM) machines are commonly used after various knee surgeries, but information on tibiofemoral forces (TFFs) during CPM cycles is limited. This study aimed to explore the changing trend of TFFs during CPM cycles under various ranges of motion (ROM) and body weights (BW) by establishing a two-dimensional mathematical model. TFFs were estimated by using joint angles, foot load, and leg–foot weight. Eleven healthy male participants were tested with ROM ranging from 0° to 120°. The values of the peak TFFs during knee flexion were higher than those during knee extension, varying nonlinearly with ROM. BW had a significant main effect on the peak TFFs and tibiofemoral shear forces, while ROM had a limited effect on the peak TFFs. No significant interaction effects were observed between BW and ROM for each peak TFF, whereas a strong linear correlation existed between the peak tibiofemoral compressive forces (TFCFs) and the peak resultant TFFs (R2 = 0.971, p < 0.01). The proposed method showed promise in serving as an input for optimizing rehabilitation devices.

Medial and Lateral Tibiofemoral Compressive Forces in Patients Following Unilateral Total Knee Arthroplasty During Stationary Cycling.

Patients following unilateral total knee arthroplasty (TKA) display interlimb differences in knee joint kinetics during gait and more recently, stationary cycling. The purpose of this study was to use musculoskeletal modeling to estimate total, medial, and lateral tibiofemoral compressive forces for patients following TKA during stationary cycling. Fifteen patients of unilateral TKA, from the same surgeon, participated in cycling at 2 workrates (80 and 100W). A knee model (OpenSim 3.2) was used to estimate total, medial, and lateral tibiofemoral compressive forces for replaced and nonreplaced limbs. A 2 × 2 (limb × workrate) and a 2 × 2 × 2 (compartment × limb × workrate) analysis of variance were run on the selected variables. Peak medial tibiofemoral compressive force was 23.5% lower for replaced compared to nonreplaced limbs (P = .004, G = 0.80). Peak medial tibiofemoral compressive force was 48.0% greater than peak lateral tibiofemoral compressive force in nonreplaced limbs (MD = 344.5N, P < .001, G = 1.6) with no difference in replaced limbs (P = .274). Following TKA, patients have greater medial compartment loading on their nonreplaced compared to their replaced limbs and ipsilateral lateral compartment loading. This disproportionate loading may be cause for concern regarding exacerbating contralateral knee osteoarthritis.

Effect of Assistance Using a Bilateral Robotic Knee Exoskeleton on Tibiofemoral Force Using a Neuromuscular Model.

Tibiofemoral compression forces present during locomotion can result in high stress and risk damage to the knee. Powered assistance using a knee exoskeleton may reduce the knee load by reducing the work required by the muscles. However, the exact effect of assistance on the tibiofemoral force is unknown. The goal of this study was to investigate the effect of knee extension assistance during the early stance phase on the tibiofemoral force. Nine able-bodied adults walked on an inclined treadmill with a bilateral knee exoskeleton with assistance and with no assistance. Using an EMG-informed neuromusculoskeletal model, muscle forces were estimated, then utilized to estimate the tibiofemoral contact force. Results showed a 28% reduction in the knee moment, which resulted in approximately a 15% decrease in knee extensor muscle activation and a 20% reduction in subsequent muscle force, leading to a significant 10% reduction in peak and 9% reduction in average tibiofemoral contact force during the early stance phase (p < 0.05). The results indicate the tibiofemoral force is highly dependent on the knee kinetics and quadricep muscle activation due to their influence on knee extensor muscle forces, the primary contributor to the knee load.

EFFECTS OF A PROPHYLACTIC KNEE SLEEVE ON THE ANTERIOR CRUCIATE LIGAMENT AND LOWER EXTREMITY BIOMECHANICS: AN EXAMINATION USING MUSCULOSKELETAL SIMULATION

The current study aimed using a two-experiment musculoskeletal simulation-based approach, measuring anterior cruciate ligament (ACL) biomechanics, knee joint kinematics, and lower extremity joint loading to examine the effects of both a prophylactic knee sleeve on (1) a sport-specific change of direction movement in female footballers and (2) a single leg landing in male footballers. Experiment 1 examined 12 female university first team level footballers (age [Formula: see text] years, height [Formula: see text][Formula: see text]m, body mass [Formula: see text][Formula: see text]kg) undertaking a [Formula: see text] cutting movement in sleeve and no-sleeve conditions. Experiment 2 examined 10 male university first team level footballers (age [Formula: see text] years, height [Formula: see text][Formula: see text]m, body mass [Formula: see text][Formula: see text]kg) undertaking a single leg drop jump landing in sleeve and no-sleeve conditions. In each experiment, data was collected in a biomechanics laboratory and three-dimensional (3D) motion capture and ground reaction force (GRF) information was collected. 3D kinematics, 3D knee kinetics, and ACL ligament forces/strains were measured using musculoskeletal simulation, and participants were also asked to subjectively rate the knee sleeve in terms of both comfort and stability. Experiment 1 showed that the sleeve condition was associated with greater ACL strain ([Formula: see text]% and no-[Formula: see text]%) and forces ([Formula: see text] BW and no-[Formula: see text] BW). In addition, the brace condition also enhanced lateral compressive tibiofemoral ([Formula: see text] BW and no-[Formula: see text] BW) and total compressive tibiofemoral force ([Formula: see text] BW and no-[Formula: see text] BW). Finally, for the subjective ratings, participants indicated that the knee sleeve significantly improved perceived comfort and stability. Experiment 2 did not reveal any statistical differences between knee sleeve and no-sleeve conditions nor any effects of the knee sleeve on subjective ratings of comfort or stability. Therefore, the findings from the current investigation suggest that the prophylactic knee sleeve examined in the current investigation does not appear to reduce the biomechanical parameters linked to the aetiology of knee pathologies in male/female footballers.

Tibiofemoral Compressive Force During Downhill Walking in Patients with Primary Total Knee Arthroplasty: A Statistical Parametric Mapping Approach

Tibiofemoral Compressive Force During Downhill Walking in Patients with Primary Total Knee Arthroplasty: A Statistical Parametric Mapping Approach

Effects of Voluntary Quadriceps-Hamstring Cocontraction on Tibiofemoral Force During Isometric Knee Extension and Knee Flexion Exercises With Constant External Resistance.

A biomechanical model has been developed to assess the effects of a voluntary effort of quadriceps-hamstring cocontraction on tibiofemoral force during isometric knee flexion and knee extension exercises with constant external resistance. The model establishes the analytic condition in the moment arms and traction angles of the quadriceps and hamstring muscles that determines the direction (anterior/posterior) of the tibiofemoral shear force developed by the cocontraction. This model also establishes the mechanical effect (loading/unloading) on the anterior cruciate ligament (ACL). At about 15° of knee flexion (where the ACL experiences its maximum quadriceps-induced strain) a voluntary quadriceps-hamstring cocontraction effort yields: (1)nearly the same enhancement in hamstring and quadriceps activation, (2)an increase in hamstring force about 1.5 times higher than that of the quadriceps, and (3)posterior (ACL unloading) tibial pull and compressive tibiofemoral force that increase linearly with the level of quadriceps and hamstring activation. The sensitivity of the results to intersubject variability in the posterior slope of the tibial plateau and muscle moment arms has been estimated with the use of anatomic data available in the literature. An anterior (ACL loading) tibial pull is actually developed at 15° of knee flexion by a voluntary effort of quadriceps-hamstring cocontraction as the posterior tibial slope exceeds 14°.

Are Medial and Lateral Tibiofemoral Compressive Forces Different in Uphill Compared to Level Walking for Patients Following Total Knee Arthroplasty?

The purpose of this study was to determine how tibiofemoral joint compressive forces and knee joint-spanning muscle forces during uphill walking change compared to level walking in patients with total knee arthroplasty (TKA). A musculoskeletal model capable of resolving total (TCF), medial (MCF), and lateral (LCF) tibiofemoral compressive forces was used to determine compressive forces and muscle forces during level and uphill walking on a 10 deg incline for twenty-five post-TKA patients. A 2 × 2 (slope: level and 10 deg × limb: replaced and nonreplaced) repeated measures analysis of variance was used to detect differences in knee contact forces between slope and limb conditions and their interaction. Peak loading-response TCF, MCF, and LCF were greater during uphill walking than level walking for nonreplaced limbs. During uphill walking, peak loading-response TCF was smaller in replaced limbs compared to nonreplaced limbs with no change in MCF or LCF. Peak knee extension moment and knee extensor muscle force were smaller in replaced limbs compared to nonreplaced limbs during uphill walking. During level walking, replaced and nonreplaced limbs experienced rather equal joint loading; however, replaced limb experienced reduced joint loading during uphill walking. Differences in joint loading between replaced and nonreplaced limbs were not present during level walking, suggesting compensation from the replaced limb during the more difficult task. Uphill walking following TKA promotes more balanced loading of replaced limbs during stance; however, these benefits may come at the expense of increased loading on nonreplaced limbs.

Biomechanical Consequences of Tibial Insert Thickness after Total Knee Arthroplasty: A Musculoskeletal Simulation Study

The thickness of the tibial polyethylene (PE) insert is a critical parameter to ensure optimal soft-tissue balancing in the intraoperative decision-making procedure of total knee arthroplasty (TKA). However, there is a paucity of information about the kinetic response to PE insert thickness variations in the tibiofemoral (TF) joint, and subsequently, the secondary effects on the patellofemoral (PF) biomechanics. Therefore, the purpose of this study was to investigate the influence of varying PE insert thickness on the ligament and TF compressive forces, as well as on the PF forces and kinematics, after a cruciate-retaining TKA. A previous patient-specific musculoskeletal model of TKA was adapted to simulate a chair-rising motion in which PE insert thickness was varied with 2 mm increments or decrements compared to the reference case (9 mm), from 5 mm up to 13 mm. Greater PE insert thickness resulted in higher ligament forces and concurrently increased the TF compressive force by 21% (13 mm), but slightly unloaded the PF joint with 7% (13 mm) while shifting the patella distally in the trochlear groove, compared to the reference case. Thinner PE inserts showed an opposite trend. Our findings suggest that the optimal PE insert thickness selection is a trade-off between the kinetic outcomes of the TF and PF joints.

Changes in knee kinematics from applied external Tibial torque: Implications for stabilizing an anterior cruciate ligament deficient knee

BackgroundChanges in knee kinematics from internal tibial torque under tibiofemoral compression force have been studied, but the potentially stabilizing effects of external tibial torque have not been reported. We hypothesized that for a given knee flexion angle, 1) external torque would significantly reduce anterior tibial translation, internal tibial rotation, and valgus tibial rotation before and after sectioning the anterior cruciate ligament and 2) changes in kinematics from applied external torque would be significantly greater with the cruciate cut. MethodsA robotic test system was used to flex intact human knees continuously from 0° to 50° under 200 N compression, without and with 5 Nm external torque. Tests were repeated after cruciate section. FindingsWith the cruciate intact, external torque had no significant effect on anterior translation, and significantly reduced internal and valgus rotations at all flexion angles. With the cruciate cut, external torque significantly reduced anterior translation beyond 25° flexion, significantly reduced internal rotation at all flexion angles, and significantly reduced valgus rotation beyond 15° flexion. Although external torque had no significant effect on anterior translation with the ACL intact, external torque produced relatively large decreases in anterior translation with the cruciate sectioned (−11.6 mm at 50° flexion). Reductions in valgus rotation from applied external torque were significantly greater for cruciate deficient knees beyond 25° flexion. InterpretationWe conclude that external tibial torque may be important for controlling the abnormal kinematics associated with an anterior cruciate ligament deficient knee, and possibly help stabilize the knee during in vivo activities.

Muscle contributions to medial and lateral tibiofemoral compressive loads during sidestep cutting

The tibiofemoral compressive forces experienced during functional activities are believed to be important for maintaining tibiofemoral stability. Previous studies have shown that both knee-spanning and non-knee-spanning muscles contribute to tibiofemoral joint compressive forces during walking. However, healthy individuals typically engage in more vigorous activities (e.g. jumping and cutting) that provide greater challenges to tibiofemoral stability. Despite this, no previous studies have investigated how both knee-spanning and non-knee-spanning muscles contribute to tibiofemoral compressive loading during such tasks. The present study investigated how muscles contributed to the medial and lateral compartment tibiofemoral compressive forces during sidestep cutting. Three-dimensional marker trajectories, ground reaction forces and muscle electromyographic signals were collected from eight healthy males whilst they completed unanticipated sidestep cutting. OpenSim was used to perform musculoskeletal simulations to compute the contribution of each lower-limb muscle to compressive loading of each compartment of the knee. The greatest contributors to medial compartment loading were the vasti, gluteus maximus and medius, and the medial gastrocnemius. The greatest contributors to lateral compartment loading were the vasti, adductors, medial and lateral gastrocnemius, and the soleus. The soleus displayed the greatest potential for unloading the medial compartment, whereas the gluteus maximus and medius displayed the greatest potential for unloading the lateral compartment. These findings may help to inform interventions aiming to modulate compressive loading at the knee.

The influence of tibiofemoral joint forces on patient-reported outcome measurements after bicruciate stabilized total knee arthroplasty.

Insall advocated that a successful clinical outcome of total knee arthroplasty (TKA) depends on soft tissue balance procedure. Spacer blocks, balancer, and instrumented tibial sensor (VERESENSE, OrthoSensor, Dania, Florida, USA) are the current methods of soft tissue balancing during TKA. The purpose of the study is to assess intraoperative medial and lateral tibiofemoral compressive force (TFCF) using novel insert sensor and investigate the relationship between TFCF and patient-reported outcome measurements (PROMs). Twenty-five patients who underwent bicruciate stabilized (BCS) TKA were evaluated retrospectively. We measured intraoperative medial and lateral TFCF in neutral position as well as the force ratio (FR %:medial TFCF/medial + lateral TFCF) in varus and valgus position using the novel insert sensor throughout the range of motion (ROM) and assessed the relationship between intraoperative medial and lateral TFCF and PROM at 6 months after TKA. Medial TFCF increased and lateral TFCF decreased throughout ROM. The mean FR was 0.44% ± 0.22 throughout ROM. Medial and lateral TFCF differences at 60° of ROM in neutral position showed a positive correlation with physical function in Western Ontario and McMaster Universities scores (r = 0.60, p < 0.05). Medial and lateral TFCF differences at 30° and 140° of ROM in valgus stress test showed a positive correlation with symptoms in 2011 Knee Society Scores (r = 0.49, p < 0.05; r = 0.51, p < 0.05). The present study revealed that BCS TKA reproduces the coronal laxity, which is similar to healthy knee. These results suggest that intraoperative medial stability is important for function and symptoms, therefore, surgeons should not release medial soft tissue for achieving better clinical outcomes after BCS TKA. II.

Lower limb muscle and joint forces during front and back squats performed on a Smith machine

BACKGROUND: Comparison of knee loads on a Smith machine, which is utilised for maintenance of health and rehabilitation, has not been attempted. OBJECTIVE: This study compared lower limb muscle and knee joint forces during front and back squats performed on a Smith Machine. METHODS: Eleven participants performed front and back squats with loads at 40%, 60% and 80% of their back squat 1-RMs. Ground reaction forces and three-dimensional full body motion were collected and used for modelling lower limb muscle and knee joint forces. RESULTS: Larger loads increased tibiofemoral compressive force during back squat at 80% compared to 40% (p&lt; 0.01; d= 1.58) and to 60% (p&lt; 0.01; d= 1.37). Patellofemoral compressive (p= 0.96) and tibiofemoral shear forces (p= 0.55) were not influenced by external load or type of squat. Gluteus medius and minimus produced more force at 80% compared to 60% (p= 0.01; d= 1.10) and to 40% (p&lt; 0.01; d= 1.87) without differences for other muscles (p= 0.09–0.91). CONCLUSIONS: Greater external load was associated with increase in gluteus medius and minimus force and with increased tibiofemoral compressive force without effects on tibiofemoral shear force, patellofemoral compressive force or other lower limb muscle forces.

Sensitivity of the knee joint response, muscle forces and stability to variations in gait kinematics-kinetics

Sensitivity analysis of the knee joint response to variations in gait kinematics-kinetics as reported in the literature is crucial for improved understanding and more effective prevention-treatment strategies. Using our validated finite element-musculoskeletal (FE-MS) model of lower extremity, we investigate the sensitivity of knee anterior cruciate ligament (ACL), muscle, and contact forces plus stability to the reported scatter in asymptomatic gait data. Three highly loaded stance instants (25, 50 and 75%) with five levels (mean, ±0.5SD and ±SD) for each of six knee joint angles-moments are used employing Taguchi approach (25 experiments) and regression equations. ACL force drops significantly at larger flexion angles (all periods) and smaller internal moment (at 75% only) but increases with the flexion moment. Tibiofemoral (TF) medial-lateral contact force partitioning is found, contrary to the common claim, most sensitive to changes in the adduction angle and not in the adduction moment. Total TF contact force increases significantly at greater moments (but not angles), especially in the sagittal plane. Forces in lateral hamstrings are significantly influenced by changes in adduction angles-moments. Larger flexion moments (at 25 and 50%) significantly increase forces in quadriceps and on patellofemoral (PF) contact. Sagittal moment, adduction moment (at 75%) and flexion angle (at 25%) contribute most to the joint stability. A strong inverse correlation exists between the joint stability and the total TF compression force. These findings can be exploited to adapt and modify intact, injured and reconstructed knee joint responses during gait.

Preliminary study of a customised total knee implant with musculoskeletal and dynamic squatting simulation

Customised total knee replacement could be the future therapy for knee joint osteoarthritis. A preliminary design of a customised total knee implant based on knee anatomy was studied in this article. To evaluate its biomechanical performance, a dynamic finite element model based on the Oxford knee rig was created to simulate a squatting motion. Unlike previous research, this dynamic model was simulated with patient-specific muscle and joint loads that were calculated from an OpenSim musculoskeletal model. The dynamic response of the customised total knee implant was simulated under three cruciate ligament scenarios: both cruciate ligaments retained, only anterior cruciate ligament removed and both cruciate ligaments removed. In addition, an off-the-shelf symmetric total knee implant with retained cruciate ligaments was simulated for comparison analysis. The customised total knee implant with both cruciate ligaments retained showed larger ranges of femoral external rotation and posterior translation than the symmetric total knee implant. The motion of the customised total knee implant was also in good agreement with a healthy knee. There were no big differences in the tibiofemoral compressive forces in the customised total knee implant model under the three scenarios. These forces were generally consistent with other experimental and simulation results. However, the customised total knee implant design resulted in larger tibiofemoral compressive force than the symmetric total knee implant after 50° knee flexion, which was caused by the larger tibiofemoral relative motion.

Femoral Chondral Lesions Increase in Severity with Aging Equally Between the Sexes and Present in Comparable Locations

ObjectiveThe objective of this study was to determine if visible, femoral chondral lesions on cadaveric knee joints exacerbate differently with aging between the sexes.Methods85 cadaveric femurs were assessed for chondral pathology overlying the femoral condyles and patellar fossa using a 0–4 qualitative grading scale for gross signs of osteoarthritis (OA). Each specimen was blinded to four raters and the raters' scores were averaged to provide each specimen a Disease Severity Score (DSS).ResultsSpecimens 80+ years old (N=22) had an average DSS of 3.19 ± 0.69 compared to a DSS of 2.7 ± 0.85 and a DSS of 2.52 ± 0.95 for specimens 70–79 years old (N=42) and specimens below 70 years old (N=22), respectively. The DSS for the 80+ years old population was significantly greater than the DSS of the 70–79 years old population (p &lt; 0.05) and the below 70 years old population (p &lt; 0.05). Specimens that scored a DSS of 2 and above, representing mild OA to severe OA, were assessed for their specific site of most severe degeneration. The most severe degeneration on the femoral articular cartilage was consistently on the patellar fossa. This degeneration was seen in 45% of specimens below 70 years old, 60% of specimens 70–79 years old and 50% of specimens above the age of 80 years old. The lateral condyle was the second most degenerated region in the below 70 years old specimens (27%). The medial condyle became the second most degenerated region in the 70–79 years old specimens (38%) and the above 80 years old specimens (68%). The males and females in the above 80 years old population each displayed a 2:7 ratio for lateral condyle vs. medial condyle as the site of most severe deterioration.ConclusionsThis study displayed increased severity of OA on the femoral condyles with aging yet, there was no difference between the sexes in the severity or location of degeneration. With increased propensity to develop shearing forces in the knee based on cruciate ligament thinning or muscular atrophy around the joint the medial joint can experience increased degeneration. Currently, over 2/3s of the American population is overweight and obesity sways tibiofemoral compression forces to the lateral respects of the joint. When patients are over the age of 80 their muscles supporting the joint have atrophied and can no longer resist degenerative shearing forces at the knee. Whereas patients between the ages of 70–79 appear to represent a split population where approximately half of this population may be affected by obesity and the other half by muscular atrophy. It is recommended that public health advisory committees target these patients earlier in adult life with recommendations to increase their muscle mass around the knee joint and reduce obesity. The most prevalent sites of degeneration per each age group should be considered as research on stem cell therapy for synovial joint pathology continues to increase.Support or Funding InformationInternal grant from Rocky Mountain University of Health ProfessionsThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Effects of tibiofemoral compression on ACL forces and knee kinematics under combined knee loads.

Injuries to the anterior cruciate ligament (ACL) can occur during landing from a jump or changing direction during a cutting maneuver. In these instances, the knee is subjected to combined forces and moments as it flexes under tibiofemoral compression force (TCF). We hypothesized that TCF would increase ACL forces and tibiofemoral motions under isolated and combined modes of loading relevant to knee injury. ACL force and knee kinematics were recorded in human cadaveric specimens during knee flexion from 0° to 50° under the following test conditions (alone and in combination): 2 N-m internal tibial torque (IT), 5 N-m valgus moment (VM), and 45N anterior tibial force (AF). Knees were tested with 25N (baseline), 250N, and 500N TCF. ACL force increased with knee flexion during all tests. As the knee was flexed, VM produced a coupled internal tibial rotation, and IT produced a coupled valgus rotation. ACL forces with IT + VM were significantly higher than with IT alone (beyond 10° flexion) or VM alone (at all flexion angles). Increasing the level of TCF above baseline did not significantly change valgus or tibial rotations for any loading condition, but did significantly increase anterior tibial translation (ATT) at all flexion angles and ACL force at flexion angles beyond 5° to 15°. Addition of AF to tests with IT + VM significantly increased ATT and ACL force without significantly altering internal and valgus rotations. The mechanism of high ACL force generation from increased TCF was related to ATT and not internal or valgus rotations of the tibia. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Influence of Varying Squat Exposure on Knee Pain and Function among People with Knee Osteoarthritis

Knee osteoarthritis (OA) is a leading cause of pain and functional disability globally. Knowledge about the influence of high-flexion postures on knee function among people with knee OA is limited. Sustained occupational squatting is assumed to increase tibio-femoral and patella-femoral compressive force and knee osteoarthritis. Additionally, people spend varying amounts of time in deep squat for performing self-care, activities of daily living (ADL), and leisure. Hence, a study was conducted to explore the influence of varying squat exposure on knee pain and function. An interview-based survey was conducted inclusive of 300 participants, following institutional ethical approval and informed consent. Participants were classified based on daily squat exposure using a validated tool: the MGM Ground Level Activity Exposure Questionnaire. Knee pain and function were assessed using the Numeric Rating Scale and the Modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. Thirty-three people from the study cohort (Nonsquatters n = 13, ADL squatters n = 10, occupational squatters n = 10) were evaluated for knee motion, muscle strength, and balance using 2D motion analysis, 30-second chair-stand test, calf-raise test, 30-second deep-squat test, single-leg stance test, and star excursion test, respectively. Prevalence of knee pain was 27% in squatters and 21% in nonsquatters. People with higher squat exposure demonstrated greater knee motion, muscle strength, and balance compared with nonsquatters. Occupational squatters continued to work on a higher level of function despite pain and difficulty. Deep-squat activity performed in moderation is a potentially beneficial activity to maintain knee range, muscle strength, and balance.

Prediction of ACL Force Produced by Tibiofemoral Compression During Controlled Knee Flexion: A New Robotic Testing Methodology.

Tibiofemoral compression force (TCF) is an important component of anterior cruciate ligament (ACL) injuries. A new robotic testing methodology was utilized to predict ACL forces generated by TCF without loading the ligament. We hypothesized that ACL force, directly recorded by a miniature load cell during an unconstrained test, could be predicted by measurements of anterior tibial restraining force (ARF) recorded during a constrained test. The knee was first flexed under load control with 25N TCF (tibia unconstrained) to record a baseline kinematic pathway. Tests were repeated with increasing levels of TCF, while recording ACL force and knee kinematics. Then tests with increasing TCF were performed under displacement control to reproduce the baseline kinematic pathway (tibia constrained), while recording ARF. This allowed testing to 1500N TCF since the ACL was not loaded. TCF generated ACL force for all knees (n=10) at 50° flexion, and for 8 knees at 30° flexion. ACL force and ARF had strong linear correlations with TCF at both flexion angles (R2 from 0.85 to 0.99), and ACL force was strongly correlated with ARF at both flexion angles (R2 from 0.76 to 0.99). Under 500N TCF the mean error between ACL force prediction from ARF regression and measured ACL force was 4.8 ± 7.3 N at 30° and 8.8 ± 27.5 N at 50° flexion. Our hypothesis was confirmed for TCF levels up to 500N, and ARF had a strong linear correlation with TCF up to 1500N TCF.