Normal Gait of Young and Old Men and Women: Ground Reaction Force Measurement on a Treadmill

Forty normal persons had their gait tested using an instrumented treadmill. All were tested at the same speed of gait. The temporal factors of gait, the ataxia, and the external work of the gait were all calculated from the ground reaction forces. Ten women and ten men aged 20-29 years and ten women and ten men aged 60-69 were tested. The study demonstrated a constant pattern of gait independent of age and sex.     

Analysis of the Vertical Ground Reaction Forces and Temporal Factors in the Landing Phase of a Countermovement Jump

In most common bilateral landings of vertical jumps, there are two peak forces (F1 and F2) in the force-time curve. The combination of these peak forces and the high frequency of jumps during sports produce a large amount of stress in the joints of the lower limbs which can be determinant of injury. The aim of this study was to find possible relationships between the jump height and F1 and F2, between F1 and F2 themselves, and between F1, F2, the time they appear (T1 and T2, respectively) and the length of the impact absorption phase (T). Thirty semi-professional football players made five countermovement jumps and the highest jump of each player was analyzed. They were instructed to perform the jumps with maximum effort and to land first with the balls of their feet and then with their heels. All the data were collected using a Kistler Quattro Jump force plate with a sample rate of 500 Hz. Quattro Jump Software, v.1.0.9.0., was used. There was neither significant correlation between T1 and F1 nor between T1 and F2. There was a significant positive correlation between flight height (FH) and F1 (r = 0.584, p = 0.01) but no significant correlation between FH and F2. A significant positive correlation between F1 and T2 (r = 0.418, p < 0.05) and a significant negative correlation between F2 and T2 (r = -0.406, p < 0.05) were also found. There is a significant negative correlation between T2 and T (r = -0. 443, p < 0.05). T1 has a little effect in the impact absorption process. F1 increases with increasing T2 but F2 decreases with increasing T2. Besides, increasing T2, with the objective of decreasing F2, makes the whole impact absorption shorter and the jump landing faster.

Key points

• In the landing phase of a jump there are always sev-eral peak forces. The combination of these peaks forces and the high frequency of jumps during sports produces a large amount of stress in the joints of the lower limbs which can be determinant of injury.
• In the most common two-footed landings usually appear two peak forces (F1 and F2) in the force-time curve and the second one is usually related to injury’s risk. In this article it is shown that increasing the time F2 appears decrease F2.
• Increasing landing times could be counterproductive with respect to the goals of the sport. In this article it is shown that increasing the time F2 appears makes, however, the whole impact absorption shorter in du-ration.

Key words: Impact absorption, peak forces, vertical jump, injuries     

腰椎间盘突出症患者步态观察与分析

运用频闪摄影计算机图象分析方法观察分析了９例腰椎间盘突出症的步态运动，并与正常人进行了对比。结果发现，患者整个步态周期延长，患肢站立相延长、摆动相相对缩短。患肢髂膝踝水平与垂直位移范围减小、速度变慢，这些变化可为评定病痛程度与治疗效果提供重要参考。     

Gait symmetry: a comparison of hip resurfacing and jumbo head total hip arthroplasty patients

Proponents of large femoral head total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) have touted the potential for restoration of more normal hip kinematics. This study examined 20 patients (10 THA and 10 HRA patients) approximately 18 months after surgery. Subjects were evaluated at a self-selected pace, while bilateral spatial-temporal gait variables, hip flexion/extension kinematics, and ground reaction forces were collected. For both groups, swing time was increased on the surgical side, whereas peak hip flexion, peak extension, and flexion at heel strike were decreased. Peak hip extension and peak vertical ground reaction forces were decreased in THA subjects compared with HRA subjects. After a large-diameter THA or HRA, subjects do not display symmetric gait approximately 18 months postoperatively. Total hip arthroplasty subjects demonstrated restricted hip extension and reduced limb loading when compared with HRA subjects.     

Gait Analysis with an Angle Diagram Technique: Application in Healthy Persons and in Studies of Marmor Knee Arthroplasties

Normal step dimension data were obtained from six healthy subjects by recording step length and step frequency at different walking speeds. In addition, an externally applied goniometer system was used to measure the sagittal knee and hip joint movements in eleven persons with healthy joints. The movements were recorded on an oscilloscope in the form of a so-called angle diagram during walking. In seven patients undergoing Marmor knee arthroplasty the same gait analysis as in the healthy subjects was performed before and after operation. The results were compared by a clinical scoring system for pain and walking ability and by measurement of passive knee mobility and passive extension deficit. The angle diagram permitted recording of functional sagittal mobility and functional extension deficit during walking. The functional knee mobility during walking was found to be pain- dependent; thus increasing pain is accompanied by a gradual decrease in functional mobility despite good passive knee joint motion. In several patients the functional extension deficit during walking was increased compared with the extension deficit on passive movement. The clinical improvements after knee arthroplasty corresponded very well to the increased functional knee mobility during walking, measured on the angle diagram.     

Usability and Reliability of the Edinburgh Visual Gait Score in Children with Spastic Cerebral Palsy Using Smartphone Slow-Motion Video Technology and a Motion Analysis Application: A Pilot Study

BackgroundThe Edinburgh Visual Gait Score (EVGS) is a comprehensive measure of gait abnormalities in children with cerebral palsy (CP) and has good psychometric properties. However, it is cumbersome to administer and requires multiple devices to record and measure its various components. We conducted this study to determine if a smartphone video protocol could be used to improve the usability and reliability of the EVGS for daily use in a clinic setting.MethodsWe used a handheld smartphone camera with slow-motion video technology and a motion analysis application to record and measure the EVGS of 30 ambulatory children with spastic CP. We tested the inter- and intra-rater reliability of various components of the EVGS between two observers.ResultsAverage age was 7 years 3 months (range 4–14 years). The mean (range) EVGS scores for the trunk, pelvis, hip, knee, ankle, and foot were 1.18 (0–3), 0.68 (0–3), 1.1 (0–4), 3.95 (1.5–7.5), 1.87 (0–4) and 4.13 (2–6.5) respectively. Total score was 12.92 (7–21.5). The mean (SD) scores for Gross Motor Function Classification System (GMFCS) levels II and III were 10.73 (3.86) and 14.96 (4.2) (p < 0.001). The intra-observer and inter-observer reliability using percentage of complete agreement was 65–98.3% and 61.7–92.5% respectively, with kappa values ranging from 0.15 to 0.87. Reliability was more for distal limb segments as compared to proximal segments.ConclusionWe have described a simple and reliable method for quantitative OGA of children with CP, using smartphone video technology and motion analysis application, which can be performed by every clinician in an office setting.Level of EvidenceLevel III.     

Reliability and Validity of the Functional Gait Assessment in Incomplete Spinal Cord Injury

Background:There are limited psychometrically sound measures to assess higher level balance in individuals with incomplete spinal cord injury (iSCI).Objectives:To evaluate interrater and intrarater reliability and convergent validity of the Functional Gait Assessment (FGA) in individuals with iSCI.Methods:Twelve participants (11 male, 1 female) 32 to 73 years old with chronic motor iSCI, American Spinal Injury Association Impairment Scale C (n = 2) or D (n = 10), were included. Participants completed five outcome measures during a single test session including lower extremity motor scores from the International Standards for the Neurological Classification of Spinal Cord Injury, FGA, 10-Meter Walk Test (10MWT), Walking Index for Spinal Cord Injury (WISCI-II), and the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP).Results:Inter- and intrarater reliability for the FGA were excellent. Interrater reliability was excellent with intraclass correlation coefficient (ICC) scores greater than 0.92 (p < .001). Interrater reliability against an expert was also excellent for all raters, with an ICC greater than or equal to 0.92 (p < .01). Intrarater reliability was excellent with an ICC score of greater than 0.91 (p < .002) for all raters. Validity of the FGA with 10MWT was −0.90 (p = .000), FGA with WISCI-II was 0.74 (p = .006), and FGA with SCI-FAP was −0.83 (p = .001).Conclusion:The FGA is a reliable and valid outcome measure to use when assessing gait and balance in individuals with motor iSCI. The FGA provides clinicians with a single tool to utilize across a variety of neurologic diagnoses.     

Kinematic Evaluation of the GMK Sphere Implant During Gait Activities: A Dynamic Videofluoroscopy Study

Joint stability is a primary concern in total knee joint replacement. The GMK Sphere prosthesis was specifically designed to provide medial compartment anterior–posterior (A–P) stability, while permitting rotational freedom of the joint through a flat lateral tibial surface. The objective of this study was to establish the changes in joint kinematics introduced by the GMK Sphere prosthesis during gait activities in comparison to conventional posterior‐stabilized (PS) fixed‐bearing and ultra‐congruent (UC) mobile‐bearing geometries. The A–P translation and internal/external rotation of three cohorts, each with 10 good outcome subjects (2.9 ± 1.6 years postop), with a GMK Sphere, GMK PS or GMK UC implant were analysed throughout complete cycles of gait activities using dynamic videofluoroscopy. The GMK Sphere showed the smallest range of medial compartment A–P translation for level walking, downhill walking, and stair descent (3.6 ± 0.9 mm, 3.1 ± 0.8 mm, 3.9 ± 1.3 mm), followed by the GMK UC (5.7 ± 1.0 mm, 8.0 ± 1.7 mm, 8.7 ± 1.9 mm) and the GMK PS (10.3 ± 2.2 mm, 10.1 ± 2.6 mm, 11.6 ± 1.6 mm) geometries. The GMK Sphere exhibited the largest range of lateral compartment A–P translation (12.1 ± 2.2 mm), and the largest range of tibial internal/external rotation (13.2 ± 2.2°), both during stair descent. This study has shown that the GMK Sphere clearly restricts A–P motion of the medial condyle during gait activities while still allowing a large range of axial rotation. The additional comparison against the conventional GMK PS and UC geometries, not only demonstrates that implant geometry is a key factor in governing tibio‐femoral kinematics, but also that the geometry itself probably plays a more dominant role for joint movement than the type of gait activity. © 2019 The Authors. Journal of Orthopaedic Research^® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2337–2347, 2019     

Dynamic and Functional Gait Analysis of Severely Displaced Intra-Articular Calcaneus Fractures Treated with a Hinged External Fixator or Internal Stabilization

The purpose of this article was to assess functional gait outcome. Fifty-five patients with severely displaced intra-articular calcaneus fractures and soft tissue damage were evaluated prospectively with computerized dynamic pedography and a clinical scoring scale. The treatment protocol assigned 30 patients to open reduction and internal fixation (ORIF) and 25 to closed reduction and stabilization with a biomechanically tested hinged external fixator. Gait parameter was evaluated by measuring plantar pressure distribution, length of a double-step, double-step duration, standing duration, effective foot length, and width of gait. Pedographic measurements were performed with a custom-made gait analysis system (medilogic Gangas, Berlin, Germany). Results were graded by an extended protocol of questionnaires and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scales. Radiographs were reviewed according to the Sanders classification at the time of follow-up (7.3 years). All measurements were statistically analyzed (t test; Mann-Whitney U test). Aberrations were associated with all calcaneal fractures in both groups. Dynamic gait analysis showed gait asymmetry in all patients. The type of treatment (ORIF or a hinged fixator) of severely displaced calcaneus fractures did not affect gait analysis nor result in significantly different (P > .05) patient outcome scores. The gait analysis system allows a valid dynamic pedographic measurement. The hinged external fixator can be recommended in displaced intra-articular calcaneal fractures with severe soft tissue damage to reduce complications associated with ORIF. ACFAS Level of Clinical Evidence: 2c.     

In Vivo Measurement of Thumb Joint Reaction Forces During Smartphone Manipulation: A Biomechanical Analysis

The relationship between arthritis or repetitive stress injuries (RSIs) in thumbs and rapidly increasing hours of smartphone usage is not fully elucidated. We evaluated axial joint reaction forces (AJRFs) and thumb torques in 19 healthy subjects performing typical smartphone tasks, which included tapping, tap game, and swiping. We measured force and torque when a subject tapped or swiped the panel of the smartphone and analyzed the motions of each joint using surface markers and motion capture systems. We calculated AJRFs and torques on each thumb joint using inverse dynamics. The results were then compared with representative activities such as computer keyboard typing and handwriting. The mean AJRFs/torques at the thumb carpometacarpal joint (CMCJ) while tapping the smartphone and tap gaming were 12.5 N/95.5 N mm and 21.1 N/187.21 N mm, respectively. AJRFs and torques were significantly higher during tap gaming activities than during simple tapping subtasks (p = 0.003 and p < 0.001, respectively). Compared with those during computer keyboard typing, the mean AJRFs and torques at the CMCJ during smartphone tapping was 3 (p = 0.075) and 1.4 times (p = 0.680) larger, respectively. Considering the rapidly increasing dependency on smartphones in our daily lives, long‐term exposure of the thumb to repetitive AJRFs and torques may lead to an acceleration of arthritis or aggravation of RSIs in thumbs. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2437–2444, 2019     

股骨粗隆间骨折术后步行状态的生物力学特性

目的：研究单臂外固定架治疗股骨粗隆间骨折术后步行状态的生物力学特性。 方法：将 CT 数据文件经Simpleware 软件进行三维重建处理,得到股骨及外固定架的三维几何模型。在 Anybody 软件中建立正常人体股骨模型,并与股骨外固定架模型（stl 几何模型）一同导入 Geomagic Studio 软件中,将两组模型进行比对配准。将配准好的股骨外固定架模型导入 Anybody 软件中,通过 Simpleware 得到的网格模型（inp 格式）导入到 Abaqus 软件中,分析 1 个步态周期的应力分布情况。结果：以左侧为例,术后在行走过程中较大应力发生在不锈钢钉与股骨的连接处以及不锈钢钉与固定架的连接处,整体未见明显应力集中现象,在典型步态右足趾离地和左全足底着地中产生较大应力,在左足跟着地、右足跟着地产生一定应力集中现象,左足趾离地时应力最小。结论：单臂外固定架治疗股骨粗隆间骨折,安全、有效,符合人体步行状态的生物力学要求。     

Gait mechanics and tibiofemoral loading in men of the ACL‐SPORTS randomized control trial

The risk for post‐traumatic osteoarthritis is elevated after anterior cruciate ligament reconstruction (ACLR), and may be especially high among individuals with aberrant walking mechanics, such as medial tibiofemoral joint underloading 6 months postoperatively. Rehabilitation training programs have been proposed as one strategy to address aberrant gait mechanics. We developed the anterior cruciate ligament specialized post‐operative return‐to‐sports (ACL‐SPORTS) randomized control trial to test the effect of 10 post‐operative training sessions consisting of strength, agility, plyometric, and secondary prevention exercises (SAPP) or SAPP plus perturbation (SAPP + PERT) training on gait mechanics after ACLR. A total of 40 male athletes (age 23 ± 7 years) after primary ACLR were randomized to SAPP or SAPP + PERT training and tested at three distinct, post‐operative time points: 1) after impairment resolution (Pre‐training); 2) following 10 training sessions (Post‐training); and 3) 2 years after ACLR. Knee kinematic and kinetic variables as well as muscle and joint contact forces were calculated via inverse dynamics and a validated electromyography‐informed musculoskeletal model. There were no significant improvements from Pre‐training to Post‐training in either intervention group. Smaller peak knee flexion angles, extension moments, extensor muscle forces, medial compartment contact forces, and tibiofemoral contact forces were present across group and time, however the magnitude of interlimb differences were generally smaller and likely not meaningful 2 years postoperatively. Neither SAPP nor SAPP + PERT training appears effective at altering gait mechanics in men in the short‐term; however, meaningful gait asymmetries mostly resolved between post‐training and 2 years after ACLR regardless of intervention group. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2364–2372, 2018.

     

Gait Mechanics in Women of the ACL‐SPORTS Randomized Control Trial: Interlimb Symmetry Improves Over Time Regardless of Treatment Group

Women after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) are more likely than men to exhibit asymmetric movement patterns, which are associated with post‐traumatic osteoarthritis. We developed the ACL specialized post‐operative return‐to‐sports (ACL‐SPORTS) randomized control trial to test the effect of strength, agility, plyometric, and secondary prevention (SAPP) training with and without perturbation training (SAPP + PERT) on gait mechanics in women after ACLR. We hypothesized that movement symmetry would improve over time across both groups but more so among the SAPP + PERT group. Thirty‐nine female athletes 3–9 months after primary ACLR were randomized to SAPP or SAPP + PERT training. Biomechanical testing during overground walking occurred before (Pre‐training) and after (Post‐training) training and one and 2 years post‐operatively. Hip and knee kinematic and kinetic variables were compared using repeated measures analysis of variance with Bonferroni corrections for post hoc comparisons (α = 0.05). There was a time by limb interaction effect (p = 0.028) for peak knee flexion angle (PKFA), the primary outcome which powered the study, characterized by smaller PKFA in the involved compared to uninvolved limbs across treatment groups at Pre‐training, Post‐training, and 1 year, but not 2 years. Similar findings occurred across sagittal plane knee excursions and kinetics and hip extension excursion at midstance. There were no meaningful interactions involving group. Neither SAPP nor SAPP + PERT training improved walking mechanics, which persisted 1 but not 2 years after ACLR. Statement of clinical significance: Asymmetrical movement patterns persisted long after participants achieved symmetrical strength and functional performance, suggesting more time is needed to recover fully after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1743–1753, 2019     

Editorial Commentary: Arthroscopic Latarjet: An Analysis of Outcomes and Complications Through its Learning Curve

The arthroscopic Latarjet has been proposed in the past decade to reduce the rate of bone block malpositioning, decrease soft-tissue damage associated with open approach, and possibly decrease intraoperative complications. Several recent studies have reported similar or even superior results with arthroscopic Latarjet compared with those achieved with open technique. However, arthroscopic Latarjet is known to be more technically demanding and some feel that it should be performed by expert shoulder surgeons with advanced arthroscopic skills. Surgical innovations should be adopted when they have potential advantages for patients. Despite the initial challenges and learning curve of arthroscopic Latarjet, experience and technical skills may reduce the rate of intraoperative complications for this technically demanding procedure.     

Screw-Home Movement of the Tibiofemoral Joint during Normal Gait: Three-Dimensional Analysis

Background

The purpose of this study was to evaluate the screw-home movement at the tibiofemoral joint during normal gait by utilizing the 3-dimensional motion capture technique.

Methods

Fifteen young males and fifteen young females (total 60 knee joints) who had no history of musculoskeletal disease or a particular gait problem were included in this study. Two more markers were attached to the subject in addition to the Helen-Hayes marker set. Thus, two virtual planes, femoral coronal plane (P_f) and tibial coronal plane (P_t), were created by Skeletal Builder software. This study measured the 3-dimensional knee joint movement in the sagittal, coronal, and transverse planes of these two virtual planes (P_f and P_t) during normal gait.

Results

With respect to kinematics and kinetics, both males and females showed normal adult gait patterns, and the mean difference in the temporal gait parameters was not statistically significant (p > 0.05). In the transverse plane, the screw-home movement occurred as expected during the pre-swing phase and the late-swing phase at an angle of about 17°. However, the tibia rotated externally with respect to the femur, rather than internally, while the knee joint started to flex during the loading response (paradoxical screw-home movement), and the angle was 6°.

Conclusions

Paradoxical screw-home movement may be an important mechanism that provides stability to the knee joint during the remaining stance phase. Obtaining the kinematic values of the knee joint during gait can be useful in diagnosing and treating the pathological knee joints.     

Patient‐Specific Functional Analysis: The Key to the Next Revolution Towards the Treatment of Hip and Knee Osteoarthritis

Lower extremity joint arthroplasty surgery remains one of the most successful interventions in orthopaedics. While improvements in patient mobility and physical functioning following surgery are well‐documented, there remains significant post‐operative functional deficits in many patients. This highlights a need and an opportunity towards improving functional and patient‐reported outcomes of arthroplasty surgery. This review summarizes key opportunities arising from the recent 2018 Orthopaedic Research Society Meeting in New Orleans, USA. In this review, the Canadian Orthopaedic Research Society (i.e., CORS) highlights key research advances, case examples, scientific messages, and personalized medical care approaches toward improving physical functioning in our knee and hip joint arthroplasty patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1754–1759, 2019     

High Hip Center Reduces the Dynamic Hip Range of Motion and Increases the Hip Load: A Gait Analysis Study in Hip Arthroplasty Patients With Unilateral Developmental Dysplasia

BackgroundLong-term favorable clinical outcomes of anatomical or high hip center techniques in total hip arthroplasty (THA) are reported in patients with developmental dysplasia of the hip (DDH). However, there is little information about the effect of the hip center location on gait characteristics. The purpose of this study was to compare these surgical techniques with gait analysis, analyze the effect of the hip rotation center location on gait parameters, and discuss the possible problems that may arise.MethodsA total of 40 patients who underwent THA due to unilateral coxarthrosis secondary to Crowe type III-IV DDH and completed 5 years of follow-up were included in the study. Group 1 included 20 patients who underwent anatomical hip center reconstruction, while group 2 included 20 patients who underwent high hip center reconstruction. Gait analysis was performed, and the groups were compared according to the gait characteristics.ResultsThe mean temporospatial values were similar between the groups. The extension of the operated side was significantly lower in group 2 (?9.11 ± 8.92) than in group 1 (?1.87 ± 11.51) (P = .04). The mean longitudinal hip joint force was found to be significantly higher in group 2 (8.92 N/kg ± 0.54) than in group 1 (8.16 N/kg ± 0.66) (P = .04). The high hip center technique has been shown to increase the load on the hip and restrict the dynamic range of motion.ConclusionThe high hip center technique can decrease the survival of the implant and increase the fall risk as it increases the load on the hip and reduces the dynamic range of motion. The hip center should be reconstructed anatomically when possible in DDH patients who undergo unilateral THA.     

Quantitative evaluation of gait pattern in patients with osteoarthrosis of the knee before and after total knee arthroplasty. Gait analysis using a pressure measuring system

Using a pressure measuring system, we quantitatively evaluated gait pattern in patients with osteoarthrosis (OA) of the knee before and after total knee arthroplasty (TKA). In the OA group, the stance time was longer, and the average vertical component of the floor reaction force (AVF) was lower than the values in normal age-matched subjects. These gait parameters correlated with the clinical score. These results suggest that changes in the gait parameters reflect gait patterns that reduce load on the knee. The center of pressure (COP) under the foot was correlated with the axial alignment of the lower limb in the mid-stance phase. In the TKA group, the clinical scores and gait parameters were improved 12 months after surgery compared with the preoperative values. The COP in the mid-stance phase moved inward after the TKA. However, in patients examined more than 2 years after a TKA, stance time and AVF did not reach normal levels, despite the patients' good clinical scores. These findings indicate that the gait pattern before surgery continues although pain on walking is reduced early after a TKA. Gait evaluation with a simple pressure measuring system revealed the changes in gait that are difficult to define by subjective clinical assessment. Received for publication on April 13, 1998; accepted on Oct. 26, 1998