Limited knee extension during gait after total knee arthroplasty is related to a low Oxford Knee Score

BackgroundAfter total knee replacement (TKR) some patients report low self-perceived function, which is clinically measured using patient reported outcome measures (PROMs). However, PROMs, e.g. the Oxford Knee Score (OKS), inherently lack objective parameters of knee function. Biomechanical gait analysis is an objective and reliable measurement to quantitatively assess joint function. Therefore, the aim of this study was to explore the relationship between biomechanical gait parameters and the OKS.MethodsGait analyses were recorded in 37 patients at least one year after primary TKR and in 24 healthy controls. Parameters from this analysis were calculated for hip, knee and ankle joint angles and joint moments in the sagittal and frontal plane including initial contact, early, late stance and swing. For the patients these parameters were expressed as its difference to control values at matched walking speed. Linear regression analyses were performed between the parameters from gait analysis and the OKS, with speed as covariate.ResultsThe difference in knee extension angle at initial contact and late stance between patients and controls was significantly related to the OKS. Per one degree knee extension difference increase, the OKS reduced with 1.0 to 1.6 points. Overall, patients extended their knee less than controls. Neither ankle and hip gait parameters, nor joint moments showed a relation with OKS.ConclusionsAll patients with a submaximal score on the OKS showed limited knee extension during gait, even without a mechanical constraint in knee extension. This could be related to motor control limitations in this patient group.     

正走和倒走的膝关节生物力学特征比较

目的 比较正走和倒走两种不同行走模式时膝关节的生物力学特征。方法 采用三维运动捕捉系统Vicon T40和测力台AMTI OR6-7采集并比较13名健康青年男性志愿者正走和倒走时的时间、空间、运动学和动力学参数。结果 与正走相比,倒走时的步速、步频和步幅均显著减小,跨步周期和支撑相所占百分比显著增加;在矢状面上,倒走时膝关节活动度、最大屈伸力矩较正走小;在冠状面上,倒走时膝关节内翻外展活动范围也较正走小,内翻力矩峰值在支撑早期较正走小,但在支撑晚期较正走大;地面反作用力在支撑早期较正走大,但在支撑晚期较正走小。结论 倒走和正走膝关节生物力学特征差异明显。与正走相比倒走在支撑相早期能减轻膝关节内侧间室的负荷,而倒走在支撑相晚期对膝关节负荷的影响则尚须进一步研究。     

Longitudinal changes in knee kinematics and moments following knee arthroplasty: A systematic review

BackgroundKnee arthroplasty (KA) is recognized as an effective treatment of knee joint osteoarthritis and up to 90% of patients experience substantial pain relief. There has been no systematic review synthesizing the longitudinal changes in gait following KA. The aims of this systematic review were to determine the effects of KA on (i) frontal plane and (ii) sagittal plane kinematic and kinetic parameters during the stance phase of gait.MethodsMEDLINE (PubMed), CINAHL, SPORTdiscus (EBSCO), and Cochrane Library (Wiley) were searched until April 10th, 2014. 1,765 articles were identified, of which 19 studies describing 3-dimensional gait analysis pre- and post-KA were included. Study quality was evaluated by two reviewers independently using the Downs and Black checklist.FindingsFollowing KA, in the frontal plane, the maximum knee adduction angle and external knee adduction moment (KAM) tended to decrease. In the sagittal plane, findings suggest that the maximum knee flexion moment is increased. From the ten studies that included a healthy reference group, it was unclear whether gait variables returned to normal following KA.InterpretationOverall, it appears that KA results in a decreased peak KAM and maximum knee adduction angles, an increased peak knee flexion moment and inconsistent changes in the peak knee flexion angle. Knowledge gaps remain due to methodological inconsistencies across studies, limited statistical analysis, and largely heterogeneous sample populations. More research is needed to determine whether KA restores gait patterns to normal, or if additional rehabilitation may be needed to optimize gait following surgery for osteoarthritis.     

Kinematic alterations of the lower limbs and pelvis during an ascending stairs task are associated with the degree of knee osteoarthritis severity

Background

Individuals with knee osteoarthritis (OA) generally demonstrate great difficulty in ascending stairs. The strategies and compensations used by these individuals in stair activities have not been fully established. The purpose of this study was to investigate the joint kinematics of the pelvis, hip, knee and ankle throughout the gait cycle, in the sagittal and frontal planes, in individuals with mild and moderate knee OA, during an ascending stairs task.

慢跑的速度对青年女性下肢关节及肌肉的影响

目的 探讨合理的慢跑速度对体形和步姿的影响,使人在慢跑健身的同时兼得柔美的体态。方法 根据相关测量选择5种慢跑速度。利用运动捕捉系统采集研究对象(15位青年女性志愿者)在慢跑速度下的运动学数据,同时对下肢8块主要肌肉的肌电信号进行采集。计算获得在不同慢跑速度下髋、膝及踝关节矢状面的关节角度变化的均值。选择数据最接近均值的对象作为研究对象并进行运动学分析。结果 计算获得了该研究对象在不同慢跑速度下髋、膝及踝关节矢状面的关节角度以及下肢8块主要肌肉的激活度曲线。运用打分的方法,本文给出了研究对象慢跑速度、慢跑阶段、肌肉激活度与关节角度之间的关系。结论 各关节角的变化范围和各肌肉最大激活度并不随慢跑速度的变化而单调变化。本文为青年女性健身时选择适合自己的慢跑速度提供了参考。     

Load-dependent movement regulation of lateral stretch shortening cycle jumps

The classical stretch shortening cycle (SSC) describes sagittal joint flexion–extensions in motions like running or hopping. However, lateral movements are integral components of team sports and are associated with frontal plane joint displacements. The purpose of this study is to identify neuromuscular and kinematical mechanisms determining motor control and performance of reactive laterally conducted SSCs. Lateral jumps were performed from four distances in order to investigate the influence of lateral stretch loads on the lower extremity. Electromyographic (EMG) data of nine lower extremity muscles were collected. Foot, ankle, knee, and hip kinematics were recorded by 3-D motion analysis. High stretch loads were characterized by a greater foot exorotation during the initial phase of contact. In the sagittal plane knee and hip joint, displacements increased, whereas in the frontal plane only the hip joint displacement was significantly raised. In particular, frontal peak joint moments increased with stretch load. Thigh muscles’ mean pre-activity amplitude was enhanced. It was possible to detect stretch reflexes in the thigh muscles, whereas in particular the short-latency reflex (SLR) was stretch load-dependently modulated. The results of the present study suggest that the foot exorotation seems to play a decisive role in the movement control of lateral jumps. The association between exorotation and increased sagittal joint displacements may be seen as a compensation strategy to shift load from the frontal to the sagittal plane. Lateral load compensation seems to strongly depend on upper leg’s kinematic and neuromuscular adjustments, rather than on the ankle joint complex.     

Erratum to: Load-dependent movement regulation of lateral stretch shortening cycle jumps

The classical stretch shortening cycle (SSC) describes sagittal joint flexion–extensions in motions like running or hopping. However, lateral movements are integral components of team sports and are associated with frontal plane joint displacements. The purpose of this study is to identify neuromuscular and kinematical mechanisms determining motor control and performance of reactive laterally conducted SSCs. Lateral jumps were performed from four distances in order to investigate the influence of lateral stretch loads on the lower extremity. Electromyographic (EMG) data of nine lower extremity muscles were collected. Foot, ankle, knee, and hip kinematics were recorded by 3-D motion analysis. High stretch loads were characterized by a greater foot exorotation during the initial phase of contact. In the sagittal plane knee and hip joint, displacements increased, whereas in the frontal plane only the hip joint displacement was significantly raised. In particular, frontal peak joint moments increased with stretch load. Thigh muscles’ mean pre-activity amplitude was enhanced. It was possible to detect stretch reflexes in the thigh muscles, whereas in particular the short-latency reflex (SLR) was stretch load-dependently modulated. The results of the present study suggest that the foot exorotation seems to play a decisive role in the movement control of lateral jumps. The association between exorotation and increased sagittal joint displacements may be seen as a compensation strategy to shift load from the frontal to the sagittal plane. Lateral load compensation seems to strongly depend on upper leg’s kinematic and neuromuscular adjustments, rather than on the ankle joint complex.     

Gait analysis in children with cerebral palsy via inertial and magnetic sensors

3D kinematic measurements in children with cerebral palsy (CP) to assess gait deviations can only be performed in gait laboratories using optoelectronic systems. Alternatively, an inertial and magnetic measurement system (IMMS) can be applied for ambulatory motion-tracking. A protocol named Outwalk has recently been developed to measure the 3D kinematics during gait with IMMS. This study preliminary validated the application of IMMS, based on the Outwalk protocol, in gait analysis of six children with CP and one typically developing child. Reference joint kinematics were simultaneously obtained from a laboratory-based system and protocol. On average, the root mean square error (RMSE) of Outwalk/IMMS, compared to the reference, was less than 17° in the transversal plane, and less than 10° in the sagittal and frontal planes. The greatest differences were found in offsets in the knee and ankle rotation, and in the hip flexion. These offset differences were mainly caused by a different anatomical calibration in the protocols. When removing the offsets, RMSE was always less than 4°. Therefore, IMMS is suitable for gait analysis of major joint angles in a laboratory-free setting. Further studies should focus on improvement of anatomical calibrations of IMMS that can be performed in children with CP.     

Asymptomatic Genu Recurvatum reshapes lower limb sagittal joint and elevation angles during gait at different speeds

BackgroundKinematic characteristics of walking with an asymptomatic genu recurvatum are currently unknown. The objective of this study is to characterize the lower limb sagittal joint and elevation angles during walking in participants with asymptomatic genu recurvatum and compare it with control participants without knee deformation at different speeds.MethodsThe spatio-temporal parameters and kinematics of the lower limb were recorded using an optoelectronic motion capture system in 26 participants (n = 13 with genu recurvatum and n = 13 controls). The participants walked on an instrumented treadmill during five minutes at three different speeds: slow, medium and fast.ResultsParticipants with genu recurvatum showed several significant differences with controls: a narrower step width, a greater maximum hip joint extension angle, a greater knee joint extension angle at mid stance, a lower maximum knee joint flexion angle during the swing phase, and a greater ankle joint extension angle at the end of the gait cycle. Participants with genu recurvatum had a greater minimum thigh elevation angle, a greater maximum foot elevation angle, and a change in the orientation of the covariance plane. Walking speed had a significant effect on nearly all lower limb joint and elevation angles, and covariance plane parameters.ConclusionOur findings show that genu recurvatum reshapes lower limb sagittal joint and elevation angles during walking at different speeds but preserves the covariation of elevation angles along a plane during both stance and swing phases and the rotation of this plane with increasing speed.     

痉挛型脑瘫患者功能性选择性脊神经后根切断术前后的三维步态特征分析

目的分析痉挛型脑瘫患者功能性选择性脊神经后根切断(functional selective posterior rhizotomy,FSPR)手术前后的步态特征,客观量化评估手术疗效。方法选取15名将要进行FSPR手术治疗的痉挛型脑瘫患者,应用VICON三维运动捕捉系统结合AMTI三维测力台对患者进行手术前后的步态采集,分析手术前后步态的时空、运动学及动力学参数。结果手术后,左、右支撑时间均大于手术前,左侧步长明显大于手术前,步高、步速及冠状面重心偏移均小于手术前;着地时的膝关节矢状面角度(即屈伸角度)出现明显提高,髋、踝关节未见明显差异。手术后,步行过程中左右侧髋、膝、踝关节活动范围(range of motion,ROM)在矢状面均出现不同程度的提高,且有统计学差异;右踝关节冠状面ROM也出现明显提高。手术后,右膝关节最小屈曲角度及左、右踝关节最大跖屈角度均出现显著减小;左、右侧支撑相最大垂直力较手术前明显提高,而下肢关节力矩未见明显差异。结论三维步态分析可以在一定程度上评估痉挛型脑瘫患者FSPR手术的疗效。术后痉挛型脑瘫患者的痉挛得到缓解,对步态的时空参数及下肢关节运动学参数改善比较明显,而对于动力学参数改善相对不明显,需进行进一步康复治疗。     

Frontal plane dynamic stability and coordination in subjects with cerebellar degeneration

Objective attempts to characterize postural control in subjects with cerebellar (Cb) pathology have focused primarily on sagittal plane responses to static standing, semi-dynamic standing, and platform perturbation. Repeated, dynamic, functional movement may provide a better opportunity to study the effects of ataxia on frontal plane postural stability. The purpose of this investigation was to quantify lateral stability using center of gravity (CG) and center of pressure (CP) movement analysis, and to examine motor responses necessary to complete a repetitive stepping task. Whole body kinematic and kinetic data were collected as patients with Cb degeneration and non-disabled volunteers repeatedly ascended forward and descended backward from a 7.6-cm step to the beat of a metronome. Cb subjects demonstrated significantly greater lateral CG instability, consistent with increased CG velocity and displacement variability in the frontal plane compared to non-disabled subjects. Significantly greater lateral CP displacement was found in subjects with Cb degeneration. Phase plot patterns from patients with Cb degeneration showed poor movement quality, indicated by abruptly changing CG phase plot patterns and abnormal CG acceleration and deceleration phases. Ataxic postural reactions were observed consistently during lateral weight shifting phases toward the stance limb. We hypothesized that lateral postural instability in Cb subjects stems from altered lower extremity intersegmental coordination and inadequate lateral CG velocity control. Frontal plane CG instability may necessitate a wide-based gait. Despite the varied neuroanatomic sites of degenerative Cb pathology, subjects with Cb pathology demonstrated similar CG movement patterns and altered motor strategies to avoid destabilization. Dynamic assessment provides important information regarding frontal plane instability not revealed by static assessment methods. These findings suggest that a dynamic, constrained stepping task effectively differentiates Cb and non-disabled volunteers, contributing to our knowledge of the effect of ataxic movement disturbances on frontal plane postural stability and lower limb coordination.     

Impaired gait in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. The spine becomes rigid from the occiput to the sacrum, leading to a stooped position. This study aims at evaluating AS subjects gait alterations. Twenty-four subjects were evaluated: 12 normal and 12 pathologic in stabilized anti-TNF-alpha treatment (mean age 49.42 (10.47), 25.44 (3.19) and mean body mass index 55.75 (3.19), 23.73 (2.7), respectively). Physical examination and gait analysis were performed. A motion capture system synchronized with two force plates was used. Three-dimensional kinematics and kinetics of trunk, pelvis, hip, knee and ankle were determined during gait. A trend towards reduction was found in gait velocity and stride length. Gait analysis results showed statistically significant alterations in the sagittal plane at each joint for AS patients (P < 0.049). Hip and knee joint extension moments showed a statistically significant reduction (P < 0.044). At the ankle joint, a decreased plantarflexion was assessed (P < 0.048) together with the absence of the heel rocker. Gait analysis, through gait alterations identification, allowed planning-specific rehabilitation intervention aimed to prevent patients’ stiffness together with improve balance and avoid muscles’ fatigue.     

足部跖趾关节约束对人体步态稳定性的影响

目的 研究足部跖趾关节约束对人体步态稳定性的影响。 方法 在水平湿滑试验台上进行足部跖趾关节有、无约束两种状态下的步态实验,分析时空步态参数、运动学参数、动力学参数以及利用摩擦因数( utilization coefficient of friction,UCOF)差异。 结果 跖趾关节有约束状态下,人体行走平均步速减小 50 mm/ s,跨步长度缩小0. 22 m,双支撑相时间缩短 70 ms;跖趾关节约束会使髋、膝关节在矢状面内的活动范围显著增大,而踝关节活动范围减小。 同时,跖趾关节约束状态 UCOF 幅值是无约束状态的 1. 15 倍,表明人体滑跌的概率增大以及行走不稳定性增加。 结论 足部跖趾关节约束会降低行走稳定性。 研究结果为足部趾屈运动康复设备的研发提供数据和理论支持     

20名青年平地行走中踝关节运动的观察

本文采用电影摄影方法,对20名男、女青年平地常速行走时踝关节在额状面和矢状面活动度进行了分析研究,测得有关数据并绘出踝关节在矢状面中角度—力曲线和额状面上角度—时间曲线。讨论了这些数据的实用价值和临床意义。     

Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot

Our objective in this study was to assess passive mechanical stiffness in the ankle of chronic hemiparetic stroke survivors and to compare it with those of healthy young and older (age-matched) individuals. Given the importance of the ankle during locomotion, an accurate estimate of passive ankle stiffness would be valuable for locomotor rehabilitation, potentially providing a measure of recovery and a quantitative basis to design treatment protocols. Using a novel ankle robot, we characterized passive ankle stiffness both in sagittal and in frontal planes by applying perturbations to the ankle joint over the entire range of motion with subjects in a relaxed state. We found that passive stiffness of the affected ankle joint was significantly higher in chronic stroke survivors than in healthy adults of a similar cohort, both in the sagittal as well as frontal plane of movement, in three out of four directions tested with indistinguishable stiffness values in plantarflexion direction. Our findings are comparable to the literature, thus indicating its plausibility, and, to our knowledge, report for the first time passive stiffness in the frontal plane for persons with chronic stroke and older healthy adults.     

Effect of body weight support on cortical activation during gait in patients with stroke

Treadmill training with body weight support (BWS) was shown to improve locomotion after stroke. We investigated whether BWS affected cortical activation during gait using an optical imaging system. In six patients with subcortical stroke, BWS lowered activation in the sensorimotor cortex (SMC) as assessed by task-related changes of oxygenated hemoglobin levels (P<0.01). The changes of SMC activation correlated with those of cadence (P<0.05). Improvement of asymmetry in SMC activation also correlated with improvement of asymmetric gait (P<0.05). In five age-matched controls, BWS increased overall activation (P<0.05) but did not modify gait parameters and there was no correlation between gait parameters and SMC activation. It is suggested that BWS might improve efficacy of SMC function in patients with stroke.     

Can total knee arthroplasty restore the correlation between radiographic mechanical axis angle and dynamic coronal plane alignment during gait?

BackgroundTotal knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis. Postoperative static knee alignment has been recognized as a key component of successful surgery. A correction toward the kinematics of a native knee is expected after TKA, with an aim for neutral mechanical alignment. The evolution of frontal plane knee kinematics is not well understood.MethodsNineteen patients awaiting TKA were recruited. Three-dimensional knee kinematics during treadmill gait were assessed pre-operatively, 12 months after surgery, and compared to a control group of 17 asymptomatic participants.ResultsMean radiographic mechanical alignment was corrected from 5.4° ± 5.0 (Standard Deviation) varus pre-operatively to 0.1° ± 2.0 (Standard Deviation) valgus postoperatively (P = 0.002). Mean stance coronal plane alignment decreased from 6.7° ± 4.0 (Standard Deviation) varus per-operatively to 2.1° ± 3.8 (Standard Deviation) postoperatively (P = 0.001). Correlation between radiographic mechanical axis angle and dynamic frontal plane alignment during gait, before and after surgery, was weak (pre-operative R = 0.41; postoperative R = 0.13) compared to control (R = 0.88). In the sagittal plane, TKA patients maintained their pre-operative stiff knee gait adaptation. Postoperative transverse plane kinematics suggested restoration of external tibial rotation during swing after TKA compared to control (Pre-operative 3.1°, postoperative 6.8°, control 7.1°, P = 0.05).ConclusionThe lack of correlation between static and dynamic alignment suggests that static radiographic coronal alignment of the knee does not accurately predict dynamic behavior. In the sagittal plane, pre-operative gait adaptations were still present 12 months after surgery, supporting the need for a functional assessment to guide postoperative rehabilitation following TKA.     

Sex Differences in 2-DOF Human Ankle Stiffness in Relaxed and Contracted Muscles

Ankle stiffness has been known as one of the most important components contributing to the maintenance of lower body stability during postural balance and locomotion. It has been repeatedly shown that women have lower stability and increased risk of injury when compared to men participating in similar sports activities, yet sex differences in neuromuscular control of the ankle, including the modulation of ankle stiffness, and their contribution to stability remain unknown. To identify sex differences in human ankle stiffness, this study quantified multi-dimensional ankle stiffness in 20 young, healthy men and 20 young, healthy women over a range of ankle muscle contractions, from relaxed to 20% of maximum voluntary co-contraction of ankle muscles. A wearable ankle robot and a system identification method were used to reliably quantify ankle stiffness in a 2-dimensional space spanning the sagittal plane and the frontal plane. In all muscle activation levels, significant sex differences in ankle stiffness were identified in both the sagittal and frontal planes. In the given experimental conditions, ankle stiffness in males was higher than females up to 15.1 and 8.3 Nm/rad in the sagittal plane and the frontal plane, respectively. In addition, sex differences in the spatial structure of ankle stiffness were investigated by quantifying three parameters defining the stiffness ellipse of the ankle: area, aspect ratio, and orientation. In all muscle activation levels, a significant sex difference was identified in the area of stiffness ellipse as expected from the sex difference in the sagittal and frontal planes. However, no statistical sex difference was observed in the aspect ratio and orientation, which would be due to little differences in major anatomical configurations of the ankle joint between sexes. This study, in combination with future studies investigating sex differences during dynamic tasks (e.g. postural balance and locomotion) would serve as a basis to develop a risk assessment tool and sex-specific training programs for efficient ankle injury prevention or rehabilitation.     

Relationships between early postoperative gait biomechanical factors and patient-reported outcome measures 6 months after total knee arthroplasty

BackgroundThis study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated.MethodsTwenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined.ResultsThe maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores.ConclusionThe early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.     

Principal component analysis of the power developed in the flexion/extension muscles of the hip in able-bodied gait

This study was undertaken to demonstrate how principal component analysis (PCA) can be used: (a) to detect the main functional structure of actions taken by hip extensors and flexors during two consecutive gait cycles of able-bodied subjects, and (b) to determine whether or not symmetrical behaviour exists between right and left hip muscle power activity. Twenty young, healthy male subjects walked along a 13 m path at a freely-chosen speed. Applying curve structure detection methods such as PCA to walking patterns can provide insight into the functional tasks accomplished by the lower limbs of able-bodied and disabled subjects. PCA was applied as a classification and curve structure detection method to hip sagittal muscle power calculated for the right and left lower limbs. Over 70% of the information provided by the first four principal components (PCs) was chosen for further biomechanical interpretation. PC1 for both right and left sides mainly described the action taken by the hip extensors/flexors corresponding to the vertical component of ground force on the respective limbs during mid-stance. Propulsion and limb preparation were identified as the second and third tasks attributed to right hip muscle power, while between limb co-ordination was recognised as the second and third functional tasks of the left hip extensors/flexors. Balance was identified as the fourth main functional contribution of the hip extensors/flexors at the right limb while for the left limb, these muscles were mainly responsible for preparing the limb to enter into new gait cycle. PCA was able to identify the four main functional contributions of hip sagittal muscle power during able-bodied gait. PCA was also able to examine the existence of functional asymmetry in gait by highlighting different task priorities at the hip level for the right and left lower limbs.