Journal articles on the topic 'Knee flexion angle'
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1
Chung, Kwangho, Chong Hyuk Choi, Sung-Hwan Kim, Sung-Jae Kim, Woosung Do, and Min Jung. "The Relationship Between Lateral Femoral Anatomic Structures and the Femoral Tunnel Outlet in Anterior Cruciate Ligament Reconstruction Using the Transportal Technique: A 3-Dimensional Simulation Analysis." Orthopaedic Journal of Sports Medicine 8, no. 9 (September 1, 2020): 232596712095278. http://dx.doi.org/10.1177/2325967120952783.
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Background: The relationship between the lateral femoral anatomic structures and femoral tunnel outlet according to changes in knee flexion and transverse drill angle during femoral tunnel creation in anterior cruciate ligament (ACL) reconstruction remains unclear. Purpose: To investigate the relationships between the lateral femoral anatomic structures and femoral tunnel outlet according to various knee flexion and transverse drill angles and to determine appropriate angles at which to minimize possible damage to the lateral femoral anatomic structures. Study Design: Controlled laboratory study. Methods: Simulation of ACL reconstruction was conducted using a 3-dimensional reconstructed knee model from the knees of 30 patients. Femoral tunnels were created using combinations of 4 knee flexion and 3 transverse drill angles. Distances between the femoral tunnel outlet and lateral femoral anatomic structures (minimum safe distance, 12 mm), tunnel length, and tunnel wall breakage were assessed. Results: Knee flexion and transverse drill angles independently affected distances between the femoral tunnel outlet and lateral femoral anatomic structures. As knee flexion angle increased, the distance to the lateral collateral ligament, lateral epicondyle, and popliteal tendon decreased, whereas the distance to the lateral head of the gastrocnemius increased ( P < .001). As the transverse drill angle decreased, distances to all lateral femoral anatomic structures increased ( P < .001). Considering safe distance, 120°, 130°, or 140° of knee flexion and maximum transverse drill angle (MTA) could damage the lateral collateral ligament; 130° or 140° of knee flexion and MTA could damage the lateral epicondyle; and 110° or 120° of knee flexion and MTA could damage the lateral head of the gastrocnemius. Tunnel wall breakage occurred under the conditions of MTA – 10° or MTA – 20° with 110° of knee flexion and MTA – 20° with 120° of knee flexion. Conclusion: Approximately 120° of knee flexion with MTA – 10° and 130° or 140° of knee flexion with MTA – 20° or MTA – 10° could be recommended to prevent damage to the lateral femoral anatomic structures, secure adequate tunnel length, and avoid tunnel wall breakage. Clinical Relevance: Knee flexion angle and transverse drill angle may affect femoral tunnel creation, but thorough studies are lacking. Our findings may help surgeons obtain a stable femoral tunnel while preventing damage to the lateral femoral anatomic structures.
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Iriuchishima, Takanori, and Keinosuke Ryu. "A Comparison of Rollback Ratio between Bicruciate Substituting Total Knee Arthroplasty and Oxford Unicompartmental Knee Arthroplasty." Journal of Knee Surgery 31, no. 06 (July 25, 2017): 568–72. http://dx.doi.org/10.1055/s-0037-1604445.
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AbstractThe purpose of this study was to compare the rollback ratio in bicruciate substituting (BCS) total knee arthroplasty (TKA) and bicruciate-retaining Oxford unicompartmental knee arthroplasty (UKA). In this study, 64 subjects (64 knees) undergoing BCS-TKA (Journey II: Smith and Nephew) and 50 subjects (50 knees) undergoing Oxford UKA (Zimmer-Biomet holdings, Inc., IN) were included. Approximately 6 months after surgery, and when the subjects had recovered their knee range of motion, following the Laidlow's method, lateral radiographic imaging of the knee was performed with active full knee flexion. The most posterior tibiofemoral contact point was measured for the evaluation of femoral rollback (rollback ratio). Flexion angle was also measured using the same radiograph and the correlation of rollback and flexion angle was analyzed. As a control, radiographs of the asymptomatic contralateral knees of subjects undergoing Oxford UKA were evaluated (50 knees). The rollback ratios of the BCS-TKA, Oxford UKA, and control knees were 37.9 ± 4.9, 35.7 ± 4.2, and 35.3 ± 4.8% respectively. No significant difference in rollback ratio was observed among the three groups. The flexion angles of the BCS-TKA, Oxford UKA, and control knees were 123.8 ± 8.4, 125.4 ± 7.5, and 127 ± 10.3 degrees, respectively. No significant difference in knee flexion angle was observed among the three groups. Significant correlation between rollback ratio and knee flexion angle was observed (p = 0.002; Pearson's correlation coefficient = − 0.384). BCS-TKA showed no significant difference in rollback ratio when compared with control knees and Oxford UKA knees. The BCS-TKA design is likely to reproduce native anterior cruciate ligament and posterior cruciate ligament function, and native knee rollback.
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Kim, Sung-Hwan, Sung-Jae Kim, Chong Hyuk Choi, Dohyun Kim, and Min Jung. "Optimal Condition to Create Femoral Tunnel Considering Combined Influence of Knee Flexion and Transverse Drill Angle in Anatomical Single-Bundle ACL Reconstruction Using Medial Portal Technique: 3D Simulation Study." BioMed Research International 2018 (July 17, 2018): 1–10. http://dx.doi.org/10.1155/2018/2643247.
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There has been no previous study using three-dimensional (3D) measurement on femoral tunnel characteristics according to the combined influence of various flexion angles of knee and transverse drill angles in single-bundle ACL reconstruction with transportal technique. The purpose of this study was to determine optimal condition of knee flexion angle and transverse drill angle to create secure femoral tunnel in single-bundle ACL reconstruction with transportal technique considering tunnel length, tunnel wall breakage, and graft bending angle. This study was conducted using simulation of 3D computed tomography of thirty subjects. Three variables of femoral tunnel changed according to combined influence of four flexion angles of knee and three transverse drill angles were measured: tunnel length, wall breakage, and graft bending angle. There was no case of short femoral tunnel less than 25 mm at 120° and 130° of flexion. There was no case of breakage of femoral tunnel at 120° of flexion with maximum transverse drill angle (MTA) and MTA-10° and at 130° of flexion. Considering effect on graft bending angle, decrease of flexion angle and transverse drill angle could be appropriate in creating femoral tunnel. Increased flexion angle and transverse drill angle secured femoral tunnel having sufficiently long length without wall breakage. However, avoiding excessive flexion angle and maximum transverse drill angle could be recommended because they tended to cause more acute graft bending angle.
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Ahmad, Christopher S., Zohara A. Cohen, William N. Levine, Thomas R. Gardner, Gerard A. Ateshian, and Van C. Mow. "Codominance of the Individual Posterior Cruciate Ligament Bundles: An Analysis of Bundle Lengths and Orientation." American Journal of Sports Medicine 31, no. 2 (March 2003): 221–25. http://dx.doi.org/10.1177/03635465030310021101.
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Background: It is unclear how each bundle of the posterior cruciate ligament contributes to posterior knee stability. Hypothesis: Changes in bundle orientation and length occur such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric knees were studied in a joint-testing rig with individual quadriceps and hamstring muscle loading. Kinematic data for the tibia and femur were obtained at knee flexion angles from 0° to 120°. The joint was then disarticulated, and the insertions of the two bundles on the tibia and femur were digitized. Results: Length of the anterolateral bundle increased with increasing knee flexion angle from 10° to 120°. Length of the posteromedial bundle decreased with increasing knee flexion angle from 0° to 45° and increased slightly from 60° to 120°. Length of the anteromedial bundle was significantly less than that of the posteromedial at 0°, 10°, and 20° of knee flexion. The anterolateral bundle was significantly more horizontal at flexion angles of 0°, 10°, 20°, 30°, and 45° (P < 0.05). The posteromedial bundle was more horizontal at 120°. Conclusions: Changes in orientation take place such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. Clinical Relevance: Double-bundle reconstructions achieve more physiologic knee function.
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Usami, Takuya, Kazuki Nishida, Hirotaka Iguchi, Taro Okumura, Hiroaki Sakai, Ruido Ida, Mitsuya Horiba, et al. "Evaluation of lower extremity gait analysis using Kinect V2® tracking system." SICOT-J 8 (2022): 27. http://dx.doi.org/10.1051/sicotj/2022027.
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Introduction: Microsoft Kinect V2® (Kinect) is a peripheral device of Xbox® and acquires information such as depth, posture, and skeleton definition. In this study, we investigated whether Kinect can be used for human gait analysis. Methods: Ten healthy volunteers walked 20 trials, and each walk was recorded by a Kinect and infrared- and marker-based-motion capture system. Pearson’s correlation and overall agreement with a method of meta-analysis of Pearson’s correlation coefficient were used to assess the reliability of each parameter, including gait velocity, gait cycle time, step length, hip and knee joint angle, ground contact time of foot, and max ankle velocity. Hip and knee angles in one gait cycle were calculated in Kinect and motion capture groups. Results: The coefficients of correlation for gait velocity (r = 0.92), step length (r = 0.81) were regarded as strong reliability. Gait cycle time (r = 0.65), minimum flexion angle of hip joint (r = 0.68) were regarded as moderate reliability. The maximum flexion angle of the hip joint (r = 0.43) and maximum flexion angle of the knee joint (r = 0.54) were regarded as fair reliability. Minimum flexion angle of knee joint (r = 0.23), ground contact time of foot (r = 0.23), and maximum ankle velocity (r = 0.22) were regarded as poor reliability. The method of meta-analysis revealed that participants with small hip and knee flexion angles tended to have poor correlations in maximum flexion angle of hip and knee joints. Similar trajectories of hip and knee angles were observed in Kinect and motion capture groups. Conclusions: Our results strongly suggest that Kinect could be a reliable device for evaluating gait parameters, including gait velocity, gait cycle time, step length, minimum flexion angle of the hip joint, and maximum flexion angle of the knee joint.
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Young, Warren, Peter Clothier, Leonie Otago, Lyndell Bruce, and David Liddell. "Relationship Between a Modified Thomas Test and Leg Range of Motion in Australian-Rules Football Kicking." Journal of Sport Rehabilitation 12, no. 4 (November 2003): 343–50. http://dx.doi.org/10.1123/jsr.12.4.343.
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Context:Flexibility tests are sometimes thought to be related to range of motion in dynamic activities, but such a relationship remains to be determined.Objective:To determine the correlation between flexibility and hip and knee angles in Australian football kicking.Design:Correlation.Setting:Biomechanics laboratory.Participants:16 Australian Rules football players.Main Outcome Measures:Hip and knee angles of the preferred kicking leg in a relaxed position were determined with a modified Thomas test. Maximum hip extension, the knee-flexion angle in this position, the maximum knee-flexion angle, and the hip angle at this position during the swing phase of maximum-effort drop-punt kicks were determined.Results:Significant correlations were found between hip flexibility and maximum hip extension (r = .65, P < .01) and hip angle at the maximum knee-flexion angle (r = .70, P < .01).Conclusions:The data indicate a moderate association between hip flexibility and hip angles during kicking.
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GERRITS, Karin, Inge GOMMANS, Baziel VAN ENGELEN, and Arnold DE HAAN. "Quadriceps weakness in a family with nemaline myopathy: influence of knee angle." Clinical Science 105, no. 5 (November 1, 2003): 585–89. http://dx.doi.org/10.1042/cs20030159.
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Nemaline myopathy is a congenital neuromuscular disorder, which primarily affects the thin filaments. Clinically the most important feature is muscle weakness; however, this weakness is poorly understood. The present investigation aimed to determine the torque angle relationship of the knee extensor muscles during in vivo muscle contractions in a family with a novel phenotype of nemaline myopathy. The results of this study show that quadriceps weakness occurs predominantly at higher knee flexion angles, but relatively normal strength was found at angles closer to full knee extension. When the relative torque angle relationships were considered, torque loss at smaller than optimum knee flexion angle was greater in the patients compared with the controls. In addition, the optimum angle for maximal quadriceps torque production was shifted towards smaller knee flexion angles in the patients. This suggests that a weakness specifically at higher knee flexion angles probably occurs as a result of adaptations consequently to the disease. Furthermore, it is important to assess muscle function at different joint positions to allow adequate interpretation of muscle weakness.
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Wang, Wei, Bin Yue, JianHua Wang, Hany Bedair, Harry Rubash, and Guoan Li. "Posterior Condyle Offset and Maximum Knee Flexion Following a Cruciate Retaining Total Knee Arthroplasty." Journal of Knee Surgery 32, no. 02 (March 7, 2018): 146–52. http://dx.doi.org/10.1055/s-0038-1636912.
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Inconsistent data has been reported on the effect of the femoral posterior condyle offset (PCO) on the maximal knee flexion after total knee arthroplasty (TKA). This study investigated the relationship between the postoperative changes of the PCO and the changes of maximal knee flexion after a cruciate retaining (CR) TKA. Nine patients with medial osteoarthritis (OA) in one knee were investigated. Before operation, each index knee was magnetic resonance imaging (MRI) scanned for construction of a three-dimensional (3D) knee model. The patient then performed a maximal weight-bearing (WB) flexion and the index knee flexion was measured using a dual fluoroscopy technique. At an average of 8 months after a CR TKA, all patients performed the same WB knee flexion. The postoperative changes of the PCO, the posterior cruciate ligament (PCL) elongation, and the posterior tibial slope (PTS) were determined. The postoperative changes of maximal knee flexion were determined by comparing with the preoperative maximal flexion angles of the knee. The correlations of the postoperative changes of PCO and PTS with the postoperative changes of the maximal flexion angle and PCL elongation of the knee were analyzed. The preoperative PCO (28.5 ± 4.5 mm) was significantly smaller than the postoperative PCO (31.1 ± 5.1 mm) (p < 0.05). The increasing of PCO after surgery is correlated with the decreasing of maximal knee flexion angle (r = 0.74) and the increasing of PCL elongation (r = 0.64) after the TKA. The PTS was not found to change significantly after the TKA and was not significantly correlated to the maximal knee flexion angle and PCL elongation. The postoperative increases of the PCO were shown to cause overstretching of the PCL and poor flexion angle of the knee after the CR TKA. Restoration of PCO could help optimize the maximal flexion of the knee after the TKA with consideration about PCL tension.
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Batty, Lachlan M., Julian A. Feller, Iswadi Damasena, Gerrit Behrens, Brian M. Devitt, Taylor Hartwig, Jodie A. McClelland, and Kate E. Webster. "Single-Leg Squat After Anterior Cruciate Ligament Reconstruction: An Analysis of the Knee Valgus Angle at 6 and 12 Months." Orthopaedic Journal of Sports Medicine 8, no. 8 (August 1, 2020): 232596712094632. http://dx.doi.org/10.1177/2325967120946328.
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Background: Deficits in neuromuscular control are common after anterior cruciate ligament (ACL) reconstruction and may be associated with further knee injury. The knee valgus angle during a single-leg squat (SLS) is one measure of neuromuscular performance. Purpose: To determine whether the knee valgus angle during SLS changes between 6 and 12 months after ACL reconstruction and to assess how the operative knee valgus angle compares with that of the contralateral side. Study Design: Case series; Level of evidence, 4. Methods: A cohort of 100 patients with uninjured contralateral knees were assessed at 6 and 12 months after primary hamstring autograft ACL reconstruction. Participants performed the SLS on each leg, and the knee valgus angle was measured via frame-by-frame video analysis at 30° of flexion and at each patient’s maximum knee flexion angle. Results: For the operative limb at 30° of flexion, a small but statistically significant reduction was noted in the valgus angle between 6 and 12 months (5.46° vs 4.44°; P = .002; effect size = 0.24). At 6 months, a slightly higher valgus angle was seen in the operative limb compared with the nonoperative limb (5.46° vs 4.29°; P = .008; effect size = 0.27). At maximum flexion, no difference was seen between limbs in the valgus angle at either 6 or 12 months, and no change was seen in the operative limb between 6 and 12 months. At 6 months and 30° of knee flexion, 13 patients had a valgus angle greater than 10°. This group also had a higher mean valgus angle in the contralateral limb compared with the contralateral limb in the other 87 patients (8.5° vs 3.65°; P < .001). Conclusion: During a controlled SLS, the knee valgus angle remained essentially constant, and minimal limb asymmetries were present over the 6- to 12-month postoperative period, a time when athletes typically increase their activity levels. Whether changes or asymmetries will be seen with more dynamically challenging tasks remains to be determined. When present, high valgus angles were commonly bilateral.
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Walsh, Meghan, Michelle C. Boling, Melanie McGrath, J. Troy Blackburn, and Darin A. Padua. "Lower Extremity Muscle Activation and Knee Flexion During a Jump-Landing Task." Journal of Athletic Training 47, no. 4 (July 1, 2012): 406–13. http://dx.doi.org/10.4085/1062-6050-47.4.17.
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Context: Decreased sagittal-plane motion at the knee during dynamic tasks has been reported to increase impact forces during landing, potentially leading to knee injuries such as anterior cruciate ligament rupture. Objective: To describe the relationship between lower extremity muscle activity and knee-flexion angle during a jump-landing task. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Thirty recreationally active volunteers (15 men, 15 women: age = 21.63 ± 2.01 years, height = 173.95 ± 11.88 cm, mass = 72.57 ± 14.25 kg). Intervention(s): Knee-flexion angle and lower extremity muscle activity were collected during 10 trials of a jump-landing task. Main Outcome Measure(s): Simple correlation analyses were performed to determine the relationship between each knee-flexion variable (initial contact, peak, and displacement) and electromyographic amplitude of the gluteus maximus (GMAX), quadriceps (VMO and VL), hamstrings, gastrocnemius, and quadriceps : hamstring (Q : H) ratio. Separate forward stepwise multiple regressions were conducted to determine which combination of muscle activity variables predicted each knee-flexion variable. Results: During preactivation, VMO and GMAX activity and the Q : H ratio were negatively correlated with knee-flexion angle at initial contact (VMO: r = −0.382, P = .045; GMAX: r = −0.385, P = .043; Q : H ratio: r = −0.442, P = .018). The VMO, VL, and GMAX deceleration values were negatively correlated with peak knee-flexion angle (VMO: r = −0.687, P = .001; VL: r = −0.467, P = .011; GMAX: r = −0.386, P = .043). The VMO and VL deceleration values were negatively correlated with knee-flexion displacement (VMO: r = −0.631, P = .001; VL: r = −0.453, P = .014). The Q : H ratio and GM activity predicted 34.7% of the variance in knee-flexion angle at initial contact (P = .006). The VMO activity predicted 47.1% of the variance in peak knee-flexion angle (P = .001). The VMO and VL activity predicted 49.5% of the variance in knee-flexion displacement (P = .001). Conclusions: Greater quadriceps and GMAX activation and less hamstrings and gastrocnemius activation were correlated with smaller knee-flexion angles. This landing strategy may predispose an individual to increased impact forces due to the negative influence on knee-flexion position.
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Wilding, Christopher P., Martyn Snow, and Lee Jeys. "Which factors affect the ability to kneel following total knee arthroplasty? An outpatient study of 100 postoperative knee replacements." Journal of Orthopaedic Surgery 27, no. 3 (September 1, 2019): 230949901988551. http://dx.doi.org/10.1177/2309499019885510.
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Background: Kneeling is an important activity of daily living, holding social, religious and occupational value. Following total knee replacement (TKR), many patients report they are unable to kneel or have been advised not to kneel. Methods: We observed 100 consecutive knee replacements in 79 patients attending outpatient clinic at a minimum 5 months post-TKR. The patients were asked to fill out a questionnaire detailing whether they were able to kneel prior to their knee replacement and whether they thought they were able to kneel since their knee replacement. The patients were then asked to kneel on a padded examination couch and then onto a pillow on the floor for 15 s. Degree of flexion achievable was also recorded. Results: Of the knees with patella resurfacing, 78.6% were able to kneel compared to only 45.6% knees with native patellae. Two-tailed Fisher’s exact test showed this difference to be statistically significant ( p = 0.001). The χ 2 analysis showed that those patients with an achievable flexion of angle of greater than 100° were significantly more likely to be able to kneel than those with a flexion angle of less than 100° ( p = 0.0148). Comparing posterior cruciate ligament (PCL) retaining against PCL sacrificing implants, there was no statistically significant difference in kneeling ability ( p = 0.541). Conclusion: Kneeling remains an important function in patients undergoing TKR, with patella resurfacing significantly improving the likelihood of a patient being able to kneel.
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Guex, Kenny, Boris Gojanovic, and Grégoire P. Millet. "Influence of Hip-Flexion Angle on Hamstrings Isokinetic Activity in Sprinters." Journal of Athletic Training 47, no. 4 (July 1, 2012): 390–95. http://dx.doi.org/10.4085/1062-6050-47.4.04.
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Context: Hamstrings strains are common and debilitating injuries in many sports. Most hamstrings exercises are performed at an inadequately low hip-flexion angle because this angle surpasses 70° at the end of the sprinting leg's swing phase, when most injuries occur. Objective: To evaluate the influence of various hip-flexion angles on peak torques of knee flexors in isometric, concentric, and eccentric contractions and on the hamstrings-to-quadriceps ratio. Design: Descriptive laboratory study. Setting: Research laboratory. Patients and Other Participants Ten national-level sprinters (5 men, 5 women; age = 21.2 ± 3.6 years, height = 175 ± 6 cm, mass = 63.8 ± 9.9 kg). Intervention(s): For each hip position (0°, 30°, 60°, and 90° of flexion), participants used the right leg to perform (1) 5 seconds of maximal isometric hamstrings contraction at 45° of knee flexion, (2) 5 maximal concentric knee flexion-extensions at 60° per second, (3) 5 maximal eccentric knee flexion-extensions at 60° per second, and (4) 5 maximal eccentric knee flexion-extensions at 150° per second. Main Outcome Measure(s): Hamstrings and quadriceps peak torque, hamstrings-to-quadriceps ratio, lateral and medial hamstrings root mean square. Results: We found no difference in quadriceps peak torque for any condition across all hip-flexion angles, whereas hamstrings peak torque was lower at 0° of hip flexion than at any other angle (P < .001) and greater at 90° of hip flexion than at 30° and 60° (P < .05), especially in eccentric conditions. As hip flexion increased, the hamstrings-to-quadriceps ratio increased. No difference in lateral or medial hamstrings root mean square was found for any condition across all hip-flexion angles (P > .05). Conclusions: Hip-flexion angle influenced hamstrings peak torque in all muscular contraction types; as hip flexion increased, hamstrings peak torque increased. Researchers should investigate further whether an eccentric resistance training program at sprint-specific hip-flexion angles (70° to 80°) could help prevent hamstrings injuries in sprinters. Moreover, hamstrings-to-quadriceps ratio assessment should be standardized at 80° of hip flexion.
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Rutkowska-Kucharska, Alicja, Katarzyna Wysocka, Sławomir Winiarski, Agnieszka Szpala, and Małgorzata Sobera. "An Investigation into the Relation between the Technique of Movement and Overload in Step Aerobics." Applied Bionics and Biomechanics 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/3954907.
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The aim of this research was to determine the features of a step workout technique which may be related to motor system overloading in step aerobics. Subjects participating in the research were instructors (n=15) and students (n=15) without any prior experience in step aerobics. Kinematic and kinetic data was collected with the use of the BTS SMART system comprised of 6 calibrated video cameras and two Kistler force plates. The subjects’ task was to perform basic steps. The following variables were analyzed: vertical, anteroposterior, and mediolateral ground reaction forces; foot flexion and abduction and adduction angles; knee joint flexion angle; and trunk flexion angle in the sagittal plane. The angle of a foot adduction recorded for the instructors was significantly smaller than that of the students. The knee joint angle while stepping up was significantly higher for the instructors compared to that for the students. Our research confirmed that foot dorsal flexion and adduction performed while stepping up increased load on the ankle joint. Both small and large angles of knee flexion while stepping up and down resulted in knee joint injuries. A small trunk flexion angle in the entire cycle of step workout shut down dorsal muscles, which stopped suppressing the load put on the spine.
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Atkinson, Patrick J., and Roger C. Haut. "Impact Responses of the Flexed Human Knee Using a Deformable Impact Interface." Journal of Biomechanical Engineering 123, no. 3 (January 11, 2001): 205–11. http://dx.doi.org/10.1115/1.1372320.
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Blunt impact trauma to the patellofemoral joint during car accidents, sporting activities, and falls can produce a range of injuries to the knee joint, including gross bone fracture, soft tissue injury, and/or microinjuries to bone and soft tissue. Currently, the only well-established knee injury criterion applies to knee impacts suffered during car accidents. This criterion is based solely on the peak impact load delivered to seated cadavers having a single knee flexion angle. More recent studies, however, suggest that the injury potential, its location, and the characteristics of the damage are also a function of knee flexion angle and the stiffness of the impacting structure. For example, at low flexion angles, fractures of the distal patella are common with a rigid impact interface, while at high flexion angles splitting of the femoral condyles is more evident. Low stiffness impact surfaces have been previously shown to distribute impact loads over the anterior surface of the patella to help mitigate gross and microscopic injuries in the 90 deg flexed knee. The objective of the current study was to determine if a deformable impact interface would just as effectively mitigate gross and microscopic injuries to the knee at various flexion angles. Paired experiments were conducted on contralateral knees of 18 human cadavers at three flexion angles (60, 90, 120 deg). One knee was subjected to a fracture level impact experiment with a rigid impactor, and the opposite knee was impacted with a deformable interface (3.3 MPa crush strength honeycomb material) to the same load. This (deformable) impact interface was effective at mitigating gross bone fractures at approximately 5 kN at all flexion angles, but the frequency of split fracture of the femoral condyles may not have been significantly reduced at 120 deg flexion. On the other hand, this deformable interface was not effective in mitigating microscopic injuries observed for all knee flexion angles. These new data, in concert with the existing literature, suggest the chosen impact interface was not optimal for knee injury protection in that fracture and other minor injuries were still produced. For example, in 18 cadavers a total of 20 gross fractures and 20 subfracture injuries were produced with a rigid interface and 5 gross fractures and 21 subfracture injuries with the deformable interface selected for the current study. Additional studies will be needed to optimize the knee impact interface for protection against gross and microscopic injuries to the knee.
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Matsuzawa, Yuta, Takasuke Miyazaki, Yasufumi Takeshita, Naoto Higashi, Hiroyuki Hayashi, Sota Araki, Shintaro Nakatsuji, Seiji Fukunaga, Masayuki Kawada, and Ryoji Kiyama. "Effect of Leg Extension Angle on Knee Flexion Angle during Swing Phase in Post-Stroke Gait." Medicina 57, no. 11 (November 9, 2021): 1222. http://dx.doi.org/10.3390/medicina57111222.
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Background and Objectives: Leg extension angle is important for increasing the propulsion force during gait and is a meaningful indicator for evaluating gait quality in stroke patients. Although leg extension angle during late stance might potentially also affect lower limb kinematics during the swing phase, the relationship between these two remains unclear. This study aimed to investigate the relationship between leg extension angle and knee flexion angle during pre-swing and swing phase in post-stroke gait. Materials and Methods: Twenty-nine stroke patients walked along a 16 m walkway at a self-selected speed. Tilt angles and acceleration of pelvis and paretic lower limb segments were measured using inertial measurement units. Leg extension angle, consisting of a line connecting the hip joint with the ankle joint, hip and knee angles, and increments of velocity during pre-swing and swing phase were calculated. Correlation analysis was conducted to examine the relationships between these parameters. Partial correlation analysis adjusted by the Fugl-Meyer assessment-lower limb (FMA-LL) was also performed. Results: On the paretic side, leg extension angle was positively correlated with knee flexion angle during the swing phase (r = 0.721, p < 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.740–0.846, p < 0.001). Partial correlation analysis adjusted by the FMA-LL showed significant correlation between leg extension angle and knee flexion angle during the swing phase (r = 0.602, p = 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.655–0.886, p < 0.001). Conclusions: Leg extension angle affected kinematics during the swing phase in post-stroke gait regardless of the severity of paralysis, and was similar during the pre-swing phase. These results would guide the development of effective gait training programs that enable a safe and efficient gait for stroke patients.
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APARICIO, GUSTAVO. "A PHOTOELASTIC MODEL OF THE PATELLOFEMORAL JOINT TO STUDY PATELLAR HEIGHT." Journal of Mechanics in Medicine and Biology 20, no. 07 (September 2020): 2050049. http://dx.doi.org/10.1142/s0219519420500499.
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Background: Patellar height has been related to anterior knee pain and Osgood–Schlatter disease. To study the influence of patellar height on knee biomechanics, a bidimensional photoelastic prototype of the patellofemoral joint was developed. Methods: Nine tests were performed at different knee flexion angles and patellar heights. A free body diagram was constructed for each test. The following parameters were calculated: lengths (patella, patella thickness and ligamentum patellae); patellar height index; angles (knee flexion, patellar flexion, quadriceps and ligamentum patellae force and reaction force at the ankle); moment arms (extensor, quadriceps and ligamentum patellae in relation to both the tibiofemoral and patellofemoral contact points), effective moment arm and forces around the extensor mechanism relative to the applied force. Results: Femoropatellar and femorotibial reaction forces were greater with increased knee flexion and a fixed patellar height. With fixed knee flexion and different patellar heights, these forces were greater if the patella was elevated. A decrease in the angle between the tibial axis and ligamentum patellae was observed when patellar height increased. Patellar flexion angle increased when patellar height increased. This was accompanied by an increase in the angle of action of the quadriceps force. Extensor moment arm decreased with increased patellar height when knee flexion and the tibiofemoral contact point were fixed. Conclusion: A new application of photoelasticity is presented. The preliminary findings obtained confirm the influence of patellar height on patellar biomechanics, and specifically on forces around the extensor mechanism of the knee.
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Lin, Cheng-Feng, Hui Liu, William E. Garrett, and Bing Yu. "Effects of a Knee Extension Constraint Brace on Selected Lower Extremity Motion Patterns during a Stop-Jump Task." Journal of Applied Biomechanics 24, no. 2 (May 2008): 158–65. http://dx.doi.org/10.1123/jab.24.2.158.
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Small knee flexion angle during landing has been proposed as a potential risk factor for sustaining noncontact ACL injury. A brace that promotes increased knee flexion and decreased posterior ground reaction force during landing may prove to be advantageous for developing prevention strategies. Forty male and forty female recreational athletes were recruited. Three-dimensional videographic and ground reaction force data in a stop-jump task were collected in three conditions. Knee flexion angle at peak posterior ground reaction force, peak posterior ground reaction force, the horizontal velocity of approach run, the vertical velocity at takeoff, and the knee flexion angle at takeoff were compared among conditions: knee extension constraint brace, nonconstraint brace, and no brace. The knee extension constraint brace significantly increased knee flexion angle at peak posterior ground reaction force. Both knee extension constraint brace and nonconstraint brace significantly decreased peak posterior ground reaction force during landing. The brace and knee extension constraint did not significantly affect the horizontal velocity of approach run, the vertical velocity at takeoff, and the knee flexion angle at takeoff. A knee extension constraint brace exhibits the ability to modify the knee flexion angle at peak posterior ground reaction force and peak posterior ground reaction force during landing.
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Zhang, Fei, Fu-Qiang Pei, Qing-Wei Shao, Yue Deng, Peng-Ju Dai, and Da-Zhao Yang. "Coronal Movement during Flexion and Extension of Knee Joints." Evidence-Based Complementary and Alternative Medicine 2022 (July 20, 2022): 1–7. http://dx.doi.org/10.1155/2022/4237558.
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Objective. There are variabilities in the distance between the tibial tuberosity and the trochlear groove. The knee angle needs to be considered when talking about patellofemoral instability. Methods. This retrospective study analyses the MRI images of knee angles from 0 and 30 degrees in the patella dislocation group (20 cases) and in the control group (20 cases) from Dec 2017 to Dec 2019. Two experienced orthopedic physicians separately measure the study with a blind experiment method. Results. The TT-TG data of the patella dislocation group and control group are 17.88 ± 3.40 mm and 13.31 ± 3.01 mm when the knee angle is 0, which indicates a difference with statistical significance ( P < 0.01 ). The TT-TG data of the patella dislocation group and control group are 11.51 ± 3.60 mm and 7.40 ± 1.93 mm when the knee angle is at 30 degrees, indicating a statistically significant difference ( P < 0.01 ). Also, the TT-TG data of both the patella dislocation group and control group have statistically significant differences within different knee angles of the same group ( P < 0.01 ). The differences of TT-TG are 6.36 ± 2.43 mm and 5.92 ± 1.65 mm when the knee angle changes from 0 to 30, which shows no statistically significant difference ( P > 0.01 ). Conclusion. This research initially obtained the relevant MRI data of the TT-TG distance from different knee angles between the Chinese patella dislocation patient group and control group. The study received a new criterion to evaluate the TT-TG of patients with patella dislocations when the knee angle is below 30 degrees. The knee flexion angles need to be considered to measure the TT-TG distance when comprehensively evaluating patellofemoral instability. The TT-TG distance gradually increases when the knee changes from flexion to extension. The difference of the TT-TG distances shows no statistically significant difference.
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Nagai, Takashi, Timothy C. Sell, Anthony J. House, John P. Abt, and Scott M. Lephart. "Knee Proprioception and Strength and Landing Kinematics During a Single-Leg Stop-Jump Task." Journal of Athletic Training 48, no. 1 (January 1, 2013): 31–38. http://dx.doi.org/10.4085/1062-6050-48.1.14.
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Context The importance of the sensorimotor system in maintaining a stable knee joint has been recognized. As individual entities, knee-joint proprioception, landing kinematics, and knee muscles play important roles in functional joint stability. Preventing knee injuries during dynamic tasks requires accurate proprioceptive information and adequate muscular strength. Few investigators have evaluated the relationship between knee proprioception and strength and landing kinematics. Objective To examine the relationship between knee proprioception and strength and landing kinematics. Design Cross-sectional study. Setting University research laboratory. Patients or Other Participants Fifty physically active men (age = 26.4 ± 5.8 years, height = 176.5 ± 8.0 cm, mass = 79.8 ± 16.6 kg). Intervention(s) Three tests were performed. Knee conscious proprioception was evaluated via threshold to detect passive motion (TTDPM). Knee strength was evaluated with a dynamometer. A 3-dimensional biomechanical analysis of a single-legged stop-jump task was used to calculate initial contact (IC) knee-flexion angle and knee-flexion excursion. Main Outcome Measure(s) The TTDPM toward knee flexion and extension, peak knee flexion and extension torque, and IC knee-flexion angle and knee flexion excursion. Linear correlation and stepwise multiple linear regression analyses were used to evaluate the relationships of both proprioception and strength against landing kinematics. The α level was set a priori at .05. Results Enhanced TTDPM and greater knee strength were positively correlated with greater IC knee-flexion angle (r range = 0.281–0.479, P range = .001–.048). The regression analysis revealed that 27.4% of the variance in IC knee-flexion angle could be accounted for by knee-flexion peak torque and TTDPM toward flexion (P = .001). Conclusions The current research highlighted the relationship between knee proprioception and strength and landing kinematics. Individuals with enhanced proprioception and muscular strength had better control of IC knee-flexion angle during a dynamic task.
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Azam, N. M. A., Rosdi Daud, H. Mas Ayu, J. Ramli, M. F. B. Hassan, M. F. B. Hassan, A. Shah, and M. A. H. M. Adib. "The Effect of Knee Flexion Angle on Contact Stress of Total Knee Arthroplasty." MATEC Web of Conferences 225 (2018): 03009. http://dx.doi.org/10.1051/matecconf/201822503009.
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The effect of flexion angle on contact stress of the knee joint still open to the debate since lack of proof shown that flexion angles does effect the contact stress of Total Knee Arthroplasty (TKA). Thus the aim of this study is to investigate the effect of different flexion angle on contact stress of TKA via finite element method. The TKA is simulated using ANSYS Workbench and the applied loads are 2200 N, 3200 N and 2800 N. The Finite element Analysis (FEA) results for maximum stress of current and proposed designed were then compared. For the new proposed design, the maximum stress for 15° is 12.2 MPa, 45° is 23.6 MPa and 60° is 22.5 MPa which is lower than current design. Thus, it can be concluded that the new proposed design better than current design in term of contact stress. While, the different flexion angle do gives an impact on the performance of the TKA.
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Domnick, Christoph, Mirco Herbort, and Alexander Zoll. "Can we use the ipsilateral Hamstrings for ACL Reconstruction in case of medial collateral ligament insufficiency?" Orthopaedic Journal of Sports Medicine 5, no. 4_suppl4 (April 1, 2017): 2325967117S0013. http://dx.doi.org/10.1177/2325967117s00135.
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Aims and Objectives: Semitendinosus and gracilis muscles (hamstring muscles) are frequently harvested autologous tendon grafts of the knee e.g. for cruciate ligament reconstruction. This study investigated the joint-stabilizing effects of these muscles in case of insufficiency of the medial collateral ligament (MCL). Hypotheses: First, both the semitendinosus and the gracilis muscles can actively stabilize the joint against valgus stress in the medial collateral unstable knee. Second, this stabilizing influence of these muscles decreases with increasing flexion angle Meterials and Methods: Kinematics were examined in ten fresh-frozen human cadaveric knees using a robotic/UFS testing system and an optical tracking system. The knee kinematics under 5 Nm and 10 Nm valgus stress were determined in the a) MCL intact and b) MCL deficient knee in different flexion angles, respectively using the following simulated muscle loads: 1) 0 N (Idle), 2) 200 N semitendinosus load (ST) and 3) 280 N combined semitendinosus and gracilis load (STGT). Results: Cutting the MCL increased valgus angle under all tested conditions and angles in contrast to the MCL intact knee by 4.3-8.1 degrees for 5 Nm, 6.5-11.9 degrees for 10 Nm valgus torque; P<.01; RM-ANOVA). Applied 200 N simulated ST load reduced the valgus angle significantly in 0°, 10°, 20° and 30° of flexion under 5 Nm and 10 Nm (P< .05) valgus stress. In 0°, 10° and 20° these values were close to the MCL intact joint under the respective torque (both P >.05). The combined 280 N simulated STGT load reduced significantly valgus angle in 0°, 10° and 20° of flexion under 5 Nm and 10 Nm of valgus stress (P< .05) to values near the intact joint (5 Nm: 0°, 10°; 10 Nm: 0°, 10°, 20° - P >.05). In 60° and 90° of flexion ST and STGT loads could not decrease resulting valgus angle of the MCL deficient knee (without hamstring load; P>.05 or valgus increase P<.05). Conclusion: In this human cadaveric study semitendinosus and gracilis muscles can successfully stabilize against valgus stress in the MCL insufficient knee in near-to-extension flexion angles. In the valgus-unstable knee, hamstring muscles should be preserved in (multi-) ligament surgery, but also in joint arthroplasty and osteosynthesis if possible.
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Miyazaki, Takasuke, Ryoji Kiyama, Yuki Nakai, Masayuki Kawada, Yasufumi Takeshita, Sota Araki, Hiroyuki Hayashi, Naoto Higashi, and Hyuma Makizako. "The Relationship between Leg Extension Angle at Late Stance and Knee Flexion Angle at Swing Phase during Gait in Community-Dwelling Older Adults." International Journal of Environmental Research and Public Health 18, no. 22 (November 13, 2021): 11925. http://dx.doi.org/10.3390/ijerph182211925.
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This study aimed to clarify the relationship between leg extension angle and knee flexion angle during gait in older adults. The subjects of this cross-sectional study were 588 community-dwelling older adults (74.6 ± 6.1 y). Segment angles and acceleration were measured using five inertial measurement units during comfortable gait, and bilateral knee and hip joint angles, and leg extension angle, reflecting whole lower limb extension at late stance, were calculated. Propulsion force was estimated using the increase in velocity calculated from anterior acceleration of the sacrum during late stance. Correlation analysis showed that leg extension angle was associated with knee flexion angle at swing phase and hip extension angle and increase in velocity at late stance (r = 0.444–508, p < 0.001). Multiple regression analysis showed that knee flexion angle at mid-swing was more affected by leg extension angle (β = 0.296, p < 0.001) than by gait speed (β = 0.219, p < 0.001) and maximum hip extension angle (β = −0.150, p < 0.001). These findings indicate that leg extension angle may be a meaningful parameter for improving gait function in older adults due to the association with knee kinematics during swing as well as propulsion force at late stance.
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Ghirardelli, Stefano, Jessica L. Asay, Erika A. Leonardi, Tommaso Amoroso, Thomas P. Andriacchi, and Pier Francesco Indelli. "Kinematic Comparison between Medially Congruent and Posterior-Stabilized Third-Generation TKA Designs." Journal of Functional Morphology and Kinesiology 6, no. 1 (March 15, 2021): 27. http://dx.doi.org/10.3390/jfmk6010027.
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Background: This study compares knee kinematics in two groups of patients who have undergone primary total knee arthroplasty (TKA) using two different modern designs: medially congruent (MC) and posterior-stabilized (PS). The aim of the study is to demonstrate only minimal differences between the groups. Methods: Ten TKA patients (4 PS, 6 MC) with successful clinical outcomes were evaluated through 3D knee kinematics analysis performed using a multicamera optoelectronic system and a force platform. Extracted kinematic data included knee flexion angle at heel-strike (KFH), peak midstance knee flexion angle (MSKFA), maximum and minimum knee adduction angle (KAA), and knee rotational angle at heel-strike. Data were compared with a group of healthy controls. Results: There were no differences in preferred walking speed between MC and PS groups, but we found consistent differences in knee function. At heel-strike, the knee tended to be more flexed in the PS group compared to the MC group; the MSKFA tended to be higher in the PS group compared to the MC group. There was a significant fluctuation in KAA during the swing phase in the PS group compared to the MC group, PS patients showed a higher peak knee flexion moment compared to MC patients, and the PS group had significantly less peak internal rotation moments than the MC group. Conclusions: Modern, third-generation TKA designs failed to reproduce normal knee kinematics. MC knees tended to reproduce a more natural kinematic pattern at heel-strike and during axial rotation, while PS knees showed better kinematics during mid-flexion.
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Bakırhan, Serkan, and Bayram Ünver. "Does preoperative knee flexion angle affect postoperative knee flexion angle and function in patients with total knee arthroplasty?" Kocaeli Medical Journal 7, no. 2 (2018): 76–80. http://dx.doi.org/10.5505/ktd.2018.96658.
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Ebihara, Bungo, Hirotaka Mutsuzaki, and Takashi Fukaya. "Relationships between Quadriceps Tendon Elasticity and Knee Flexion Angle in Young Healthy Adults." Medicina 55, no. 2 (February 15, 2019): 53. http://dx.doi.org/10.3390/medicina55020053.
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Background and objectives: Although tendon elasticity by elastography is useful for diagnosing tendon disorders and planning rehabilitation regimens of the tendon, there are few reports on the quadriceps tendon. Moreover, relationships between the quadriceps tendon elasticity and knee angle have not been investigated. The purpose of this study was to clarify the relationship between quadriceps tendon elasticity and knee flexion angle in young healthy adults using elastography, and to investigate the difference in elasticity by sex and leg dominance. Materials and Methods: A total of 40 knees in 20 young healthy adults were included in this study (age: 25.5 (23.3–27.5) years). At knee flexion of 30°, 60°, and 90°, quadriceps tendon elasticity was measured using ShearWave™ Elastography during the ultrasound examination. Results: There were significant differences in the elasticity between all angles (p < 0.001). Elasticity was increased more at 60° than at 30° and at 90° than at 60°. Elasticity in men was higher than that in women at 60° (p = 0.029). There were no differences (p = 0.798) in elasticity at each angle between the dominant and non-dominant legs. Conclusions: The quadriceps tendon elasticity increased according to the knee flexion angle in young healthy adults. Moreover, elasticity was affected by sex, but not by leg dominance. Clinically, in a rehabilitation regimen, attention should be paid to exercises that could increase stiffness accompanying flexion of the knee to avoid further tendon damage as risk management in the acute phase.
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Ebihara, Bungo, Takashi Fukaya, and Hirotaka Mutsuzaki. "Relationship between Quadriceps Tendon Young’s Modulus and Maximum Knee Flexion Angle in the Swing Phase of Gait in Patients with Severe Knee Osteoarthritis." Medicina 56, no. 9 (August 28, 2020): 437. http://dx.doi.org/10.3390/medicina56090437.
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Background and objectives: Decreased knee flexion in the swing phase of gait can be one of the causes of falls in severe knee osteoarthritis (OA). The quadriceps tendon is one of the causes of knee flexion limitation; however, it is unclear whether the stiffness of the quadriceps tendon affects the maximum knee flexion angle in the swing phase. The purpose of this study was to clarify the relationship between quadriceps tendon stiffness and maximum knee flexion angle in the swing phase of gait in patients with severe knee OA. Materials and Methods: This study was conducted from August 2018 to January 2020. Thirty patients with severe knee OA (median age 75.0 (interquartile range 67.5–76.0) years, Kellgren–Lawrence grade: 3 or 4) were evaluated. Quadriceps tendon stiffness was measured using Young’s modulus by ShearWave Elastography. The measurements were taken with the patient in the supine position with the knee bent at 60° in a relaxed state. A three-dimensional motion analysis system measured the maximum knee flexion angle in the swing phase. The measurements were taken at a self-selected gait speed. The motion analysis system also measured gait speed, step length, and cadence. Multiple regression analysis by the stepwise method was performed with maximum knee flexion angle in the swing phase as the dependent variable. Results: Multiple regression analysis identified quadriceps tendon Young’s modulus (standardized partial regression coefficients [β] = −0.410; p = 0.013) and gait speed (β = 0.433; p = 0.009) as independent variables for maximum knee flexion angle in the swing phase (adjusted coefficient of determination = 0.509; p < 0.001). Conclusions: Quadriceps tendon Young’s modulus is a predictor of the maximum knee flexion angle. Clinically, decreasing Young’s modulus may help to increase the maximum knee flexion angle in the swing phase in those with severe knee OA.
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Haris, Andi, and Vincent Beng Chye Tan. "Effectiveness of bilateral single-hinged knee bracing in osteoarthritis: A finite element study." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 235, no. 8 (April 29, 2021): 873–82. http://dx.doi.org/10.1177/09544119211012493.
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Effectiveness of knee braces remains to be identified. Therefore, the purpose of this study was to investigate the effectiveness of bilateral single-hinged knee bracing in knee osteoarthritis (OA) using finite element (FE) method. A three-dimensional FE model consisted of main model (knee-brace structure) and submodel (strap-muscle system) was developed. The submodel was used to convert the elastic strap-muscle interaction into an equivalent stiffness value required by the main model. Adding 100 N · mm/rad torsion spring to the brace with 5 kPa strap pressure lowered maximum von Mises stress in the knee OA components at a flexion angle greater than or equal to 90°. Separately, employing 10% brace pre-tension to the brace with 5 kPa strap pressure started to reduce stresses at a flexion angle of 70°. The configuration involving a combination of 10% brace pre-tension and 300 N · mm/rad torsion spring with 30 kPa strap tightness produced stress reduction over the entire range from 0° to 100° flexion angle. The basic bilateral single-hinged knee brace has shown to reduce stresses in the knee OA at high flexion angles only. Compared to the torsion spring, the brace pre-tension has shown to provide more significant benefits (i.e. stress reduction at lower flexion angles). The most sophisticated effects were achieved when the torsion spring was used in combination with the brace pre-tension. These two features can be potentially used for the development of an active knee brace if they can be modulated at different flexion angles or during the gait cycle.
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Herbort, Mirco, Philipp Michel, Michael J. Raschke, Nils Vogel, Martin Schulze, Alexander Zoll, Christian Fink, Wolf Petersen, and Christoph Domnick. "Should the Ipsilateral Hamstrings Be Used for Anterior Cruciate Ligament Reconstruction in the Case of Medial Collateral Ligament Insufficiency? Biomechanical Investigation Regarding Dynamic Stabilization of the Medial Compartment by the Hamstring Muscles." American Journal of Sports Medicine 45, no. 4 (December 28, 2016): 819–25. http://dx.doi.org/10.1177/0363546516677728.
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Background: Semitendinosus and gracilis muscles are frequently harvested for autologous tendon grafts for cruciate ligament reconstruction. This study investigated the joint-stabilizing effects of these hamstring muscles in cases of insufficiency of the medial collateral ligament (MCL). Hypotheses: First, both the semitendinosus and gracilis muscles can actively stabilize the joint against valgus moments in the MCL-deficient knee. Second, the stabilizing influence of these muscles decreases with an increasing knee flexion angle. Study Design: Controlled laboratory study. Methods: The kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force moment sensor system and an optical tracking system. The knee kinematics under 5- and 10-N·m valgus moments were determined in the different flexion angles of the (1) MCL-intact and (2) MCL-deficient knee using the following simulated muscle loads: (1) 0-N (idle) load, (2) 200-N semitendinosus (ST) load, and (3) 280-N (200/80-N) combined semitendinosus/gracilis (STGT) load. Results: Cutting the MCL increased the valgus angle under all tested conditions and angles compared with the MCL-intact knee by 4.3° to 8.1° for the 5-N·m valgus moment and 6.5° to 11.9° for the 10-N·m valgus moment ( P < .01). The applied 200-N simulated ST load reduced the valgus angle significantly at 0°, 10°, 20°, and 30° of flexion under 5- and 10-N·m valgus moments ( P < .05). At 0°, 10°, and 20° of flexion, these values were close to those for the MCL-intact joint under the respective moments (both P > .05). The combined 280-N simulated STGT load significantly reduced the valgus angle in 0°, 10°, and 20° of flexion under 5- and 10-N·m valgus moments ( P < .05) to values near those for the intact joint (5 N·m: 0°, 10°; 10 N·m: 0°, 10°, 20°; P > .05). In 60° and 90° of flexion, ST and STGT loads did not decrease the resulting valgus angle of the MCL-deficient knee without hamstring loads ( P > .05 vs deficient; P = .0001 vs intact). Conclusion: In this human cadaveric study, semitendinosus and gracilis muscles successfully stabilize valgus moments applied to the MCL-insufficient knee when the knee is near extension. Clinical Relevance: In the valgus-unstable knee, these data suggest that the hamstring muscles should be preserved in (multi-) ligament surgery when possible.
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Wada, Keizo, Daisuke Hamada, Tomoya Takasago, Tomohiro Goto, Ichiro Tonogai, Yoshihiro Tsuruo, and Koichi Sairyo. "Rotational and varus–valgus laxity affects kinematics of the normal knee: A cadaveric study." Journal of Orthopaedic Surgery 27, no. 3 (September 1, 2019): 230949901987372. http://dx.doi.org/10.1177/2309499019873726.
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Purpose: The aim of this study was to evaluate the relationship between soft tissue laxity and kinematics of the normal knee using a navigation system. Methods: Fifteen cadaveric knees from 11 fresh frozen whole-body specimens were included in this study. The navigation system automatically recorded the rotation angle of the tibia as the internal–external (IE) kinematics and the coronal alignment of the lower limb as the varus–valgus (VV) kinematics. These measurements were made with the joint in maximal extension, at 10° intervals from 0° to 120° of flexion, and at maximal flexion during passive knee motion. For evaluation of laxity, the examiner gently applied maximum manual IE and VV stress to the knee at 0°, 30°, 60°, and 90° of flexion. Results: The measurements showed almost perfect reliability. The mean correlation coefficient between the intraoperative tibial rotation angle and the intermediate angle of IE laxity was 0.82, while that between the coronal alignment of the lower limb and the intermediate angle of the VV laxity was 0.96. There was a statistically significant correlation between kinematics and laxity at all degrees of knee flexion. Conclusion: The present study revealed that the rotation angle of the tibia was correlated to the intermediate angle of IE laxity at 0°, 30°, 60°, and 90° of knee flexion and the coronal alignment of the lower limb also correlated to the intermediate angle of VV laxity. These findings provide important reference data on soft tissue laxity and kinematics of the normal knee.
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Ibrahim, I. W., M. M. M. Aruwa, A. H. A. Razak, A. Ahmad, and R. N. Khir. "Investigation of Knee Flexion Angle Influences on Intra-Body Communication’s (IBC) Signal Attenuation." Indonesian Journal of Electrical Engineering and Computer Science 9, no. 2 (February 1, 2018): 424. http://dx.doi.org/10.11591/ijeecs.v9.i2.pp424-430.
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Galvanic coupling method is one of the methods introduced in intra-body communication (IBC). IBC uses human body to as the communication medium for data transmission. In this paper, the investigation focuses on signal attenuation performance across knee joint using the galvanic coupling analysis. The signal attenuation was determined by implementing the galvanic coupling analysis at specific knee flexion angle. The galvanic analysis initiated by deciding the operating frequency in between 40 to 60 MHz in order to analyze the signal attenuation between the knee flexion angles. This paper found that the lowest signal attenuation at the operating frequency was 47.25dB, while the highest one was 52.63dB where the knee flexion angle is 0o and 155o respectively. It was concluded that the signal attenuation decrease with the increasing of knee joint existence at the specific flexion angle. However, a wider experiment must be conducted for various data that will correspond to signal attenuation for various influenced human data characteristics.
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Li, PH, YC Wong, and YL Wai. "Knee Flexion after Total Knee Arthroplasty." Journal of Orthopaedic Surgery 15, no. 2 (August 2007): 149–53. http://dx.doi.org/10.1177/230949900701500204.
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Purpose. To identify factors related to knee flexion after total knee arthroplasty in a Chinese population. Methods. Records of 242 total knee arthroplasties were retrospectively reviewed. The parameters evaluated were age, gender, diagnosis, preoperative knee flexion and extension, preoperative flexion arc, tibiofemoral angle, Knee Society knee score and functional score, and implant design. Results. Advanced age, female gender, and good preoperative flexion and flexion arc were related to better postoperative flexion. Postoperative flexion tended to migrate to the middle range despite different ranges of preoperative flexion. Preoperative tibiofemoral malalignment had no significant effect on postoperative flexion. Conclusion. Contemporary designs of posterior stabilised prostheses with right and left femoral components were superior to older designs.
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Antunes, Ricardo, Paul Jacob, Andrew Meyer, Michael A. Conditt, Martin W. Roche, and Matthias A. Verstraete. "Accuracy of Measuring Knee Flexion after TKA through Wearable IMU Sensors." Journal of Functional Morphology and Kinesiology 6, no. 3 (July 5, 2021): 60. http://dx.doi.org/10.3390/jfmk6030060.
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Wearable sensors have the potential to facilitate remote monitoring for patients recovering from knee replacement surgery. Using IMU sensors attached to the patients’ leg, knee flexion can be monitored while the patients are recovering in their home environment. Ideally, these flexion angle measurements will have an accuracy and repeatability at least on par with current clinical standards. To validate the clinical accuracy of a two-sensor IMU system, knee flexion angles were measured in eight subjects post-TKA and compared with other in-clinic angle measurement techniques. These sensors are aligned to the patients’ anatomy by taking a pose resting their operated leg on a box; an initial goniometer measurement defines the patients’ knee flexion while taking that pose. The repeatability and accuracy of the system was subsequently evaluated by comparing knee flexion angles against goniometer readings and markerless optical motion capture data. The alignment pose was repeatable with a mean absolute error of 1.6 degrees. The sensor accuracy through the range of motion had a mean absolute error of 2.6 degrees. In conclusion, the presented sensor system facilitates a repeatable and accurate measurement of the knee flexion, holding the potential for effective remote monitoring of patients recovering from knee replacement surgery.
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Felicio, Lílian Ramiro, Marcelo Camargo Saad, Rogério Ferreira Liporaci, Augusto do Prado Baffa, Antônio Carlos dos Santos, and Débora Bevilaqua-Grossi. "Evaluating Patellar Kinematics Through Magnetic Resonance Imaging During Open- and Closed-Kinetic-Chain Exercises." Journal of Sport Rehabilitation 19, no. 1 (February 2010): 1–11. http://dx.doi.org/10.1123/jsr.19.1.1.
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Purpose:To evaluate patellar kinematics of volunteers without knee pain at rest and during isometric contraction in open- and closed-kinetic-chain exercises.Methods:Twenty individuals took part in this study. All were submitted to magnetic resonance imaging (MRI) during rest and voluntary isometric contraction (VIC) in the open and closed kinetic chain at 15°, 30°, and 45° of knee flexion. Through MRI and using medical e-film software, the following measurements were evaluated: sulcus angle, patellar-tilt angle, and bisect offset. The mixed-effects linear model was used for comparison between knee positions, between rest and isometric contractions, and between the exercises.Results:Data analysis revealed that the sulcus angle decreased as knee flexion increased and revealed increases with isometric contractions in both the open and closed kinetic chain for all knee-flexion angles. The patellar-tilt angle decreased with isometric contractions in both the open and closed kinetic chain for every knee position. However, in the closed kinetic chain, patellar tilt increased significantly with the knee flexed at 15°. The bisect offset increased with the knee flexed at 15° during isometric contractions and decreased as knee flexion increased during both exercises.Conclusion:VIC in the last degrees of knee extension may compromise patellar dynamics. On the other hand, it is possible to favor patellar stability by performing muscle contractions with the knee flexed at 30° and 45° in either the open or closed kinetic chain.
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Zhang, Juan, Rui Wang, Yili Zheng, Jiao Xu, Ya Wu, and Xueqiang Wang. "Effect of Whole-Body Vibration Training on Muscle Activation for Individuals with Knee Osteoarthritis." BioMed Research International 2021 (March 26, 2021): 1–8. http://dx.doi.org/10.1155/2021/6671390.
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Whole-body vibration (WBV) training may improve the strength of lower extremity muscles in patients with knee osteoarthritis (KOA), but the inconsistency in vibration parameters leads to differences in findings. This cross-sectional study is aimed at observing the effects of different vibration frequencies and knee flexion angles on the activation of lower extremity muscles in patients with KOA. Enrolled participants received WBV training at 0, 30, and 60° knee flexion angles with vibration frequencies of 0, 5, 10, and 20 Hz. Activation rates for vastus medialis, vastus lateralis, rectus femoris, biceps femoris, and semitendinosus in different combinations were collected through surface electromyography. The effects of frequency and angle on muscle activation rate were quantified by repeated measures ANOVA. Individual and synergistic effects of frequency and angle were also analysed. Twenty-six participants with KOA were included. Muscle activation increased with the vibration frequency in 0–20 Hz range and with knee flexion angle in 0–60° range. WBV training at 20 Hz was the most effective for knee muscle activation, and static squatting at 60° was the most suitable for WBV training. Therefore, WBV training can increase the activation rate of knee flexor and extensor muscles in patients with KOA, and the most efficient combination was 20 Hz vibration frequency and 60° knee flexion. When applying WBV to patients with KOA, individual differences and rehabilitation purposes should be considered in selecting vibration parameters and knee angle to effectively increase neuromuscular activity.
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Yu, Bing, Scott B. McClure, James A. Onate, Kevin M. Guskiewicz, Donald T. Kirkendall, and William E. Garrett. "Age and Gender Effects on Lower Extremity Kinematics of Youth Soccer Players in a Stop-Jump Task." American Journal of Sports Medicine 33, no. 9 (September 2005): 1356–64. http://dx.doi.org/10.1177/0363546504273049.
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Background Gender differences in lower extremity motion patterns were previously identified as a possible risk factor for non-contact anterior cruciate ligament injuries in sports. Hypothesis Gender differences in lower extremity kinematics in the stop-jump task are functions of age for youth soccer players between 11 and 16 years of age. Study Design Descriptive laboratory study. Methods Three-dimensional videographic data were collected for 30 male and 30 female adolescent soccer players between 11 and 16 years of age performing a stop-jump task. The age effects on hip and knee joint angular motions were compared between genders using multiple regression analyses with dummy variables. Results Gender and age have significant interaction effects on standing height (P = .00), body mass (P = .00), knee flexion angle at initial foot contact with the ground (P = .00), maximum knee flexion angle (P = .00), knee valgus-varus angle (P = .00), knee valgus-varus motion (P = .00), and hip flexion angle at initial foot contact with the ground (P = .00). Conclusion Youth female recreational soccer players have decreased knee and hip flexion angles at initial ground contact and decreased knee and hip flexion motions during the landing of the stop-jump task compared to those of their male counterparts. These gender differences in knee and hip flexion motion patterns of youth recreational soccer players occur after 12 years of age and increase with age before 16 years. Clinical Relevance The results of this study provide significant information for research on the prevention of noncontact anterior cruciate ligament injuries.
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Deie, Masataka, Tomoyuki Nakasa, Goki Kamei, Atsuo Nakamae, and Mitsuo Ochi. "High flexion knee arthroplasty: the relationship between rotational angles and flexion angle after total knee arthroplasty." Current Reviews in Musculoskeletal Medicine 7, no. 2 (March 23, 2014): 103–7. http://dx.doi.org/10.1007/s12178-014-9215-1.
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Biscarini, Andrea, Samuele Contemori, Cristina V. Dieni, and Roberto Panichi. "Joint Torques and Tibiofemoral Joint Reaction Force in the Bodyweight “Wall Squat” Therapeutic Exercise." Applied Sciences 10, no. 9 (April 26, 2020): 3019. http://dx.doi.org/10.3390/app10093019.
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This study provides a biomechanical analysis of the bodyweight wall-squat exercise considering four exercise variants: knee angle; horizontal hip-ankle distance (d); shift between the rearfoot and forefoot of the centre of pressure (xGR) of the ground reaction force; back supported via the scapular or pelvic zone. The ankle and hip angles corresponding to a given knee angle can be modulated, changing the distance d, to manage limitation in lumbopelvic and ankle mobility. The knee-extensor muscles can be overloaded (250 Nm muscle torque) with knees flexed at 90°, back supported through the pelvic zone, and feet away from the wall (d = 50 cm). Scapular support, xGR at forefoot, and d = 50 cm, yield a higher level of muscle-torque for hip-extension (130 Nm) and knee-flexion (65 Nm), with knees at 90° of flexion or near full extension, respectively. Ankle-dorsiflexion (plantarflexion) muscle torque up to 40 Nm is reached with xGR at the forefoot (rearfoot). This study may aid trainers and therapists to finely modulate the muscle torques (up to the above-mentioned levels) by an appropriate selection of exercise variants for training or rehabilitation purposes. Low levels (60 N) of anterior tibial pull may occur near 25° of knee flexion with x GR at the rearfoot.
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Andersen, Susan B., Donna M. Terwilliger, and Craig R. Denegar. "Comparison of Open versus Closed Kinetic Chain Test Positions for Measuring Joint Position Sense." Journal of Sport Rehabilitation 4, no. 3 (August 1995): 165–71. http://dx.doi.org/10.1123/jsr.4.3.165.
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The purpose of this study was to determine if a difference exists in the reproducibility of knee joint flexion angles in an open versus a closed kinetic chain. Thirty generally healthy subjects (12 males, 18 females; mean age 23.8 years) participated. Subjects actively reproduced small, medium, and large knee flexion angles (with target angles of 15°, 45°, and 75°, respectively) in an open and a closed kinetic chain while being videotaped. Goniometric measurements were taken from the videotape of initial and reproduced joint angles. Data were analyzed using ANOVA with repeated measures on kinetic chain test position and joint angle. Subjects more accurately reproduced knee flexion angles in a closed kinetic chain position. The main effect for angle and the interaction of angle and test position were nonsignificant. The results indicate that knee joint position is more accurately reproduced in closed kinetic chain. Closed kinetic chain testing is also a more functional assessment of joint position sense, and thus closed kinetic chain assessment of lower extremity joint position sense is recommended.
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Ali, Nicholas, Gholamreza Rouhi, and Gordon Robertson. "Gender, Vertical Height and Horizontal Distance Effects on Single-Leg Landing Kinematics: Implications for Risk of non-contact ACL Injury." Journal of Human Kinetics 37, no. 1 (June 1, 2013): 27–38. http://dx.doi.org/10.2478/hukin-2013-0022.
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There is a lack of studies investigating gender differences in whole-body kinematics during single-leg landings from increasing vertical heights and horizontal distances. This study determined the main effects and interactions of gender, vertical height, and horizontal distance on whole-body joint kinematics during single-leg landings, and established whether these findings could explain the gender disparity in non-contact anterior cruciate ligament (ACL) injury rate. Recreationally active males (n=6) and females (n=6) performed single-leg landings from a takeoff deck of vertical height of 20, 40, and 60 cm placed at a horizontal distance of 30, 50 and 70 cm from the edge of a force platform, while 3D kinematics and kinetics were simultaneously measured. It was determined that peak vertical ground reaction force (VGRF) and the ankle flexion angle exhibited significant gender differences (p=0.028, partial η2=0.40 and p=0.035, partial η2=0.37, respectively). Peak VGRF was significantly correlated to the ankle flexion angle (r= -0.59, p=0.04), hip flexion angle (r= -0.74, p=0.006), and trunk flexion angle (r= -0.59, p=0.045). Peak posterior ground reaction force (PGRF) was significantly correlated to the ankle flexion angle (r= -0.56, p=0.035), while peak knee abduction moment was significantly correlated to the knee flexion angle (r= -0.64, p=0.03). Rearfoot landings may explain the higher ACL injury rate among females. Higher plantar-flexed ankle, hip, and trunk flexion angles were associated with lower peak ground reaction forces, while higher knee flexion angle was associated with lower peak knee abduction moment, and these kinematics implicate reduced risk of non-contact ACL injury.
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BELLI, GUIDO, LUCA VITALI, MATTEO BOTTEGHI, LEYDI NATALIA VITTORI, ELISABETTA PETRACCI, and PASQUALINO MAIETTA LATESSA. "ELECTROMYOGRAPHIC ANALYSIS OF LEG EXTENSION EXERCISE DURING DIFFERENT ANKLE AND KNEE POSITIONS." Journal of Mechanics in Medicine and Biology 15, no. 02 (April 2015): 1540037. http://dx.doi.org/10.1142/s0219519415400370.
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The imbalance between vastus medialis oblique (VMO) and vastus lateralis (VL) strength is one of the main factor for patellofemoral pain syndrome (PFPS) onset, related to improper alignment of the patella. The aim of this paper is to investigate the effects of knee flexion, knee rotation and ankle flexion attitudes on the activity of the VMO and VL muscles during unilateral maximal voluntary isometric contraction (MIVC) of the quadriceps femoris. Eighteen healthy subjects volunteered for the study. Five conditions for two different knee flexion angles (90°; 30°) were tested using leg extension machine: Neutral (N) condition, maximal knee medial rotation (MR), maximal knee lateral rotation (LR), maximal ankle plantarflexion (PF) and maximal ankle dorsiflexion (DF). Data were normalized in order to calculate the normalized VMO/VL ratio. The normalized VMO/VL ratio for all the conditions occurred at 90° of knee flexion was higher than the same conditions at 30° of knee flexion (p = 0.02). No statistical differences between conditions at the same knee angle and for angle x condition interaction were observed (p > 0.05). These findings suggest that knee flexion should be the first variable to be managed during isometric knee extension movement performed by leg extension machine, in order to increase VMO/VL ratio.
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Wu, Xubo, Lixi Chu, Lianbo Xiao, Yong He, Shuyun Jiang, Songbin Yang, and Yijie Liu. "Early Spatiotemporal Patterns and Knee Kinematics during Level Walking in Individuals following Total Knee Arthroplasty." Journal of Healthcare Engineering 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/7056469.
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Purpose. With the aim of investigating the spatiotemporal features of early gait pattern and knee kinematics after total knee arthroplasty and analyzing the association between outcomes of gait analyses and knee kinematic parameters, the relationship between walking and dynamic knee deformity at the early period after total knee arthroplasty was assessed in this study. Methods. Eighteen patients including 14 women and 4 men who underwent total knee arthroplasty were analyzed using three-dimensional gait analysis system to observe gait parameters and values of maximum knee flexion angle (MKFA) during swing phase and knee flexion angle (KFA) and knee valgus angle (KVA) at midstance phase. Results. 3D gait analysis showed that operated side exhibited significantly less total support time and single support time as well as significantly longer swing phase compared with the other side. During walking, the operated side had significantly smaller MKFA and greater KFA and KVA than the nonoperated side. There was moderate to significant correlation between gait pattern and the dynamic knee kinematics. Conclusion. The gait abnormality of patients after TKA was associated with inadequate flexion of knees at swing phase and insufficient extension at stance phase as well as increased range of valgus.
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Richards, Jim, Dominic Thewlis, James Selfe, Andrew Cunningham, and Colin Hayes. "A Biomechanical Investigation of A Single-Limb Squat: Implications for Lower Extremity Rehabilitation Exercise." Journal of Athletic Training 43, no. 5 (September 1, 2008): 477–82. http://dx.doi.org/10.4085/1062-6050-43.5.477.
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Abstract Context: Single-limb squats on a decline angle have been suggested as a rehabilitative intervention to target the knee extensors. Investigators, however, have presented very little empirical research in which they have documented the biomechanics of these exercises or have determined the optimum angle of decline used. Objective: To determine the involvement of the gastrocnemius and rectus femoris muscles and the external ankle and knee joint moments at 60° of knee flexion while performing a single-limb squat at different decline angles. Design: Participants acted as their own controls in a repeated-measures design. Patients or Other Participants: We recruited 10 participants who had no pain, injury, or neurologic disorder. Intervention(s): Participants performed single-limb squats at different decline angles. Main Outcome Measure(s): Angle-specific knee and ankle moments were calculated at 60° of knee flexion. Angle-specific electromyography (EMG) activity was calculated at 60° of knee flexion. Integrated EMG also was calculated to determine the level of muscle activity over the entire squat. Results: An increase was seen in the knee moments (P < .05) and integrated EMG in the rectus femoris (P < .001) as the decline angle increased. A decrease was seen in the ankle moments as the decline angle increased (P = .001), but EMG activity in the gastrocnemius increased between 16° and 24° (P = .018). Conclusions: As the decline angle increased, the knee extensor moment and EMG activity increased. As the decline angle increased, the ankle plantar-flexor moments decreased; however, an increase in the EMG activity was seen with the 24° decline angle compared with the 16° decline angle. This indicates that decline squats at an angle greater than 16° may not reduce passive calf tension, as was suggested previously, and may provide no mechanical advantage for the knee.
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Vigotsky, Andrew D., Gregory J. Lehman, Bret Contreras, Chris Beardsley, Bryan Chung, and Erin H. Feser. "Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test." PeerJ 3 (September 24, 2015): e1281. http://dx.doi.org/10.7717/peerj.1281.
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Background.Foam rolling has been shown to acutely increase range of motion (ROM) during knee flexion and hip flexion with the experimenter applying an external force, yet no study to date has measured hip extensibility as a result of foam rolling with controlled knee flexion and hip extension moments. The purpose of this study was to investigate the acute effects of foam rolling on hip extension, knee flexion, and rectus femoris length during the modified Thomas test.Methods.Twenty-three healthy participants (male = 7; female = 16; age = 22 ± 3.3 years; height = 170 ± 9.18 cm; mass = 67.7 ± 14.9 kg) performed two, one-minute bouts of foam rolling applied to the anterior thigh. Hip extension and knee flexion were measured via motion capture before and after the foam rolling intervention, from which rectus femoris length was calculated.Results.Although the increase in hip extension (change = +1.86° (+0.11, +3.61); z(22) = 2.08;p= 0.0372; Pearson’sr= 0.43 (0.02, 0.72)) was not due to chance alone, it cannot be said that the observed changes in knee flexion (change = −1.39° (−5.53, +2.75); t(22) = −0.70;p= 0.4933; Cohen’sd= − 0.15 (−0.58, 0.29)) or rectus femoris length (change = −0.005 (−0.013, +0.003); t(22) = −1.30;p= 0.2070; Cohen’sd= − 0.27 (−0.70, 0.16)) were not due to chance alone.Conclusions.Although a small change in hip extension was observed, no changes in knee flexion or rectus femoris length were observed. From these data, it appears unlikely that foam rolling applied to the anterior thigh will improve passive hip extension and knee flexion ROM, especially if performed in combination with a dynamic stretching protocol.
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Shuib, Solehuddin, Mohammad Arsyad Azemi, Iffa Binti Mohd Arrif, and Najwa Syakirah Hamizan. "Design for Additive Manufacturing and Finite Element Analysis for High Flexion Total Knee Replacement (TKR)." Journal of Mechanical Engineering 18, no. 2 (April 15, 2021): 97–110. http://dx.doi.org/10.24191/jmeche.v18i2.14963.
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The patient from the Asian region always demanded a fully functional knee implant, which implied a high-flexion range of motion. Most of their daily life activities utilized the deep knee flexion which flexed until 165° such as the Japanese proper sitting style and Muslim prayer position. The problem of the study is extending the range of motion or achieving the high flexion of total knee replacement as the traditional total knee replacement was incapable to achieve more than 115°. Hence, the purpose of this study is to achieve a modified design of a knee implant that can flex up to 165° by carried out a static structural analysis in the ANSYS R16. There are 0°, 90°, 135°, and 165° angles of flexion with a different net force based on the percentage of body weight implemented on the knee implant. The analysis includes total deformation, Von Mises stress, shear stress, and contact pressure on knee implant were observed and compared to find better modification design. The total deformation had been decreased by about 69% at 0° flexion, 58.5% at 90° flexion, 90.93% at 135° flexion. The contact pressure also had been decreased by about 99.2%, 22.2%, 99.98% at angle flexion of 0, 90, and 135, respectively. The same declination happened to von Mises stress at about 85.05%, 9.52%, and 88.04% at the same angle of 0, 90, and 135, respectively.
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Willadsen, Erica M., Andrea B. Zahn, and Chris J. Durall. "What Is the Most Effective Training Approach for Preventing Noncontact ACL Injuries in High School–Aged Female Athletes?" Journal of Sport Rehabilitation 28, no. 1 (January 1, 2019): 94–98. http://dx.doi.org/10.1123/jsr.2017-0055.
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Clinical Scenario: A variety of training approaches have been adopted in anterior cruciate ligament (ACL) prevention programs, including neuromuscular control training, core stability training, balance training, and plyometric exercise. This review was conducted to determine if current evidence supports one of these training approaches over the others for reducing noncontact ACL injuries in adolescent female athletes. Focused Clinical Question: What is the most effective training approach for preventing noncontact ACL injuries in adolescent and/or high school–aged female athletes? Summary of Key Findings: A literature search generated 2 level 1b randomized control trials and 1 level 2b cohort study. Plyometric training resulted in decreased knee valgus during landing in 3 studies and increased knee flexion at landing in 2 studies. Balance training or neuromuscular training led to decreased knee valgus and increased knee-flexion angles with landing in 2 studies. Core stability training had conflicting effects on knee valgus and knee-flexion angles at landing, with 1 study reporting no effect and another reporting an undesirable decrease in knee joint flexion angle at landing. Clinical Bottom Line: Based on this review, plyometric training, balance training, and neuromuscular training approaches appear sensible to include in ACL prevention programs for female athletes to help decrease knee valgus and knee flexion during landing. Core stability training may be somewhat beneficial for decreasing knee valgus angles at landing, although may have nominal or even deleterious effects on knee-flexion angle at landing, and thus should be implemented with caution. Strength of Recommendation: Our recommendations were derived from the results of 2 level 1b randomized control trials and 1 level 2b cohort study.
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Takeshita, Yasufumi, Masayuki Kawada, Takasuke Miyazaki, Yuki Nakai, Sota Araki, Shintaro Nakatsuji, Yuta Matsuzawa, Shobu Nakashima, and Ryoji Kiyama. "Effects of Knee Flexion Angles on the Joint Force and Muscle Force during Bridging Exercise: A Musculoskeletal Model Simulation." Journal of Healthcare Engineering 2022 (May 29, 2022): 1–7. http://dx.doi.org/10.1155/2022/7975827.
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Bridging exercise is commonly used to increase the strength of the hip extensor and trunk muscles in physical therapy practice. However, the effect of lower limb positioning on the joint and muscle forces during the bridging exercise has not been analyzed. The purpose of this study was to use a musculoskeletal model simulation to examine joint and muscle forces during bridging at three different knee joint angle positions. Fifteen healthy young males (average age: 23.5 ± 2.2 years) participated in this study. Muscle and joint forces of the lumbar spine and hip joint during the bridging exercise were estimated at knee flexion angles of 60°, 90°, and 120° utilizing motion capture data. The lumbar joint force and erector spinae muscle force decreased significantly as the angle of the knee joint increased. The resultant joint forces were 200.0 ± 23.2% of body weight (%BW), 174.6 ± 18.6% BW, and 150.5 ± 15.8% BW at 60°, 90°, and 120° knee flexion angles, respectively. On the other hand, the hip joint force, muscle force of the gluteus maxims, and adductor magnus tended to increase as the angle of the knee joint increased. The resultant joint forces were 274.4 ± 63.7% BW, 303.9 ± 85.8% BW, and 341.1 ± 85.7% BW at a knee flexion angle of 60°, 90°, and 120°, respectively. The muscle force of the biceps femoris decreased significantly with increased knee flexion during the bridging exercise. In conclusion, the knee flexion position during bridging exercise has different effects on the joint and muscle forces around the hip joint and lumbar spine. These findings would help clinicians prescribe an effective bridging exercise that includes optimal lower limb positioning for patients who require training of back and hip extensor muscles.
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SIVARASU, SUDESH, SAM PRASANNA, and LAZAR MATHEW. "KNEE KINEMATICS SIMULATION AND COMPARATIVE FLEXION ANGLE ANALYSIS OF RECONSTRUCTED KNEE VERSUS STANDARD ARTIFICIAL KNEE VERSUS HIGH FLEXION ARTIFICIAL KNEE." International Journal of Modeling, Simulation, and Scientific Computing 01, no. 04 (December 2010): 477–83. http://dx.doi.org/10.1142/s1793962310000316.
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Knee simulation has been used as the primary tool in the estimation of knee flexion–extension levels for many years. This paper discusses the suitability of AdamsView simulation tool for estimating the flexion–extension angles in the knee joint, i.e. three versions namely: 3D reconstructed knee joint, standard artificial knee joint and artificial high flexion knee joint. The high flexion artificial knee joint model reaches a maximum flexion up to 120.2°. Whereas the standard knee Joint gets about 84.6°. However, the 3D reconstructed knee joint was capable of producing 134.4°. Thus the usage of the mechanical simulation tools in the medical applications has been proved once again.
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Cardenas, Cesar, Auralea C. Fain, Nicholas J. Lobb, Kayla D. Seymore, and Tyler N. Brown. "EFFECT OF BODY-BORNE LOAD ON LATERAL TRUNK FLEXION AND ITS RELATION TO KNEE ABDUCTION BIOMECHANICS DURING A SINGLE-LEG CUT." Journal of Musculoskeletal Research 24, no. 03 (June 25, 2021): 2150009. http://dx.doi.org/10.1142/s0218957721500093.
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Body-borne load reportedly increases incidence of military-related knee injury by altering trunk and lower limb biomechanics. This investigation determined whether body-borne load impacts lateral trunk flexion during a single-leg cut, and whether greater lateral trunk flexion exaggerates knee abduction biomechanics. Thirty-six participants had trunk and knee biomechanics quantified during a single-leg cut with four body-borne loads (20, 25, 30 and 35[Formula: see text]kg). To evaluate the impact of load on lateral trunk flexion and its relation with knee abduction biomechanics, peak stance lateral trunk flexion was submitted to a linear mixed model with load (20, 25, 30, and 35[Formula: see text]kg) and sex (male, female) as fixed effects, and dominant limb peak stance knee abduction joint angle and moment considered as covariates. During the cut, there was a significant sex by load interaction for peak stance lateral trunk flexion ([Formula: see text]), and peak stance lateral trunk flexion angle exhibited a significant association with peak stance knee abduction angle ([Formula: see text]) and moment ([Formula: see text]). Adopting lateral trunk flexion during loaded single-leg cuts may increase knee biomechanics related to ACL injury, but adding load only decreased lateral trunk flexion for female participants and did not further exaggerate knee abduction biomechanics.
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Ma, Yuan, Wei-Jia Chen, and Ryuji Nagamine. "Comparative evaluation of posterior cruciate ligament in total knee arthroplasty." Journal of Orthopaedic Surgery 25, no. 1 (January 1, 2017): 230949901769097. http://dx.doi.org/10.1177/2309499017690976.
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Introduction: It has been realized that for osteoarthritis (OA) knee with varus deformity, posterior cruciate ligament (PCL) release resulted in the increase of the flexion gap without significant effect on the extension gap. While the effect of release on gap angle is still obscure. On the other hand, gap distance and varus angle measured under different distraction forces suggest different patterns. Objectives: In the current study, mechanical gap balance in displacement and angular alternation of extension and flexion gaps will be evaluated, with PCL fully retained or resected under different distracting forces in varus knees. Methods: Fifty cases with medial OA undergoing posterior-stabilized (PS) total knee arthroplasty (TKA) were included in the study. PCL of all the cases were identified intact before resection. After distal femoral and proximal tibial cuts were initially performed and anterior cruciate ligament was excised, joint gap angle and distance in full extension and at 90° flexion were obtained by means of a tensioning device with 10, 20 and 30 inch-pounds (in-lbf) of distraction force. The gap angle and distance were measured three times at each step. After the excision of PCL, the same measurement was performed. Results: Both the distance and the varus angles of the knee gap enlarged accordingly with the augment of distraction forces at both extension and flexion with or without PCL resection. As to the gap distance, it remained the same after PCL resection at extension; while at flexion, the gap distance significantly ( p < 0.001) enlarged – 1.2, 1.6 and 1.9 mm – under 10, 20 and 30 in-lbf, respectively, after PCL resection. As to the varus angles, it significantly ( p < .050) decreased 0.6°, 0.3° and 0.4° at extension; while at flexion, the varus angles decreased 0° (not significant), 0.6° ( p < 0.050) and 1.1° ( p < 0.001) with 10, 20 and 30 in-lbf, respectively, after PCL resection. Conclusion: Our study indicated that the sacrifice of PCL will decrease the varus deformity at both extension and flexion, but with the exception under low distraction force at flexion. A proper distraction tension is of great importance in gap balancing during TKA. Sufficient attention of varus differences should be paid to the gap balance technique when choosing from different techniques, PCL-retained TKA or PCL-sacrificed TKA, as well as and an appropriate distract tension during measurement.
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Inui, Hiroshi, Shuji Taketomi, Ryota Yamagami, Kohei Kawaguchi, Keiu Nakazato, and Sakae Tanaka. "Necessary Factors to Achieve Deep Flexion for Asian Populations after Oxford Unicompartmental Knee Arthroplasty." Journal of Knee Surgery 33, no. 03 (February 8, 2019): 294–300. http://dx.doi.org/10.1055/s-0039-1678539.
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AbstractThere have been many reports on the clinical outcomes of Oxford unicompartmental knee arthroplasty (UKA); however, none have investigated the influence of flexion angle after UKA on clinical outcomes. The objective of this study was to clarify the relationship between outcomes and the postoperative maximum flexion angle and reveal the necessary factors for maximum flexion angle ≥ 140 degrees which is considered necessary for Asian populations. We categorized 212 UKA patients into the following three groups based on the postoperative maximum flexion angle: group 1 had flexion angle ≥ 140 degrees in 80 patients (38%), group 2 had 130 degrees ≤ flexion angle < 140 degrees in 80 patients (38%), and group 3 had flexion angle < 130 degrees in 52 patients (24%). Furthermore, we compared the postoperative clinical outcomes between the three groups and conducted multivariable regression analyses to assess parameters affecting the flexion angle. Postoperative Knee Society function scores for group 1 was significantly higher than for group 3. Group 1 had higher mean knee injury and osteoarthritis outcome scores (KOOS) in all subscales and significantly higher KOOS scores in the sports and quality of life subscales compared with group 2 and in all subscales compared with group 3. Multivariable logistic regression showed that preoperative flexion angle and tibial component posterior slope were associated with maximum flexion angle ≥ 140 degrees. Maximum flexion angle ≥ 140 degrees after Oxford UKA improved the clinical results, particularly for patient-reported outcomes. Furthermore, the tibial posterior slope was an important factor in achieving maximum flexion angle ≥ 140 degrees in UKA patients.