Journal articles on the topic 'Knee lever'
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Nielsen, S., I. Hvid, and K. Andersen. "Experimental Measurement of Rotatory and Translatory Instability of the Knee Joint." Engineering in Medicine 14, no. 3 (July 1985): 123–26. http://dx.doi.org/10.1243/emed_jour_1985_014_029_02.
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In the evaluation and treatment of knee ligament injuries and for comprehensive understanding of knee ligament function, it is important to know where in the movement of extension-flexion the different types of instability released by wellknown ligament injuries occur. An apparatus was developed to record anterior– posterior tibial displacement, valgus–varus instability, and axial tibial rotation instability on knee preparations, continuously, in the extension–flexion movement, when the tibia was submitted to a well-defined constant torque or force. Osteoligamentous knee preparations were suspended in the femur and a lever was fixed to the tibial segment. The lever was fitted with strain gauges to measure the torque in three planes. Potentiometers recording extension–flexion, anterior–posterior tibial displacement, valgus–varus, and axial rotation angulations were mounted. The lever was moved manually, and signals from strain gauges and potentiometers passed through an amplifier and a data acquisition system to a microcomputer, which stored the results of the measurements. The final movement curves were calculated and plotted at a regional computer service centre. Tests for reproducibility of measurements at different ligament status demonstrated a high level of reproducibility.
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Lieber, R. L., and J. L. Boakes. "Sarcomere length and joint kinematics during torque production in frog hindlimb." American Journal of Physiology-Cell Physiology 254, no. 6 (June 1, 1988): C759—C768. http://dx.doi.org/10.1152/ajpcell.1988.254.6.c759.
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The relationship between semitendinosus muscle force and knee joint kinematics during isometric torque production was examined in the frog (Rana pipiens) hindlimb. Passive muscle sarcomere length was monitored by laser diffraction during knee rotation, and joint center of rotation was determined later using principles of rigid body kinematics. Contractile force at the distal tibia, resulting from semitendinosus contraction, was also measured, and, using the kinematic data, a torque vs. joint angle curve constructed. Muscle sarcomere length varied from 3.6 micron at full knee extension to 2.0 micron at full knee flexion. Effective lever arm varied almost as a sine function, with optimal lever arm at 90 degrees of flexion. Joint torque increased linearly from 0 to 140 degrees of flexion and then sharply decreased to 160 degrees of flexion. Thus the optimal joint angle occurred at an angle (140 degrees) that was neither the angle at which muscle force was maximum (160 degrees) nor the angle at which the effective lever arm was maximum (90 degrees). These data indicate that knee torque production in the frog results from the interaction between muscular and joint properties and not either property alone.
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Fantini Pagani, Cynthia H., Steffen Willwacher, Rita Benker, and Gert-Peter Brüggemann. "Effect of an ankle–foot orthosis on knee joint mechanics: A novel conservative treatment for knee osteoarthritis." Prosthetics and Orthotics International 38, no. 6 (December 10, 2013): 481–91. http://dx.doi.org/10.1177/0309364613513297.
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Background: Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success. Objective: To analyze the effect of an ankle–foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment. Study design: Controlled laboratory study, repeated measurements. Methods: In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle–foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis. Results: Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle–foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles. Conclusion: The ankle–foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane. Clinical relevance This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis.
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Carvalho, Jose Andre, Mauricio Dias Mongon, William Dias Belangero, and Bruno Livani. "A case series featuring extremely short below-knee stumps." Prosthetics and Orthotics International 36, no. 2 (December 14, 2011): 236–38. http://dx.doi.org/10.1177/0309364611430535.
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Background: Lower limb amputations should be evaluated carefully, especially with regard to the possibility of preserving the knee joint to enable a more physiological gait and lower energy consumption. Below-knee amputations were performed immediately below the tibial tuberosity with maintenance of the insertion of the patellar tendon, resulting in very short, but functional stumps. This case study examined whether very short below-knee stumps allow a more functional gait, as compared to more proximal amputations.Case Description and Methods: Between June 2010 and June 2011, four patients had extremely short below-knee amputations, with resection of the head of the fibula at the junction and reinsertion of the collateral ligaments and structures attached to the tibia. This was followed by placement of a prosthesis with a vacuum-assisted suspension socket.Findings and Outcome: At the end of treatment, patients that underwent transtibial amputations with an extremely short stump were considered well adapted to their prosthesis and were satisfied in relation to the acquired gait patterns.Conclusion: The extremely short below-knee amputation, despite having a short lever arm should be considered as another option for lower-limb amputations, although we cannot yet assure that other patient groups undergoing this level of amputation may have the same results of the study.Clinical relevanceThe extremely short below-knee amputation, despite having a short lever arm should be considered as an option for lower limb amputations, as it can provide a prosthetic provision with a good functional outcome.
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Colliander, Erland B., and Per A. Tesch. "Isokinetic torque expressed relative to knee versus lever arm angle." Journal of Biomechanics 22, no. 10 (January 1989): 997. http://dx.doi.org/10.1016/0021-9290(89)90154-1.
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Lichtenberg, Miranda C., Christiaan H. Koster, Lennart P. J. Teunissen, Frits G. J. Oosterveld, Annelieke M. K. Harmsen, Daniel Haverkamp, Daniel Hoornenborg, Robert P. Berg, Frank W. Bloemers, and Irene R. Faber. "Does the Lever Sign Test Have Added Value for Diagnosing Anterior Cruciate Ligament Ruptures?" Orthopaedic Journal of Sports Medicine 6, no. 3 (March 1, 2018): 232596711875963. http://dx.doi.org/10.1177/2325967118759631.
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Background: Diagnosing an anterior cruciate ligament (ACL) rupture based on a physical examination remains a challenge for both surgeons and physical therapists. The lever sign test was developed to overcome the practical limitations of other tests and to optimize diagnosis. An evaluation of the measurement properties of the lever sign test is needed to make adequate interpretations in practice. Purpose: To evaluate the reliability and diagnostic value of the lever sign test. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 94 patients were recruited between November 2014 and July 2016. Patients were included if they were at least 16 years old, suffered from knee trauma, and had indications for knee arthroscopic surgery. Lever sign, anterior drawer, Lachman, and pivot-shift test outcomes were examined by an orthopaedic/trauma surgeon and a physical therapist. A test-retest design was used to investigate interrater reliability. Moreover, the lever sign test outcomes, alone and in combination with the other diagnostic tests, were compared with arthroscopic results, which served as the gold standard for the test’s diagnostic value. Results: The lever sign test and pivot-shift test had kappa values exceeding 0.80 for interrater reliability. The kappa values for the anterior drawer test and Lachman test were 0.80 and 0.77, respectively. The lever sign test showed the highest specificity (100%) and the lowest sensitivity (39%) when compared with the other 3 tests. Moreover, its positive and negative predictive values were 100% and 65%, respectively, while an accuracy of 71% was calculated. Clustering the lever sign test parallel with the other 3 tests resulted in the highest accuracy of 91%. Conclusion: The lever sign test appears to have high interrater reliability and is the most specific test, showing a maximal positive predictive value. A positive lever sign test result indicates an ACL rupture. These results support the added value of the lever sign test for diagnosing ACL ruptures.
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Squillantini, Rafael, Brielle Ringle, and Julie Cavallario. "Comparing the Diagnostic Accuracy of Two Selective Tissue Tests for Anterior Cruciate Ligament Injuries: A Critically Appraised Topic." International Journal of Athletic Therapy and Training 24, no. 4 (July 1, 2019): 145–50. http://dx.doi.org/10.1123/ijatt.2018-0056.
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Clinical Question:In patients with acute knee injuries, is there evidence to support that the lever sign test is more accurate in diagnosing an anterior cruciate ligament sprain than the Lachman test?Clinical Bottom Line:The evidence does not indicate that the lever sign test can be used in isolation in lieu of the Lachman test, but there is sufficient evidence to support adding the lever sign test to the examination of potential anterior cruciate ligament sprains.
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Li, Bin. "Numerical Simulation of Ligament Force in Pitching Motion." Applied Mechanics and Materials 170-173 (May 2012): 3292–95. http://dx.doi.org/10.4028/www.scientific.net/amm.170-173.3292.
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The knee joint is a vulnerable joint that is easily injured. This is due in part to the fact that the joint is in the middle of two long lever-arms, the femur and the tibia. This makes the knee ligaments prone to injury from any strong contact to the knee, or sometimes even from just the force of the body moving through space with a hard muscle contraction. Simulation of ligament force in pitching motion of basketball player is studied in this paper.
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Zhu, Jun, Yu Wang, Jinlin Jiang, Bo Sun, and Heng Cao. "Unidirectional variable stiffness hydraulic actuator for load-carrying knee exoskeleton." International Journal of Advanced Robotic Systems 14, no. 1 (January 1, 2017): 172988141668695. http://dx.doi.org/10.1177/1729881416686955.
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This article presents the design and experimental testing of a unidirectional variable stiffness hydraulic actuator for load-carrying knee exoskeleton. The proposed actuator is designed for mimicking the high-efficiency passive behavior of biological knee and providing actively assistance in locomotion. The adjustable passive compliance of exoskeletal knee is achieved through a variable ratio lever mechanism with linear elastic element. A compact customized electrohydraulic system is also designed to accommodate application demands. Preliminary experimental results show the prototype has good performances in terms of stiffness regulation and joint torque control. The actuator is also implemented in an exoskeleton knee joint, resulting in anticipant human-like passive compliance behavior.
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Shuleikin, V. N., and G. V. Kupovykh. "Performance assessment of the atmospheric electric dowsing mechanism." Actual Problems of Oil and Gas, no. 29 (November 19, 2020): 51–63. http://dx.doi.org/10.29222/ipng.2078-5712.2020-29.art4.
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The movement of the frame in the operator’s hand is provoked by the repulsion of the excess negative charge of air and the negative charge of the frame, equal in density to the charge of the Earth. A powerful increase in the repulsive forces is achieved due to the lever effect and is estimated by the ratio of the distance of the point on the horizontal knee to the radius of the vertical knee. Further strengthening is achieved by increasing the radius of the horizontal knee of the frame.
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Mine, Koya, Takashi Nakayama, Steve Milanese, and Karen Grimmer. "The effectiveness of braces and orthoses for patients with knee osteoarthritis: A systematic review of Japanese-language randomised controlled trials." Prosthetics and Orthotics International 41, no. 2 (April 26, 2016): 115–26. http://dx.doi.org/10.1177/0309364616640926.
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Background:Knee osteoarthritis is common. The evidence regarding the effectiveness of braces and orthoses for patients with knee osteoarthritis is inconclusive according to English-language literature. English-language reviews to date have not included Japanese-language studies.Objectives:This study aimed to collect and synthesise Japanese-language randomised controlled trials investigating the effectiveness of braces and orthoses for patients with knee osteoarthritis.Study design:Systematic review.Methods:Eight databases were systematically searched from inception to 29 July 2015. Only Japanese-language randomised controlled trials were included. Risk of bias was assessed using Physiotherapy Evidence Database scale. A meta-analysis was not appropriate due to the heterogeneity in the included studies.Results:Seven randomised controlled trials with low to high risks of bias were included. Six of seven included studies were conducted by the same author group. Limited evidence supported the positive effects of short-lever elastic knee braces to improve pain and functional disability in specific outcomes. No evidence was found to support the use of foot orthoses, such as laterally wedged insoles, medial arch support and metatarsal arch pad.Conclusion:Our systematic review found no conclusive evidence about the effectiveness of any braces and orthoses for patients with medial knee osteoarthritis. Future Japanese-language studies should address methodological flaws exposed in this review and strengthen the international evidence base.Clinical relevanceThis is the first systematic review of Japanese-language randomised controlled trials investigating orthoses for patients with knee osteoarthritis. Clinicians can consider the use of short-lever elastic knee braces to improve specifically pain on squat or walking. Evidence found in this review does not support the use of foot orthoses.
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Jarbo, Keith A., David E. Hartigan, Kelly L. Scott, Karan A. Patel, and Anikar Chhabra. "Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries." Orthopaedic Journal of Sports Medicine 5, no. 10 (October 1, 2017): 232596711772980. http://dx.doi.org/10.1177/2325967117729809.
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Background: The lever sign test is a new physical examination tool to diagnose anterior cruciate ligament (ACL) tears. Preliminary results suggest almost 100% sensitivity and specificity to diagnose acute and chronic complete ACL tears and clinically significant partial tears as compared with magnetic resonance imaging (MRI). Purpose: To assess the sensitivity and specificity of the lever sign test for the diagnosis of acute ACL injuries, as compared to MRI. We also aimed to determine the accuracy of the lever sign test compared with 3 other tests (anterior drawer, Lachman, and pivot shift) when performed by providers of various training levels, and with the patient awake or under anesthesia. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We evaluated patients with a chief concern of acute (≤4 weeks) knee pain seen between October 2014 and January 2015, with a thorough history, physical examination, and standard radiographs. MRI was the reference standard; patients without an MRI evaluation were excluded. The 4 physical examination maneuvers were performed on each symptomatic knee during the initial clinic visit (for nonsurgical patients) or under anesthesia in the operating room (for surgical patients) by a randomly assigned undergraduate student, medical student, orthopaedic resident, or orthopaedic fellow. The senior author trained all staff to perform the lever sign test. Statistical analyses were performed. Results: Of 102 patients, 54 were surgical (28 female, 26 male), and 48 were nonsurgical (16 female, 32 male); the mean patient age was 23 years (range, 15-66 years). The overall accuracy of the lever sign test was 77% (63% sensitivity, 90% specificity); the accuracy was similar between patients under anesthesia and awake (77% vs 76%, respectively). There were no significant differences when comparing the sensitivity and specificity of the lever sign test with patients under anesthesia and awake (sensitivity: under anesthesia, 86%, and awake, 68% [ P = .40]; specificity: under anesthesia, 85%, and awake, 96% [ P = .17]). Furthermore, the accuracy of the lever sign test was similar when performed on female versus male patients (75% vs 79%, respectively) or when performed by undergraduate students and medical students compared with orthopaedic residents and fellows (84% vs 88%, respectively). Conclusion: Our study results challenge the exceptional sensitivity and specificity values (both 100%) of the lever sign test, as reported by the original author of the test.
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Chang, Ssu-Yu, Yi-Jia Lin, Wei-Chun Hsu, Lin-Fen Hsieh, Yuan-Hsiang Lin, Chao-Chin Chang, You-Cai Chou, and Li-Fei Chen. "Exercise Alters Gait Pattern but Not Knee Load in Patients with Knee Osteoarthritis." BioMed Research International 2016 (2016): 1–12. http://dx.doi.org/10.1155/2016/7468937.
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Six female patients with bilateral medial knee OA and 6 healthy controls were recruited. Patients with knee OA received a 6-week physiotherapist-supervised and home-based exercise program. Outcome measures, including the Western Ontario and McMaster Universities Arthritis Index and Short Form-36 Health Survey as well as objective biomechanical indices were obtained at baseline and follow-up. After treatment, no significant difference was observed in the knee abductor moment (KAM), lever arm, and ground reaction force. We, however, observed significantly improved pain and physical function as well as altered gait patterns, including a higher hip flexor moment and hip extension angle with a faster walking speed. Although KAM was unchanged, patients with bilateral knee OA showed an improved walking speed and altered the gait pattern after 6 weeks of supervised exercise. This finding suggests that the exercise intervention improves proximal joint mechanics during walking and can be considered for patients with bilateral knee OA. Non-weight-bearing strengthening without external resistance combined with stretching exercise may be an option to improve pain and function in individuals with OA who cannot perform high resistance exercises owing to pain or other reasons.
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Hunt, Michael A., Trevor B. Birmingham, J. Robert Giffin, and Thomas R. Jenkyn. "Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis." Journal of Biomechanics 39, no. 12 (January 2006): 2213–20. http://dx.doi.org/10.1016/j.jbiomech.2005.07.002.
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Dan, Michael J., James McMahon, William C. H. Parr, David Broe, Phil Lucas, Meryvn Cross, and William R. Walsh. "Evaluation of Intrinsic Biomechanical Risk Factors in Patellar Tendinopathy: A Retrospective Radiographic Case-Control Series." Orthopaedic Journal of Sports Medicine 6, no. 12 (December 1, 2018): 232596711881603. http://dx.doi.org/10.1177/2325967118816038.
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Background: Patellar tendinopathy is an overuse condition often affecting athletes. It has been postulated that patellar tendinopathy is associated with patella alta; however, this and any other anatomic risk factors have not been identified. Purpose: To explore whether lever arm differences from radiographic measurements exist between patients with and without tendinopathy. This may provide surgeons with a simple radiographic means to identify patients at risk. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Magnetic resonance imaging scans of the knee from a sports imaging facility were screened and reviewed to identify 2 groups of patients: those with and those without imaging signs of patellar tendinopathy. The lateral radiographs were reviewed and measurements made to determine (1) lever arm ratio, (2) moment arm ratio, (3) angle between the moment and line of pull of the patellar tendon, (4) patellar tendon pivot point angle, and (5) patellar height (alta). Measurements were obtained directly from radiographs. The images and measurements were reviewed by 2 experienced orthopaedic clinicians. Results: A total of 105 patients were included in this study: 52 with patellar tendinopathy and 53 without patellar tendinopathy (controls). The mean age was similar between groups (23 years); females accounted for 8 of 52 patients with patellar tendinopathy and 24 of 53 patients without. The lever arm ratio in the group with patellar tendinopathy versus controls was 1.71 versus 1.01 ( P = .01), with a moment arm difference of 1.00 versus 0.80 ( P < .01), respectively. There was no difference detected between groups for patellar tendon angle, patellar tendon pivot point angle, knee flexion angle, or incidence of patella alta. No correlation was found with our measurements and the Insall-Salvati ratio. Statistical analysis was also performed according to sex, and a statistically significant difference between groups was found for differences in lever arm ratio and moment arm. Conclusion: The lever arm ratio and moment arm ratio from lateral radiographs were significantly different between patients with and without patellar tendinopathy. Further study is needed on the biomechanical implications of the pivot point and how altering it can affect stress within the patellar tendon, patellofemoral joint, and associated clinical outcomes.
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SOBRADO, MARCEL FARACO, MARCELO BATISTA BONADIO, GABRIEL FERNANDES RIBEIRO, PEDRO NOGUEIRA GIGLIO, CAMILO PARTEZANI HELITO, and MARCO KAWAMURA DEMANGE. "LEVER SIGN TEST FOR CHRONIC ACL INJURY: A COMPARISON WITH LACHMAN AND ANTERIOR DRAWER TESTS." Acta Ortopédica Brasileira 29, no. 3 (August 2021): 132–36. http://dx.doi.org/10.1590/1413-785220212903238345.
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ABSTRACT Objective: This study aims to evaluate the sensitivity and specificity of the lever sign test in patients with and without chronic Anterior Cruciate Ligament (ACL) injuries in an outpatient setting and the inter-examiner agreement of surgeons with different levels of experience. Methods: 72 consecutive patients with a history of previous knee sprains were included. The Lachman, anterior drawer, and Lever Sign tests were performed for all subjects in a randomized order by three blinded raters with different levels of experience. Sensitivity, specificity, positive predictive value, negative predictive value, and inter-rater agreement were estimated for all tests. Results: Among the 72 patients, the prevalence of ACL injuries was 54%. The lever test showed sensitivity of 64.1% (95% CI 0.47-0.78) and specificity of 100% (95% CI 0.87-1.00) for the senior examiner. For the less experienced examiner the sensitivity was 51.8% and the specificity was 93.7%. Positive predictive values (PPV) and negative predictive values (NPV) were 100% and 70.2%, respectively. Conclusion: Lever Sign test shows to be a maneuver of easy execution, with 100% specificity and 100% PPV. Moderate agreement between experienced examiners and low agreement among experienced and inexperienced examiners was found. This test may play a role as an auxiliary maneuver. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test.
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Kukić, Filip, Vladimir Mrdaković, Aleksandar Stanković, and Duško Ilić. "Effects of Knee Extension Joint Angle on Quadriceps Femoris Muscle Activation and Exerted Torque in Maximal Voluntary Isometric Contraction." Biology 11, no. 10 (October 12, 2022): 1490. http://dx.doi.org/10.3390/biology11101490.
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This study investigated the effects of knee joint angle on muscle activation, exerted torque, and whether the knee angle affects the muscle activation–torque ratio. Nine healthy adult male participants participated in the study. They performed maximal voluntary isometric contraction (MVIC) at six (80°, 90°, 100°, 110°, 120°, and 130°) different knee joint angles (i.e., angles between the thigh and shin bones). Their maximal torque was assessed utilizing an isokinetic chair, while their muscle activation (root mean square [RMS]) was assessed using an eight-channel single differential surface EMG sensor. For the purposes of the torque–knee angle relationship and muscle activation–knee angle relationship, the torque and RMS were normalized relative to the maximal value obtained by each participant. To evaluate the muscle activation–torque ratio in function of knee angle, RMS was normalized relative to the corresponding torque obtained at each knee angle. Repeated measure analysis of variance was used to investigate the effects of knee angle on muscle activation, torque, and muscle activation–torque ratio. There was a significant effect of knee joint angle on normalized torque (F = 27.521, p < 0.001), while the activation of vastus lateralis and vastus medialis remained unchanged. The changes in knee angle affected the muscle activation–torque ratio of vastus lateralis (Chi-square = 16.246, p = 0.006) but not the vastus medialis. These results suggest that knee joint angles from 80° to 130° provide a stable milieu for muscle electrification, while mechanical factor such as knee joint angle (i.e., lever arm length) affect the torque output when one needs to contract quadriceps maximally during the isometric contraction.
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Zhang, Min, Jian Pang, Jiehang Lu, Meng Kang, Bo Chen, Richard K. Jones, Hongsheng Zhan, and Anmin Liu. "The Immediate Effect of Backward Walking on External Knee Adduction Moment in Healthy Individuals." Journal of Healthcare Engineering 2022 (November 11, 2022): 1–8. http://dx.doi.org/10.1155/2022/4232990.
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Backward walking (BW) has been recommended as a rehabilitation intervention to prevent, manage, or improve diseases. However, previous studies showed that BW significantly increased the first vertical ground reaction force (GRF) during gait, which might lead to higher loading at the knee. Published reports have not examined the effects of BW on medial compartment knee loading. The objective of this study was to investigate the effects of BW on external knee adduction moment (EKAM). Twenty-seven healthy adults participated in the present study. A sixteen-camera three-dimensional VICON gait analysis system, with two force platforms, was used to collect the EKAM, KAAI, and other biomechanical data during BW and forward walking (FW). The first ( P < 0.001 ) and second ( P < 0.001 ) EKAM peaks and KAAI ( P = 0.02 ) were significantly decreased during BW when compared with FW. The BW significantly decreased the lever arm length at the first EKAM peak ( P = 0.02 ) when compared with FW. In conclusion, BW was found to be a useful strategy for reducing the medial compartment knee loading even though the first peak ground reaction force was significantly increased.
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Greenblatt, David. "The construction and evaluation of a low-cost isokinetic knee exerciser." South African Journal of Physiotherapy 48, no. 2 (May 31, 1992): 15–22. http://dx.doi.org/10.4102/sajp.v48i2.741.
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An inexpensive knee exerciser which closely approximates the performance of state-of-the-art isokinetic equipment has been constructed and a preliminary evaluation has been carried out. Unlike other exercisers, the lower limb angular velocity cannot be set a priori but, on the basis of patient performance it is possible to restrict limb velocity to within upper and lower bounds. The exerciser makes use of a shock absorber and lever mechanism which allow easy calibration of the system while elementary electronics and computer interfacing allow the measurement angle, velocity and torque in real time. A significant advantage of this exerciser over some isokinetic knee exercisers currently on the market is that limited arc rotation can be enforced. This type of limb restriction is important in many rehabilitation programs.
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Rucinski, Kylee, Jonathan Williams, Cory R. Crecelius, Lindsey Redington, Trent M. Guess, and James L. Cook. "Are All Unloader Braces Created Equal? Recommendations for Evidence-Based Implementation of Unloader Braces for Patients with Unicompartmental Knee OA." Journal of Knee Surgery 35, no. 03 (December 24, 2021): 249–54. http://dx.doi.org/10.1055/s-0041-1740931.
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AbstractUnicompartmental knee osteoarthritis (UKOA) is a complex issue that is estimated to affect roughly 28% of patients with knee OA, and can result in severe cartilage degeneration, meniscus deficiency, and concomitant varus or valgus malalignment. This malalignment results in abnormally high joint reaction forces in the affected compartment, which can elicit pain, cause dysfunction, and exacerbate joint degradation. For more than two decades, the use of knee unloader braces has been advocated as a cost-effective option for symptomatic management of UKOA.During bipedal ambulation with a normal lower extremity mechanical axis, ground reaction forces create a knee adduction moment (KAM) such that the medial compartment of the knee experiences approximately 60% of joint loading and the lateral compartment experiences approximately 40% of joint loading. UKOA disrupts the mechanical axis, altering KAM and joint loading and causing pain, dysfunction, and disease progression. In theory, knee unloader braces were designed to mitigate the symptoms of UKOA by normalizing KAM via shifts in the lever arms about the knee. However, studies vary, and suggest that push-mechanism knee unloaders do not consistently provide significant biomechanical benefits for medial or lateral UKOA. Current evidence suggests that pull-mechanism unloaders may be more effective, though contrasting data have also been reported, such that further validation is necessary. The purpose of our study was to synthesize current best evidence for use of knee unloader braces for management of UKOA to suggest evidence-based best practices as well as gaps in knowledge to target for future studies. Unloader bracing for patients with UKOA appears to be a cost-effective treatment option for patients with medial UKOA who have insurance coverage. Pull-mechanism unloader bracing should be considered in conjunction with other nonoperative management therapies for those who are willing to adhere to consistent brace use for weight-bearing activities.
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Kim, SungHyek, Katsumi TANAKA, Haruo TAKESHIMA, Hiroyuki TSUCHIMOCHI, and Kazumasa SHIBATA. "Effects of lever arms in the long head of biceps femoris and gastrocnemius on knee extension." Biomechanisms 24 (2018): 37–45. http://dx.doi.org/10.3951/biomechanisms.24.37.
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Valsalam, Pramod, Ibad Sha I, and Ajin Edwin. "Lever Test: Role of Its Assistance in Diagnosis of Anterior Cruciate Ligament Injury." Journal of Research in Orthopedic Science 7, no. 3 (August 1, 2020): 115–20. http://dx.doi.org/10.32598/jrosj.7.3.702.1.
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Background: The diagnosis of ACL tear is aided by clinical tests and imaging evaluation with MRI. The main clinical tests include Lachman, Anterior Drawer and Pivot shift test. A newer clinical test called lever test was proposed recently with higher sensitivity compared to traditional tests. Objectives: To investigate the sensitivity, specificity and other statistical parameters of newly proposed lever test for ACL injury along with other established tests, Lachman test, Anterior Drawer test and Pivot Shift test. Methods: 242 patients consecutive patients with a complaint of knee pain were included in the study over a period of 4 years between ages of 18 to 50 years. They were evaluated with clinical tests Lever test, Lachman test, Anterior Drawer test and Pivot Shift test without anaesthesia and under anaesthesia. Results of diagnostic arthroscopy was taken as gold standard. Results: A total of 242 consecutive subjects were eligible during the study period, of which 182 were males while the remaining 60 were females. Compared to gold standard, without anaesthesia the lever test had a sensitivity of 85.57%, specificity of 25.00%, PPV of 82.18%, NPV of 30.00%, and accuracy of 73.55%. Similarly regarding other tests the sensitivity and specificity without anaesthesia were, Lachman test sensitivity of 93.81%, specificity of 20.83%, PPV of 82.73%, NPV of 45.45%, and accuracy of 79.34%, Anterior Drawer test sensitivity of 80.41%, specificity of 33.33%, PPV of 82.98%, NPV of 29.63%, and accuracy of 71.07%, Pivot Shift test sensitivity of 40.21%, specificity of 91.67%, PPV of 80.17%, NPV of 95.12%, and accuracy of 50.41%. The results under anaesthesia compared to arthroscopy findings were Lever Test Lachman Anterior Drawer Pivot Shift Accuracy, % 77.69, 79.34, 71.90, 80.99 Sensitivity, % 91.75, 98.97, 93.81, 98.97, Specificity, % 20.83, 36.33, 20.83, 58.33 PPV, % 82.41, 81.36, 58.33, 87.95 NPV, % 38.46, 66.67, 39, 36.84. Conclusion: The lever test needs to be studied extensively considering multiple variables like correlation with BMI, position of wrist, partial injuries and also interobserver variations before it gets standardized into routine examination.
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Solomonow-Avnon, Deborah, Amir Herman, and Alon Wolf. "Mechanism of reducing knee adduction moment by shortening of the knee lever arm via medio-lateral manipulation of foot center of pressure: A pilot study." Journal of Biomechanics 83 (January 2019): 143–49. http://dx.doi.org/10.1016/j.jbiomech.2018.11.041.
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Jennings, Jason M., and Leslie D. Wontorcik. "Fitting a Knee Disarticulation as a BK Utilizing the ALPS Locking Pin as a Pseudo-Tibial Lever." JPO Journal of Prosthetics and Orthotics 10, no. 1 (1998): 7???10. http://dx.doi.org/10.1097/00008526-199801000-00004.
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Krakowski, Przemysław, Adam Nogalski, Andrzej Jurkiewicz, Robert Karpiński, Ryszard Maciejewski, and Józef Jonak. "Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries." Applied Sciences 9, no. 19 (October 1, 2019): 4102. http://dx.doi.org/10.3390/app9194102.
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Purpose: This study evaluated the diagnostic accuracy of physical examination and magnetic resonance imaging (MRI) in knee injuries. Methods: Ninety-six patients at a regional hospital were included in the study. Each participant underwent a physical examination in which menisci and ACL were evaluated. Knee joint MRI was collected from each patient. Physical examination and MRI scans were then compared with knee arthroscopy findings as a golden standard for meniscal and ligamentous lesions. The data were analyzed and specificity and sensitivity were calculated and correlated on receiver operating characteristics (ROC) curves. Results: Knee arthroscopy diagnosed 32 total ACL ruptures, 45 medial meniscus and 17 lateral meniscus lesions. Three patients were diagnosed with bilateral meniscal lesions. The highest sensitivities were the McMurray test (87.5%) for medial meniscus (MM) and the Thessaly test (70%) for lateral meniscus (LM). The most sensitive ACL test was Lachman (84.5%), whereas, the pivot shift and Lelli tests were the most specific (98.5%). MRI was highly sensitive for MM (96%) with specificity of 52%. MRI showed lower sensitivity (70%) and higher specificity (85.5%) for LM. The specificity of MRI for ACL rupture was 92%, with sensitivity only 75%. Conclusion: McMurray and Apley tests for meniscal lesions seem the most appropriate in daily practice. A combination of lever signs, pivot shifts (PSs) and Lachman tests showed the best sensitivity and specificity in detecting ACL deficiency, and was superior to MRI.
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Shore, Benjamin J., James McCarthy, M. Wade Shrader, H. Kerr Graham, Matthew Veerkamp, Erich Rutz, Henry Chambers, et al. "Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: Establishing surgical indications and techniques using the modified Delphi method and literature review." Journal of Children's Orthopaedics 16, no. 1 (February 2022): 65–74. http://dx.doi.org/10.1177/18632521221087529.
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Purpose: The purpose of this study was to develop consensus for the surgical indications of anterior distal femur hemiepiphysiodesis in children with cerebral palsy using expert surgeon opinion through a modified Delphi technique. Methods: The panel used a 5-level Likert-type scale to record agreement or disagreement with 27 statements regarding anterior distal femur hemiepiphysiodesis. Consensus was defined as at least 80% of responses being in the highest or lowest 2 of the Likert-type ratings. General agreement was defined as 60%–79% falling into the highest or lowest 2 ratings. Results: For anterior distal femur hemiepiphysiodesis, 27 statements were surveyed: consensus or general agreement among the panelists was achieved for 22 of 27 statements (22/27, 82%) and 5 statements had no agreement (5/27, 18%). There was general consensus that anterior distal femur hemiepiphysiodesis is indicated for ambulatory children with cerebral palsy, with at least 2 years growth remaining, and smaller (<30 degrees) knee flexion contractures and for minimally ambulatory children to aid in standing/transfers. Consensus was achieved regarding the importance of close radiographic follow-up after screw insertion to identify or prevent secondary deformity. There was general agreement that percutaneous screws are preferred over anterior plates due to the pain and irritation associated with plates. Finally, it was agreed that anterior distal femur hemiepiphysiodesis was not indicated in the absence of a knee flexion contracture. Conclusion: Anterior distal femur hemiepiphysiodesis can be used to treat fixed knee flexion contractures in the setting of crouch gait, but other associated lever arm dysfunctions must be addressed by single-event multilevel surgery. Level of evidence: V
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Biscarini, Andrea. "Measurement of Power in Selectorized Strength-Training Equipment." Journal of Applied Biomechanics 28, no. 3 (July 2012): 229–41. http://dx.doi.org/10.1123/jab.28.3.229.
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The author derived the exact analytical expression of the instantaneous joint power in exercises with single-joint, variable-resistance, selectorized strength-training equipment, taking into account all the relevant geometric, kinematic, and dynamic variables of both the movable equipment elements (resistance input lever, cam–pulley system, weight stack) and of the user’s exercising limb. A numerical algorithm was also designed to express, in the presence of a cam, the rectilinear kinematic variables of the weight stack as a function of the rotational kinematic variables of the resistance input lever, and vice versa. Given that information, one can measure the value of the instantaneous and mean joint power exclusively by means of a linear encoder placed on the weight stack or, alternatively, only by the use of an angular encoder placed on the rotational axis of the resistance lever. The results highlight that, for knee extension exercises with leg extension equipment, the real values of both instantaneous and mean joint power may differ by more than 50% in comparison with the values obtained by taking into account only the mass and velocity of the weight stack. These differences are notable not only in explosive exercises, but also whenever considerable joint velocities/accelerations occur within the range of motion.
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Romagnoli, Cristian, Vincenzo Bonaiuto, Giorgio Gatta, Naomi Romagnoli, Anas Alashram, Elvira Padua, and Giuseppe Annino. "2D Video Analysis System to Analyze the Performance Model of Figure Roller Skating: A Pilot Study." Proceedings 49, no. 1 (June 15, 2020): 155. http://dx.doi.org/10.3390/proceedings2020049155.
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Figure roller skating is a discipline composed of various movements which involve jumps, artistic figures and spins in a seamless program which has both technical and shapely difficult. A biomechanical analysis of a double salchow was performed using a 2D video analysis of one European and in two Italian roller skaters. On average, the high level (HL) roller skater showed a horizontal velocity of the center of mass higher than the average, especially in the prop stage, whereas the medium level (ML) and low level (LL) athletes reduced their velocity significantly. The spin angular velocity of the ML and LL skaters was always higher than of the HL. This phenomenon would seem to be a compensatory strategy for a lower jump height, with a reduced trunk-thigh angle and less thigh lever arm (coxo-femur/knee joints) during the take-off and landing phases of the double salchow jump.
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Highsmith, M. Jason, Derek J. Lura, Stephanie L. Carey, Larry J. Mengelkoch, Seok Hun Kim, William S. Quillen, Jason T. Kahle, and Rebecca M. Miro. "Correlations between residual limb length and joint moments during sitting and standing movements in transfemoral amputees." Prosthetics and Orthotics International 40, no. 4 (January 27, 2015): 522–27. http://dx.doi.org/10.1177/0309364614564025.
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Background and aim: Longer residual limb lengths provide an increased lever arm. Longer residual limbs may produce increased joint moments; the two may be correlated. These correlations have not been evaluated in transfemoral amputees during transitional movements. Correlations between residual limb length and involved side joint moment could contribute to justification supporting maximal residual limb length preservation. This study investigated possible correlations between hip or knee moment and residual limb length. Technique: Hip and knee joint moments were determined while 21 transfemoral amputees performed sitting and standing movements and then evaluated for correlation with residual limb length. Discussion: Residual limb length was not correlated with either knee or involved side hip moments during sit to stand or stand to sit. Conversely, weak inverse correlations ( p < 0.05) existed between sound hip moment magnitude and residual limb length. These correlations suggest that in community ambulating transfemoral amputees, longer residual limb length could decrease sound hip kinetic burden during transitional movement. Beyond correlations between residual limb length and sound hip transitional movement kinetics, there are other considerations in determining residual limb length during amputation. Clinical relevance This study examines relationships between lower limb joint moments and residual limb length related to sit-to-stand and stand-to-sit activities. The results have implications for amputation surgery and rehabilitation.
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Lewinson, Ryan T., Jay T. Worobets, and Darren J. Stefanyshyn. "Calculation of external knee adduction moments: A comparison of an inverse dynamics approach and a simplified lever-arm approach." Knee 22, no. 4 (September 2015): 292–97. http://dx.doi.org/10.1016/j.knee.2015.04.003.
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C, Sanchez Jorielle, Manlutac Crisalyn T, Salas Joven V, Soriano Marilou R, Santos Michael E, and Martin Jonar T. "Movement Analysis of Philippine Folk Dance Tinikling." Asian Journal of Interdisciplinary Research 2, no. 1 (March 25, 2019): 30–34. http://dx.doi.org/10.34256/ajir1913.
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The purpose of the study was to describe the dance movements of the folk dance Tinikling which is the most popular traditional dance and former national dance of the Philippines. The researchers adopted the movement analysis method similar to that of Mackenzie that involves the (1) description of the actual movements which occur at the joints involved; (2) the plane in which the movement occurs; and (3) the muscles producing the movement (agonist & antagonist). In addition, the researchers also had done a mechanical analysis on the lever type involved in the execution of the dance movement in terms of force, axis, and resistance. The prominent dance steps in the Philippine local dance Tinikling are the (1) running, (2) tinikling steps, (3) diagonal step, and (4) straddle jump with a turn step. The joints involved are: hip muscle which is ball and socket type of joint; and knee and ankle which are hinge joints. The major muscles involved in the dance include mostly the lower body muscle groups such as the quadriceps, hamstring, gluts, adductor muscle group, and calves. The type of lever used in performing the dance comprise majority of 1st, 2nd and 3rd class levers. Thus, the Tinikling is a viable dance which could improve the health related fitness of the performers in terms of muscular strength, muscular endurance, cardiovascular endurance and flexibility. Also, the dance could improve skill-related fitness such as power, agility, balance and coordination.
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Funken, Johannes, Steffen Willwacher, Kai Heinrich, Ralf Müller, Hiroaki Hobara, Alena M. Grabowski, and Wolfgang Potthast. "Long jumpers with and without a transtibial amputation have different three-dimensional centre of mass and joint take-off step kinematics." Royal Society Open Science 6, no. 4 (April 2019): 190107. http://dx.doi.org/10.1098/rsos.190107.
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Long jumpers with below the knee amputation (BKA) have achieved remarkable performances, yet the underlying biomechanics resulting in these jump distances are unknown. We measured three-dimensional motion and used multi-segment modelling to quantify and compare the centre of mass (COM) and joint kinematics of three long jumpers with BKA and seven non-amputee long jumpers during the take-off step of the long jump. Despite having the same jump distances, athletes with BKA, who used their affected leg for the take-off step, had lower sagittal plane hip and knee joint range of motion and positioned their affected leg more laterally relative to the COM compared to non-amputee athletes. Athletes with BKA had a longer compression phase and greater downward movement of their COM, suggesting that their affected leg (lever) was less rigid compared to the biological leg of non-amputees. Thus, athletes with BKA used a different kinematic mechanism to redirect horizontal to vertical velocity compared to non-amputee athletes. The specific movement patterns of athletes with BKA during the take-off step were constrained by the mechanical properties of the prosthesis. These results provide a basis for coaches and athletes to develop training protocols that improve performance and inform the design of future prostheses.
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Lanshammar, Håkan. "Variation of medial and lateral plateau loads at the knee joint with different lever arms of the ground reaction force vector." Journal of Biomechanics 22, no. 10 (January 1989): 1044. http://dx.doi.org/10.1016/0021-9290(89)90343-6.
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Jennings, Jason M., and Leslie D. Wontorcik. "Fitting a Knee Disarticulation as a BK Utilizing the ALPS Locking Pin as a Pseudo-Tibial Lever: A Single Case Review." JPO Journal of Prosthetics and Orthotics 10, no. 1 (1998): 7–10. http://dx.doi.org/10.1097/00008526-199801010-00003.
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C, Pangilinan Math, Fontanilla Lyndo V, Pineda Israel C, Rocelle E. Agtang, Soriano Ria M, and Martin Jonar T. "Movement Analysis of Philippine Folk Dance Itik-itik." Asian Journal of Interdisciplinary Research 2, no. 1 (March 28, 2019): 56–63. http://dx.doi.org/10.34256/ajir1916.
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The purpose of the study was to describe and analyze the dance movements of the Philippine folk dance Itik-itik. The researchers adopted the movement analysis method similar to that of Mackenzie that involves the (1) description of the actual movements which occur at the joints involved; (2) the plane in which the movement occurs; and (3) the muscles producing the movement (agonist & antagonist). In addition, similar to the study of Martin and Miller, the researchers also had done a mechanical analysis on the lever type involved in the execution of the dance movement in terms of force, axis, and resistance. Results revealed that the prominent dance steps in the Philippine local dance Itik-itik are the (1) running, (2) cross step, slide close, slide close step, (3) heel, close-ball, close arm, (4) step, slide-close, slide, (5) arms extension/flexion, and (6) flapping of the arms. The joints involved are the shoulder and hip muscle which are ball and socket type of joints; and elbow, knee and ankle which are hinge joints. The major muscles involved in the dance for the lower body include the quadriceps, hamstring muscle group, adductor muscle group, calves and gluts. While for the upper body muscles involved are the pectoralis major, latissimus dorsi, deltoid, trapezius, biceps, and triceps muscles. The type of lever used in performing the dance comprise majority of 1st class and 3rd class levers. By knowing the muscles involved in the dance the dance teacher may be able to devise activities to gradually prepare the prime mover muscles before the actual execution for injury prevention. Thus, the movements in the dance may improve the health and skill related fitness of the performers.
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Samuels, Mark E., Sophie Regnault, and John R. Hutchinson. "Evolution of the patellar sesamoid bone in mammals." PeerJ 5 (March 21, 2017): e3103. http://dx.doi.org/10.7717/peerj.3103.
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The patella is a sesamoid bone located in the major extensor tendon of the knee joint, in the hindlimb of many tetrapods. Although numerous aspects of knee morphology are ancient and conserved among most tetrapods, the evolutionary occurrence of an ossified patella is highly variable. Among extant (crown clade) groups it is found in most birds, most lizards, the monotreme mammals and almost all placental mammals, but it is absent in most marsupial mammals as well as many reptiles. Here, we integrate data from the literature and first-hand studies of fossil and recent skeletal remains to reconstruct the evolution of the mammalian patella. We infer that bony patellae most likely evolved between four and six times in crown group Mammalia: in monotremes, in the extinct multituberculates, in one or more stem-mammal genera outside of therian or eutherian mammals and up to three times in therian mammals. Furthermore, an ossified patella was lost several times in mammals, not including those with absent hindlimbs: once or more in marsupials (with some re-acquisition) and at least once in bats. Our inferences about patellar evolution in mammals are reciprocally informed by the existence of several human genetic conditions in which the patella is either absent or severely reduced. Clearly, development of the patella is under close genomic control, although its responsiveness to its mechanical environment is also important (and perhaps variable among taxa). Where a bony patella is present it plays an important role in hindlimb function, especially in resisting gravity by providing an enhanced lever system for the knee joint. Yet the evolutionary origins, persistence and modifications of a patella in diverse groups with widely varying habits and habitats—from digging to running to aquatic, small or large body sizes, bipeds or quadrupeds—remain complex and perplexing, impeding a conclusive synthesis of form, function, development and genetics across mammalian evolution. This meta-analysis takes an initial step toward such a synthesis by collating available data and elucidating areas of promising future inquiry.
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Bilgin, Emre, Ali Turgut, Sertan Hancıoğlu, Emre Sarıekiz, Melikşah Uzakgider, and Önder Kalenderer. "The influence of anesthesia- body mass index and chronicity of the injury on the reliability of diagnostic tests for anterior cruciate ligament rupture." Journal of Exercise Rehabilitation 17, no. 6 (December 27, 2021): 428–34. http://dx.doi.org/10.12965/jer.2142580.290.
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This study aimed to analyze the accuracy and interobserver reliability of the four common diagnostic tests for anterior cruciate ligament (ACL) rupture. The effect of anesthesia, chronicity of the injury and patient’s body mass index (BMI) on the reliabilities was also assessed. Patients who underwent arthroscopic knee surgery were examined before the surgery and under anesthesia by three observers categorized based on their experience levels. One hundred two patients were evaluated to determine the accuracy of these tests. Sixty-two patients with ACL rupture were further examined to assess the effect of BMI (≤ 25 kg/m2, or > 25 kg/m2) and chronicity (≤ 4 or > 4 weeks) of the injury on reliabilities with using the Fleiss kappa method. The Lachman test performed under anesthesia had the highest sensitivity (100%, 100%, and 96.7%). In contrast, pivot shift and lever sign tests had the lowest sensitivity both in awake (24.2%, 17.7%, 8.1% and 37.1%, 33.8%, 29%) and anesthetized condition (75.8%, 75.8%, 67.7% and 41.9%, 43.5%, 40.3%). Specificities of the tests except pivot shift were negatively affected when performed under anesthesia. The reliability of the anterior drawer test was perfect under anesthesia. The lever sign test had the highest reliability in the awake condition in patients with a BMI of > 25 kg/m2. Furthermore, the reliabilities of the anterior drawer, Lachman, and pivot-shift tests in awake condition were found to be increased in patients with a chronic injury. Finally, the examiner’s experience is not important for the physical diagnosis of ACL rupture.
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WANG, SHANGCHENG, ZHIHONG LIU, JIANMING FENG, LIANFU DENG, and NAIQUAN NIGEL ZHENG. "COMPARING TRANSVERSE PLANE BIOMECHANICS BETWEEN FIXED- AND MOBILE-BEARING TOTAL KNEE ARTHROPLASTY DURING LEVEL WALKING, STAIR NEGOTIATION AND PIVOTING." Journal of Mechanics in Medicine and Biology 19, no. 05 (August 2019): 1950028. http://dx.doi.org/10.1142/s0219519419500283.
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Compared with fixed-bearing (FB) total knee arthroplasty (TKA), mobile-bearing (MB) TKA may promote knee rotation and reduce rotational load at bone–implant interface. Unfortunately, this hypothesis has not been examined with neither knee rotation during stance of pivoting nor knee rotational moment during activities other than level walking. This study used 3D motion analysis to obtain the rotation of tibia relative to the femur and knee rotation moment during stance phase of level walking, stair ascent/descent, step and spin turn for 17 FB, 20[Formula: see text]MB and 28 healthy knees. Statistical comparisons revealed that transverse plane biomechanics was similar between MB and FB knees. Compared with healthy knees ([Formula: see text]), both FB ([Formula: see text]) and MB knees ([Formula: see text]) reduced internal rotation during step turn at early stance. During spin turn, FB knees ([Formula: see text] vs. [Formula: see text]) reduced internal rotation at late stance, whereas MB knees ([Formula: see text] versus [Formula: see text]) reduced external rotation at early stance. MB knees (0.064% and 0.126% body weight [Formula: see text] height) had lower peak external rotation moments during early stance phase of both level walking and spin turn than healthy knees (0.108% and 0.238% body weight [Formula: see text] height). Using FB for TKA surgery without bias and step-turn strategy for pivoting were recommended.
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Takahashi, Kota Z., Rebecca L. Krupenevich, Amy L. Lenz, Luke A. Kelly, Michael J. Rainbow, and Jason R. Franz. "Mechanics and Energetics of Human Feet: A Contemporary Perspective for Understanding Mobility Impairments in Older Adults." Biomechanics 2, no. 4 (September 23, 2022): 494–99. http://dx.doi.org/10.3390/biomechanics2040038.
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Much of our current understanding of age-related declines in mobility has been aided by decades of investigations on the role of muscle–tendon units spanning major lower extremity joints (e.g., hip, knee and ankle) for powering locomotion. Yet, mechanical contributions from foot structures are often neglected. This is despite the emerging evidence of their critical importance in youthful locomotion. With the rapid growth in the field of human foot biomechanics over the last decade, our theoretical knowledge of young asymptomatic feet has transformed, from long-held views of the foot as a stiff lever and a shock absorber to that of a versatile system that can modulate mechanical power and energy output to accommodate various locomotor task demands. In this perspective review, we predict that the next set of impactful discoveries related to locomotion in older adults will emerge by integrating the novel tools and approaches that are currently transforming the field of human foot biomechanics. By illuminating the functions of the feet in older adults, we envision that future investigations will refine our mechanistic understanding of mobility deficits affecting our aging population, which may ultimately inspire targeted interventions to rejuvenate the mechanics and energetics of locomotion.
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Strong, Andrew, Ashokan Arumugam, Eva Tengman, Ulrik Röijezon, and Charlotte K. Häger. "Properties of Knee Joint Position Sense Tests for Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis." Orthopaedic Journal of Sports Medicine 9, no. 8 (July 15, 2021): 232596712110078. http://dx.doi.org/10.1177/23259671211007878.
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Background: Knee proprioception is believed to be deficient after anterior cruciate ligament (ACL) injury. Tests of joint position sense (JPS) are commonly used to assess knee proprioception, but their psychometric properties (PMPs) are largely unknown. Purpose: To evaluate the PMPs (reliability, validity, and responsiveness) of existing knee JPS tests targeting individuals with ACL injury. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, Allied and Complementary Medicine, CINAHL, SPORTDiscus, Web of Science, Scopus, CENTRAL, and ProQuest databases were searched to identify studies that assessed PMPs of knee JPS tests in individuals with ACL injury. The risk of bias for each included study was assessed and rated at the outcome level for each knee JPS test. Overall quality and levels of evidence for each PMP were rated according to established criteria. Meta-analyses with mean differences were conducted using random effects models when adequate data were available. Results: Included were 80 studies covering 119 versions of knee JPS tests. Meta-analyses indicated sufficient quality for known-groups and discriminative validity (ACL-injured knees vs knees of asymptomatic controls and contralateral noninjured knees, respectively), owing to significantly greater absolute errors for ACL-injured knees based on a strong level of evidence. A meta-analysis showed insufficient quality for responsiveness, which was attributed to a lack of significant change over time after diverse interventions with a moderate level of evidence. Statistical heterogeneity ( I 2 > 40%) was evident in the majority of meta-analyses. All remaining PMPs (reliability, measurement error, criterion validity, convergent validity, and other PMPs related to responsiveness) were assessed qualitatively, and they failed to achieve a sufficient quality rating. This was a result of either the study outcomes not agreeing with the statistical cutoff values/hypotheses or the level of evidence being rated as conflicting/unknown or based on only a single study. Conclusion: Knee JPS tests appear to have sufficient validity in differentiating ACL-injured knees from asymptomatic knees. Further evidence of high methodologic quality is required to ascertain the reliability, responsiveness, and other types of validity assessed here. We recommend investigations that compare the modifiable methodologic components of knee JPS tests on their PMPs to develop standardized evidence-based tests.
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Choi, Jin Seung, Dong Won Kang, Jeong Woo Seo, Ju Young Kim, Seung Tae Yang, Dae Hyeok Kim, and Gye Rae Tack. "Changes in Gait Characteristics due to Outsole Structure of Shoe." Applied Mechanics and Materials 775 (July 2015): 28–33. http://dx.doi.org/10.4028/www.scientific.net/amm.775.28.
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The purpose of this study was to evaluate changes in kinematic and kinetic gait characteristics due to outsole structure of the shoe. In this experiment, cushioning shoe having cushion for heel (BOSS Corps., Korea) which is designed as a lever, MBT having an unstable rounded shoe (Masai Barefoot Technology, MBT, Swiss) and normal running shoe (Adidas, Germany) were compared. The experiment was performed walking on the straight walkway (10m x 3m) five times with preferred walking speed. 3D motion capture system was used to acquire kinematic and kinetic data using six infrared cameras and two force plates. For comparison among shoes, walking velocity, hip, knee and ankle joint angles (range of motion, trajectory), ground reaction force (loading rate, the decay rate, maximal vertical ground reaction force), and center of mass - center of pressure inclination angle (COM-COP angle) were used. The results showed that there were different effects of types of shoe on lower extremities. Joint angle trajectory of ankle, joint range of motion (ROM) of the hip, and peak force were significantly different among shoe types. MBT provided a decreased impact force. Cushioning shoe provided increased progressive force, decreased loading rate, and decreased COM-COP angle. For further study, it is necessary to analyze additional subjects (i.e., elderly) and long-term effects.
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Nagai, Kanto, Elmar Herbst, Tom Gale, Yasutaka Tashiro, James J. Irrgang, William Anderst, and Freddie H. Fu. "Patient-reported outcome measures following anterior cruciate ligament reconstruction are not related to dynamic knee extension angle." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 3, no. 1 (January 2018): 33–37. http://dx.doi.org/10.1136/jisakos-2017-000173.
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ObjectivesControversy still exists on whether knee hyperextension affects the outcome following anterior cruciate ligament reconstruction (ACL-R). Therefore, the purpose of the present study was to determine if maximum knee extension angle of ACL-R knees and contralateral uninjured knees during walking is related to the clinical outcome following ACL-R. It was hypothesised that maximum knee extension angle would not be significantly correlated with patient-reported outcome measures (PROMs) following ACL-R.MethodsForty-two patients (age at surgery: 23±9 years, 23 male and 19 female) underwent unilateral ACL-R. Twenty-four months after surgery, subjects performed level walking on a treadmill while biplane radiographs were acquired at 100 Hz. Three-dimensional tibiofemoral motion was determined using a validated model-based tracking process. Tibiofemoral rotations were calculated from foot strike through early stance. The primary kinematic outcome measure was maximum knee extension angle of ACL-R and contralateral uninjured knees during walking, with positive values indicating hyperextension. The side-to-side difference (SSD) in maximum knee extension angle was calculated by subtracting the angle of the contralateral uninjured knee from that of the ACL reconstructed knee. PROMs (International Knee Documentation Committee Subjective Knee Form, Knee Injury and Osteoarthritis Score and Marx Activity Rating Scale) were obtained at 24 months after surgery. Correlations between PROMs and maximum dynamic knee extension angle in ACL-R and contralateral knee were evaluated (P<0.05).ResultsMaximum knee extension angle during walking was 2.3±4.5° in ACL-R knees and 4.3±4.2° in contralateral uninjured knees at 24 months after surgery, indicating hyperextension during walking on average. SSD in maximum knee extension angle was −2.0±3.7°. No significant correlation was observed between maximum knee extension angle and the PROMs.ConclusionMaximum knee extension angle during walking was not significantly correlated with PROMs, suggesting that clinically, physiologic knee hyperextension can be restored after ACL-R and not adversely affect PROMs.Level of evidenceLevel III.
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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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Stefanik, Joshua J., Tuhina Neogi, Jingbo Niu, Frank W. Roemer, Neil A. Segal, Cora E. Lewis, Michael Nevitt, Ali Guermazi, and David T. Felson. "The Diagnostic Performance of Anterior Knee Pain and Activity-related Pain in Identifying Knees with Structural Damage in the Patellofemoral Joint: The Multicenter Osteoarthritis Study." Journal of Rheumatology 41, no. 8 (June 15, 2014): 1695–702. http://dx.doi.org/10.3899/jrheum.131555.
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Objective.To determine the diagnostic test performance of location of pain and activity-related pain in identifying knees with patellofemoral joint (PFJ) structural damage.Methods.The Multicenter Osteoarthritis Study is a US National Institutes of Health-funded cohort study of older adults with or at risk of knee osteoarthritis. Subjects identified painful areas around the knee on a knee pain map and the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain with stairs and walking on level ground. Cartilage damage and bone marrow lesions were assessed from knee magnetic resonance imaging. We determined the sensitivity, specificity, positive and negative predictive values for presence of anterior knee pain (AKP), pain with stairs, absence of pain while walking on level ground, and combinations of tests in discriminating knees with isolated PFJ structural damage from those with isolated tibiofemoral joint (TFJ) or no structural damage. Knees with mixed PFJ/TFJ damage were removed from our analyses because of the inability to determine which compartment was causing pain.Results.There were 407 knees that met our inclusion criteria. “Any” AKP had a sensitivity of 60% and specificity of 53%; and if AKP was the only area of pain, the sensitivity dropped to 27% but specificity rose to 81%. Absence of moderate pain with walking on level ground had the greatest sensitivity (93%) but poor specificity (13%). The combination of “isolated” AKP and moderate pain with stairs had poor sensitivity (9%) but the greatest specificity (97%) of strategies tested.Conclusion.Commonly used questions purported to identify knees with PFJ structural damage do not identify this condition with great accuracy.
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WISE, BARTON L., DAVID T. FELSON, MARGARET CLANCY, JINGBO NIU, TUHINA NEOGI, NANCY E. LANE, JEAN HIETPAS, et al. "Consistency of Knee Pain and Risk of Knee Replacement: The Multicenter Osteoarthritis Study." Journal of Rheumatology 38, no. 7 (April 15, 2011): 1390–95. http://dx.doi.org/10.3899/jrheum.100743.
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Objective.To examine whether the consistency or persistence of knee pain, in addition to its severity, predicts incident total knee replacement (TKR).Methods.The Multicenter Osteoarthritis Study (MOST) is a longitudinal study of persons aged 50 to 79 years with symptomatic knee osteoarthritis or at high risk of disease. Subjects were queried about the presence of knee pain on most days of the previous 30 days (i.e., frequent knee pain; FKP) at 2 timepoints: a telephone screen followed by a clinic visit (median separation 4 weeks). We defined a knee as having “consistent pain” if the subject answered positively to the FKP question at both timepoints, “inconsistent pain” if FKP was positive at only one timepoint, or as “no FKP” if negative at both. We examined the association between consistent FKP and risk of TKR using multiple binomial regression with generalized estimating equations.Results.In 3026 persons (mean age 63 yrs, mean body mass index 30.4), 2979 knees (50%) had no FKP at baseline, 1279 knees (21.5%) had inconsistent FKP, and 1696 knees (28.5%) had consistent FKP. Risk of TKR over 30 months was 0.8%, 2.6%, and 8.8% for knees with no, inconsistent, and consistent FKP, respectively. Relative risks of TKR over 30 months were 1.2 (95% CI 0.6–2.3) and 2.3 (95% CI 1.2–4.4) for knees with inconsistent and consistent FKP, compared with those without FKP. This association was consistent across each level of pain severity on the Western Ontario and McMaster Universities Osteoarthritis Index.Conclusion.Consistency of frequent knee pain is associated with an increased risk of TKR independently of knee pain severity.
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Fuenzalida Squella, Sara Agueda, Andreas Kannenberg, and Ângelo Brandão Benetti. "Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation." Prosthetics and Orthotics International 42, no. 2 (July 9, 2017): 228–35. http://dx.doi.org/10.1177/0309364617716207.
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Background:Despite the evidence for improved safety and function of microprocessor stance and swing-controlled prosthetic knees, non-microprocessor-controlled prosthetic knees are still standard of care for persons with transfemoral amputations in most countries. Limited feature microprocessor-control enhancement of such knees could stand to significantly improve patient outcomes.Objectives:To evaluate gait speed, balance, and fall reduction benefits of the new 3E80 default stance hydraulic knee compared to standard non-microprocessor-controlled prosthetic knees.Study design:Comparative within-subject clinical study.Methods:A total of 13 young, high-functioning community ambulators with a transfemoral amputation underwent assessment of performance-based (e.g. 2-min walk test, timed ramp/stair tests) and self-reported (e.g. falls, Activities-Specific Balance Confidence scale, Prosthesis Evaluation Questionnaire question #1, Satisfaction with the Prosthesis) outcome measures for their non-microprocessor-controlled prosthetic knees and again after 8 weeks of accommodation to the 3E80 microprocessor–enhanced knee.Results:Self-reported falls significantly declined 77% ( p = .04), Activities-Specific Balance Confidence scores improved 12 points ( p = .005), 2-min walk test walking distance increased 20 m on level ( p = .01) and uneven ( p = .045) terrain, and patient satisfaction significantly improved ( p < .01) when using the 3E80 knee. Slope and stair ambulation performance did not differ between knee conditions.Conclusion:The 3E80 knee reduced self-reported fall incidents and improved balance confidence. Walking performance on both level and uneven terrains also improved compared to non-microprocessor-controlled prosthetic knees. Subjects’ satisfaction was significantly higher than with their previous non-microprocessor-controlled prosthetic knees. The 3E80 may be considered a prosthetic option for improving gait performance, balance confidence, and safety in highly active amputees.Clinical relevanceThis study compared performance-based and self-reported outcome measures when using non-microprocessor and a new microprocessor-enhanced, default stance rotary hydraulic knee. The results inform rehabilitation professionals about the functional benefits of a limited-feature, microprocessor-enhanced hydraulic prosthetic knee over standard non-microprocessor-controlled prosthetic knees.
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Ekinci, Mehmet, Turgut Akgül, Ufuk Arzu, Serkan Bayram, Taha Furkan Yağcı, and Önder Kılıçoğlu. "Anatomical bone structure differences in patients with hemophilic arthropathy of the knee." Journal of Clinical Imaging Science 12 (August 8, 2022): 46. http://dx.doi.org/10.25259/jcis_59_2022.
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Objectives: The anatomical differences of the bony structure of the knee joint in patients with hemophilia were evaluated, and the results were compared with the knees of patients with primary gonarthrosis and no arthrosis. Material and Methods: This study reviewed 41 knees in 21 patients (with an Arnold-Hilgartner classification of Stages 4 and 5 hemophilic arthropathy) who underwent total knee arthroplasty in single center. Two control groups including 21 asymptomatic patients (42 knees) and 21 primary knee osteoarthritis patients (42 knees) were formed to compare the measurements with hemophiliacs. Femoral mediolateral width, femoral anteroposterior width, femur and tibia diaphysis width, adductor tubercle-joint line distance, tibial plateau width, and medial and lateral tibia plateau width were measured separately. Results: Femoral mediolateral width was significantly narrow comparing with healthy individuals and primary knee osteoarthritis group. Tibial plateau was similar to asymptomatic group but significantly narrow compared with primary knee osteoarthritis group. With the correlation, the tibial plateau measurements and medial and lateral plateau were significantly narrow at hemophilic arthropathy group (P < 0.05). The slope was less in hemophilic patients as compared with asymptomatic individuals (P: 0.001). Hemophilic patients had larger femoral aspect ratios than asymptomatic group but there were no observable differences with the primary osteoarthritis group. For the tibial aspect ratios, hemophilic had a smaller ratio than the primary osteoarthritis group but there were no significant differences with the asymptomatic group. Conclusion: Hemophilic knee has a mismatch between femoral and tibial side while comparing with the other groups. Level of Evidence: Level IV, cross-sectional study.
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Cammisa, Eugenio, Iacopo Sassoli, Matteo La Verde, Stefano Fratini, Vito Gaetano Rinaldi, Giada Lullini, Vittorio Vaccari, Stefano Zaffagnini, and Giulio Maria Marcheggiani Muccioli. "Bilateral Knee Arthroplasty in Patients Affected by Windswept Deformity: A Systematic Review." Journal of Clinical Medicine 11, no. 21 (November 6, 2022): 6580. http://dx.doi.org/10.3390/jcm11216580.
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Background: “Windswept” deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. Methods: A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). Results: All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. Conclusion: The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. Level of evidence: II —Systematic review of cohort studies.
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Muaidi, Qassim Ibrahim, Leslie Lorenda Nicholson, Kathryn Margaret Refshauge, Roger David Adams, and Justin Phillip Roe. "Effect of Anterior Cruciate Ligament Injury and Reconstruction on Proprioceptive Acuity of Knee Rotation in the Transverse Plane." American Journal of Sports Medicine 37, no. 8 (May 13, 2009): 1618–26. http://dx.doi.org/10.1177/0363546509332429.
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Background Studies assessing proprioceptive acuity in anterior cruciate ligament (ACL)–deficient knees have only considered proprioception for knee movements in the sagittal plane rather than in the transverse plane (ie, rotation), despite the fact that the ACL plays a critical role in knee rotational stability and that the ACL is injured almost exclusively with a rotation mechanism. Therefore a test of proprioception is needed that involves movements similar to the mechanism of injury, in this case, rotation. Purpose To determine whether proprioceptive acuity in rotation changes after ACL injury and reconstruction, and to examine differences in proprioceptive acuity, range, laxity, and activity level among injured knees, contralateral knees, and healthy controls. Design Cohort study; Level of evidence, 2. Methods Proprioceptive acuity for active knee rotation movements, passive rotation range of motion, anterior knee laxity, and knee function were measured in 20 consecutive participants with unilateral ACL rupture and 20 matched controls. Reconstruction was performed using a single-incision technique with a 4-strand hamstring tendon autograft. Thirty participants (15 control and 15 ACL reconstructed) were retested at 3 months, and 14 with ACL reconstruction were tested at 6 months. Results A deficit was found in preoperative knee rotation proprioception compared with healthy controls (P =. 031). Three months after reconstruction, there was a significant improvement (P =. 049) in proprioceptive acuity, single-plane anterior laxity (P =. 01), and self-reported knee function (P =. 001). At 3 months after reconstruction, proprioceptive acuity of the ACLreconstructed knee was correlated with reported activity level (r =. 63; P =. 021). Conclusion Knee rotation proprioception is reduced in ACL-deficient participants compared with healthy controls. Three to 6 months after reconstruction, rotation proprioceptive acuity, laxity, and function were improved. While these findings are consistent with a return to previous activity level 6 months after reconstruction, the extent of graft maturation and restoration of kinematics should also inform the decision about return to sport.
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Tanaka, Noriyuki, and Minoru Hoshiyama. "ARTICULAR SOUND AND CLINICAL STAGES IN KNEE ARTHROPATHY." Journal of Musculoskeletal Research 14, no. 01 (March 2011): 1150006. http://dx.doi.org/10.1142/s0218957711500060.
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Objective: To clarify the pathophysiology of knee arthropathy, articular sound in the knee joint was recorded using an accelerometer, vibroarthrography (VAG), during standing-up and sitting-down movements in patients with osteoarthropathy (OA) of the knees. Methods: VAG signals and angular changes of the knee joint during standing-up and sitting-down movements were recorded in patients with OA, including 17 knees with OA at Kellgren–Lawrence stage I and II, 16 knees with OA at III and IV stages, and 20 knees of age-matched control subjects. Results: The level of VAG signals was greater in knees with a higher stage of OA at 50–99 and 100–149 Hz among the groups (ANOVA with Tukey–Kramer multiple comparisons test, p < 0.01). The VAG signals did not correlate with WOMAC-pain or physical scores. Conclusions: We considered that the increase in VAG signals in these ranges of frequency corresponded with pathological changes of OA, but not self-reported clinical symptoms. This method of VAG can be used by clinicians during interventions to obtain pathological information regarding structural changes of the knee joint.