INTRODUCTION: Patellofemoral pain (PFP) is a common condition seen in orthopedic practice, accounting for approximately 25-40% of all knee injuries . A commonly cited hypothesis as to the cause of PFP is elevated patellofemoral joint (PFJ) stress  secondary to abnormal PFJ structure. Previous studies have shown that persons with PFP exhibit altered patella position , abnormal femoral morphology , and decreased patella cartilage thickness  when compared to healthy individuals. However, the influence of the abnormal morphology on PFJ stress is unknown.
METHODS: Nineteen subjects (10 PFP and 9 pain-free controls) were recruited for this study. Each subject completed 2 phases of data collection: magnetic resonance imaging (MRI) assessment and biomechanical testing. The measurement of morphological variables (patella height (Insall-Salvati ratio or ISR), lateral trochlear inclination angle (LTI), and patella cartilage thickness). For the biomechanical testing, kinematic, kinetic, and electromyographic were obtained.
RESULTS AND DISCUSSION: Pearson correlation coefficients revealed that only patella height (r=0.48, p=0.018) and patella cartilage thickness (r=-0.58, p=0.005) were significantly correlated with peak hydrostatic pressure (Table 1). Results of the stepwise regression analysis revealed that patella cartilage thickness was the single best predictor of peak hydrostatic pressure, followed by patella height. Together, these 2 variables explained 50% of the variance in peak PFJ stress.
The results of the current study support the premise that PFJ stress is associated with PFJ morphology. Patella height was the best predictor of PFJ stress with greater degrees of patella height being correlated with greater stress. This is logical given that a higher positioned patella articulates with the more shallow portion of the trochlear groove, thus decreasing PFJ contact area . The finding that patella cartilage thickness was negatively correlated with PFJ stress is in agreement with the results of Li et al. , who demonstrated that a reduction of cartilage thickness causes increase cartilage stress. Furthermore, our findings revealed that 50% of the variance in PFJ stress could be explained by morphological factors.
CONCLUSIONS: Identifying the underlying factors that contribute to elevated PFJ stress is an important step in developing effective interventions for persons with PFP. Although abnormal structure may not be correctable through conservative measures, it is important to recognize abnormal structure may play a role in contributing to pain and pathology.
Tai Ji is one of the recommended non-pharmacologic treatments for knee osteoarthritis (OA), but it is not clear if all Tai Ji movements would be suitable and beneficial for knee OA patients. PURPOSE: To examine knee biomechanical characteristics of the selected knee unfriendly Tai Ji movement elements performed in high-pose position compared to slow walking. METHODS: Seventeen healthy participants (age: 23.9 ± 2.7 years, height: 1.73 ± 0.08 m, body mass: 69.0 ± 13.0 kg) performed three trials in each of the following five test conditions: level walking at 0.8 m/s and four identified knee unfriendly Tai Ji movement elements: lunge, pushdown and kick performed in high-pose position (35 ± 5°) and pseudo-step. Simultaneous collection of 3D kinematics (120 Hz) and ground reaction forces (1200 Hz) was conducted. A one-way ANOVA was performed with post hoc paired samples t-tests to determine differences of the high-pose lunge, pushdown, and kick, and pseudo-step and walking. RESULTS: Knee flexion range of motion for high-pose lunge (29.5°), pushdown (24.3°) and kick (11.1°) was lower than pseudo-step (45.0°, p<0.001 for all comparisons) and walking (47.8°, p<0.001 for all comparisons). Peak knee extensor moment was lower in high-pose lunge (1.04 Nm/kg), pushdown (1.01 Nm/kg) and kick (0.48 Nm/kg) than pseudo-step (1.46 Nm/kg, p<0.001 for all comparisons), but higher than walking (0.38 Nm/kg, p<0.001 for all comparisons) except for kick. Peak knee abduction moment was higher in pseudo-step (-0.61 Nm/kg) than high-pose pushdown (-0.43 Nm/kg), kick (-0.44 Nm/kg), and walking (-0.45 Nm/kg, for all comparisons p<0.001). CONCLUSION: These findings demonstrate higher peak knee extensor moment in most of the Tai Ji knee unfriendly movement elements compared to slow walking. It is recommended that Tai Ji participants with knee OA and other knee pathological conditions modify knee unfriendly movement elements (e.g. lunge) and reduce the size of their movements to minimize knee joint loading. The Tai Ji movement elements including pushdown and pseudo-step should be avoided in the Tai Ji exercises designed for knee OA patients.
Introduction and Objectives: Traditional motion analysis provides limited insight into muscle and tendon forces during movement. This study used B-mode ultrasound, in combination with measured joint angles and scaled musculoskeletal models, to provide subject-specific estimates of in vivo Achilles tendon (AT) force. Previous studies have used ultrasound images, tracked in 3D space, to estimate AT strains during walking, running, and jumping [1,2]. Our approach extends this work in one novel way. Specifically, we characterized AT stiffness on a subject-specific basis by recording subjects’ ankle moments and AT strains during a series of isometric tests. We then used these data to estimate AT force during movement from in vivo measurements of tendon strain.
To demonstrate this approach, we report AT forces measured during cycling. Cycling offers a unique paradigm for studying AT mechanics. First, because the crank trajectory is constrained, joint angles and muscle-tendon unit (MTU) lengths of the gastrocnemius (MG, LG) and soleus (SOL) are also constrained. By varying crank load, subjects’ ankle moments can be altered without imposing changes in MTU lengths. For this study, 10 competitive cyclists were tested at 4 different crank loads while pedaling at 80 rpm. Based on published EMG recordings (e.g., ) and on in vivo tendon force buckle data from one subject , we hypothesized that the cyclists’ AT forces would increase systematically with crank load.
Methods: We coupled B-mode ultrasound with motion capture, EMG, and pedal forces to estimate in vivo AT forces non-invasively during cycling and during a series of isometric ankle plantarflexion tests. Marker trajectories were tracked using an optical motion capture system. Joint angles and MTU lengths were calculated based on scaled musculoskeletal models  using OpenSim . A 50 mm linear-array B-mode ultrasound probe was secured over the distal muscle-tendon junction (MTJ) of the MG and was tracked using rigid-body clusters of LEDs. AT lengths were calculated as the distance from a calcaneus marker to the 3D coordinates of the MG MTJ. Subject-specific AT force-strain curves were obtained from isometric tests using ultrasound to track the MTJ, markers to track both the ultrasound probe and the AT insertion, and a strain gauge to measure the net ankle torques generated by each of the subjects at ankle angles of -10° dorsiflexion, 0°, +10° plantarflexion, and +20° plantarflexion. AT strain during cycling was converted to AT force using each subject’s force-strain relation. Subject-specific tendon slack lengths were calculated as the mean tendon length at 310° over all pedal cycles, based on examination of the AT length changes and on published data showing that this position in the pedal cycle precedes tendon loading across multiple pedalling conditions .
Results: Peak AT forces during cycling ranged from 1320 to 2160 N ± 400 N (mean± SD) and increased systematically with load (p<0.001; Fig. 1A/B). At the highest load, the peak AT forces represented, on average, 50 to 70 % of the combined MG, LG, and SOL muscles’ maximum isometric force-generating capacity, as estimated from the muscles’ scaled volumes , the muscles’ scaled optimal fiber lengths , and a specific tension of 20-30 N/cm2. Peak AT forces occurred midway through the pedaling downstroke, at about 80°, which is consistent with the AT forces directly measured from one subject  and with patterns of EMG during cycling . Peak AT strains during cycling were uncoupled from the MG MTU strains and ranged from 3 to 5 % across the different loads examined, measured at the MG MTJ.
Conclusion: Our results are consistent with published data from a single subject in which AT force was measured using an implanted tendon buckle ; however, our results were obtained non-invasively using ultrasound and motion capture. These methods substantially augment the experimental tools available to study muscle-tendon dynamics during movement.
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Introduction and Objectives: It has previously been reported that deterioration in contractile strength and tendon
stiffness in the elderly is associated with altered motor task execution and reduced performance while walking [1,2], and
that resistance training improves muscle function, resulting in more effective and safer gait characteristics in the older
population . In particular, triceps surae (TS) muscle-tendon unit (MTU) properties seem to be an important determinant
for walk-to-run transition speed , emphasizing the relevant role intrinsic MTU properties play in gait performance. The
objective of this empirical study was to examine the hypothesis that maximal walking velocity is related to TS MTU
mechanical and morphological properties and their enhanced capacities would improve gait velocity in the elderly.
Methods: Thirty four older female adults (66±7 yrs.) took part in the study. Nineteen of them were recruited for the
experimental group, who underwent a 14-week TS MTU physical exercise intervention which has been previously
established to increase muscle strength and tendon stiffness . The remaining 15 subjects formed the control group (no
physical exercise intervention). The experimental group performed three times per week five sets of four repetitive (3·s
loading, 3·s relaxation) isometric plantar flexion contractions in order to induce high cyclic strain magnitudes on the TS
tendon and aponeurosis. Maximal walking velocity, defined as walking with a double support phase, was determined by
using two force plates (60 x 40 cm, 1080 Hz; Kistler, Winterthur, CH) and a motion capture system (Vicon Motion
Systems, Oxford, UK) with 12 infrared cameras operating at a frequency of 120 Hz. TS MTU properties were assessed
using simultaneous dynamometry and ultrasonography (Esaote MyLab Five; Esaote Biomedica, Genoa, IT).
Results: A significant correlation was found between the TS MTU mechanical and morphological properties and maximal
gait velocity (0.40 < r < 0.64; P < 0.05; n = 34). The experimental group showed higher TS contractile strength, tendon
stiffness, and higher gastrocnemius medialis muscle thickness post- compared to pre-intervention (P < 0.05). However,
calculated maximal gait velocity did not differ between pre and post-intervention measurements (2.39 ± 0.41 vs. 2.44 ±
0.45 m·s-1). Control subjects showed no statistically significant differences in maximal gait velocity or TS MTU mechanical
and morphological properties.
Conclusion: This empirical study confirms previous forward simulation models  proposing that intrinsic TS MTU
properties are significant determinants of gait performance. However, older adults may not be capable of fully utilizing
improvements of the MTU capacities while walking at maximal velocities following a 14 week physical exercise
intervention. Therefore, the benefits of a long term physical exercise intervention (1.5 years) will be discussed.
One in three individuals who suffer a lateral ankle sprain (LAS) subsequently develop chronic ankle instability. However, our inability to properly treat acute LAS is not surprising given our limited understanding of post-LAS consequences. 12 patients (21.6±2.9yrs; 172.9±13.1cm; 79.1±21.4kg) with an acute LAS participated. All participants were evaluated for dorsiflexion range of motion (DFROM), time-to-boundary (TTB) in single limb balance (SLB), and self-reported function (SRF) at 1-week, 2-weeks, 4-weeks, 6-weeks, and 8-weeks post injury. Both the involved and uninvolved limbs were measured during the patients first test session. DFROM was assessed using the weight-bearing lunge test and all participants performed 3, 10s of single limb stance with eyes open on a force plate to measure their single limb balance. SRF was measured using the Foot and Ankle Ability Measure (FAAM) and FAAM-Sport (FAAM-S). Post injury time points were compared to a control condition using multivariate ANOVAs (α=0.05). Relative to the control condition, FAAM and FAAM-S were significantly lower at 1-week and 2-weeks post injury. The FAAM-S was also significantly lower score compare to control condition at 4-weeks post-injury. Both FAAM and FAAM-S were not significant different at 6-weeks post-injury. Post-injury TTB measures and DFROM were not significantly different from the control condition. Non-significant declines in DFROM and TTB were observed as in this sample of acute LAS and appear to present with unique recovery patterns. Different recovery patterns among the tested outcomes indicate the need for further research with a larger cohort and for a longer post-injury duration.
Strength measurements are popular in the clinical practice to evaluate the health status of patients and quantify the outcome of training programs. Currently a common method to measure strength is based on Hand Held Dynamometers (HHD) which is operator-dependent. Some studies were conducted on repeatability of strength measurements but they were limited to the statistical analysis of repeated measurements of force. In this work, the authors developed a methodology to study the quality of knee flexion/extension strength measurements by measuring the effective HHD position and orientation with respect to the patient. HHD positioning attitude was measured by means of an Optoelectronic System for which a marker protocol was defined ad-hoc. The approach allowed to assess quality of measurements and operator’s ability by means of quantitative indices. The protocol permitted the evaluation of: angles of HHD application, angular range of motion of the knee and range of motion of the HHD. RMSE parameters allowed to quantify the inaccuracy associated to the selected indices. Results showed that the operator was not able to keep the subject’s limb completely still. The force exerted by the subject was higher in knee extension and the knee range of motion was higher than expected, however the operator had more difficulties in holding the HHD in knee flexion trials. This work showed that HHD positioning should be as accurate as possible, as it plays an important role for the strength evaluation. Moreover, the operator should be properly trained and should be strong enough to counteract the force of the subject.
Patients with unilateral peripheral vestibular disorder (UPVD) have diminished postural stability and therefore the aim of this study was to examine the contribution of multiple sensory systems to postural control in UPVD. Seventeen adults with UPVD and 17 healthy controls participated in this study. Centre of pressure (COP) trajectories were assessed using a force plate during six standing tasks: Forwards and backwards leaning, and standing with and without Achilles tendon vibration, each with eyes open and eyes closed. Postural stability was evaluated over 30s by means of: total COP excursion distance (COPPath) and the distances between the most anterior and posterior points of the COPPath and the anterior and posterior anatomical boundaries of the base of support (COPAmin and COPPmin). In addition, the corrected COPAmin and COPPmin was assessed by taking the corrected base of support boundaries into account using the anterior and posterior COP data from the leaning tasks. UPVD patients showed a tendency for smaller limits of stability during the leaning tasks in both directions. Subject group and task condition effects were found (P<0.05) for COPPath, (i.e. higher values for patients compared to controls). UPVD patients showed lower (P<0.05) COPPmin values compared to the control group for all conditions (more pronounced with the corrected COPPmin). Disturbance of the visual system alone lead to a distinct postural backward sway in both subject groups which became significantly more pronounced in combination with Achilles tendon vibration. The individual limits of stability should be considered in future research when conducting posturographic measurements.
Background: Knee joint pain (KJP) independently alters motor function and gait mechanics, and these alterations may accelerate chronic knee joint disease. While TENS restores motor function deficits, it is unclear whether TENS restores compensatory gait mechanics. The purpose was to examine the effects of KJP on lower-extremity joint moments, and the effects of TENS on the aforementioned variables. We hypothesized that KJP will result in altered gait patterns, and TENS will help restore these mechanical alterations.
Methods: We randomly selected 15 subjects for the TENS group, after which subjects were matched for the placebo group. Subjects underwent 3 sessions (hypertonic, isotonic, control). A 20-gauge flexible catheter was inserted into the right infrapatellar fat pad, and an infusion pump infused a saline of 0.154 mL•min¯¹ for 50 min (total = 7.7 mL). A TENS protocol was set at a biphasic mode with 120 µs and 180 Hz for 20 min. To blind placebo treatment, subjects in the placebo group was told that an electrical stimulation had been set to sub-sensory level. High-speed video (240 Hz) and an instrumented treadmill (1200 Hz) were used for gait analysis. Functional analysis of variance were used to evaluate differences between groups over time for joint moments. The mean curve with 95% CIs is represented by polynomial functions, showing us the entire stance, rather than identifying discrete peak points. If 95% CIs did not cross zero, significant difference existed (P < 0.05).
Discussion: KJP independently increase internal knee varus moments, which were consistent with previous finding using patients with osteoarthritic knee pain. These compensatory gait patterns may be a result of a pain-avoidance motor deficits strategies. Since observed patterns can create altered mechanical and biological stress patterns on articular surface, it may increase the risk of degenerative knee disease. However, attempting to reduce perceived pain and increase neuron activation through TENS can help overcome deficits in knee and hip joint moments.
Victims of improvised explosive devices (IEDs) that have presented spinal injury in recent conflicts have been shown to have a high incidence of lumbar spine fractures. Previous studies have shown that the initial positioning of spinal bone-disc-bone complexes affects their biomechanical response when loaded quasi-statically; such a correlation, however, has not been explored at appropriate high loading rate scenarios that simulate injury. This study aims to investigate the response of lumbar spine cadaveric segments in different postures under axial impact conditions. Three T11-L1 bi-segments were dissected and tested destructively in a drop tower under flexed/neutral/extended postures. Strains were measured on the vertebral body and the spinous process of T12. Forces were measured cranially using a 6-axis load cell, and a high-speed camera was used to capture displacements and fracture. The impacted specimens were CT-scanned to identify the fracture pattern. Whilst axial force to failure was similar for flexed and extended postures, the non-axial forces and the bending moments, however, were dissimilar between postures. Although all specimens showed a burst fracture pattern, the extended posture failed more posteriorly. This suggests that axial force alone is not adequate to predict injury severity in the lumbar spine. This insight would not have been possible without the use of the 6-axis load cell. As metrics for spinal injury in surrogates take into account only the axial force, this programme of work may provide data for a better injury criterion and allow for a mechanistic understanding of the effects of posture on injury risk.
People with diabetes mellitus (DM) have been reported of increased ground reaction force (GRF) and plantar propulsion force (PPF) that will worsen the formation of plantar ulcer. The reliance of perception of self-motion has been previously addressed for maintaining stability during locomotion in DM. Therefore, we speculate that perception of self-motion will affect DM’s plantar force adjustment by decreasing GRF/PPF along with reducing of variability (CV). We recruited five DMs and three healthy controls to walk on an instrumented treadmill with their self-selected pace. All subjects went through three no self-motion and three self-motion walking trials (120s/trial). The self-motion was generated by presenting a virtual corridor that moved toward subjects with their matched velocity. Three-axis force data were recorded at 300 Hz. Two-factor ANOVA with repeated measures were conducted to examine the role of visual cue impacts GRF/PPF in DM and age-matched healthy. The visual cue and group factors show significant interaction on PPFPeak and PPFCV. The following comparisons showed significant visual effect on reducing: (1) PPFPeak in healthy controls; (2) PPFCV in DM patients. Generally, the decreased PPFPeak and PPFCV founded in this study were in line with previous study and can be explained as the optimization of neuromuscular locomotor system in the anteroposterior direction. Furthermore, visual perception of self-motion shows its effect on reducing PPFPeak during toe-off in healthy controls. Lastly, the significant decreased PPFCV of DM versus healthy stands for the reduced human movement variability observed in DM’s neuromuscular locomotor system when perception of self-motion is provided.