Purpose: Anterior cruciate ligament (ACL) tear greatly increases the risk of knee osteoarthritis (OA), even when patients undergo ACL reconstruction surgery (ACLR). Changes to walking kinematics following ACLR have been suggested to play a role in this degenerative path to post-traumatic OA by shifting the location of repetitive joint contact loads that occur during walking to regions of cartilage not conditioned for altered loads. Recent work has shown that changes to the average knee center of rotation during walking (KCOR) between 2 and 4 years after ACLR are associated with long term changes in patient reported outcomes at 8 years. Changes to KCOR result in changes to contact patterns between the femur and the tibial plateau. However, it is unknown if changes to this kinematic measure are reflected by changes to cartilage as early as 2 years after surgery. Ultrashort TE-enhanced T2* (UTE-T2*) mapping has been shown to be sensitive to subsurface changes occurring in deep articular cartilage early after ACL injury and over 2 years after ACLR that were not detectable by standard morphological MRI. Thus, the purpose of this study was to test the hypothesis that side to side differences in KCOR correlate with side to side differences in UTE-T2* quantitative MRI (qMRI) in the central weight bearing regions of the medial and lateral tibial plateaus at 2 years following ACLR. Methods: Thirty-five human participants (18F, Age: 33.8±10.5 yrs, BMI: 24.1±3.3) with a history of unilateral ACL reconstruction (2.19±0.22 yrs post-surgery) and no other history of serious lower limb injury received bilateral examinations on a 3T MRI scanner. UTE-T2* maps were calculated via mono-exponential fitting on a series of T2*-weighted MR images acquired at eight TEs (32μs -16 ms, non-uniform echo spacing) using a radial out 3D cones acquisition. All subjects completed bilateral gait analysis. Medial-lateral (ML) and anterior-posterior (AP) coordinates of average KCOR during stance of walking were calculated for both knees. Side to side differences in KCOR were tested for correlations with side to side differences in mean full thickness UTE-T2* quantitative values in the central weight bearing regions of the medial and lateral tibial plateau using Pearson correlation coefficients. Results: There was a distribution in UTE-T2* values, with some subjects having higher UTE-T2* and some lower in the ACLR knee relative to the contralateral knee. A significant correlation (R=0.407, p=0.015, Figure 1A) was observed between UTE-T2* and the ML KCOR with a more lateral KCOR corresponding to higher values of UTE-T2* for the medial tibia. Similarly, for the lateral tibia, a lower UTE-T2* was correlated with a more posterior KCOR (R=0.363, p=0.032, Figure 1B). Significant correlations were not observed for UTE-T2* in the lateral tibia with the ML position of KCOR or for UTE-T2* in the medial tibia with the AP position of KCOR. Conclusions: The results of this study support the hypothesis that side to side differences in mean full thickness UTE-T2* qMRI correlate with side to side differences in knee kinematics at 2 years after ACLR. The finding that a more lateral KCOR in the ACLR knee correlates with UTE T2* values in the medial tibia that were higher than the contralateral side suggests that this kinematic change, which has been previously shown to result in more relative motion between the femur and tibia in the medial compartment, could be affecting subsurface matrix integrity, inducing changes detectable by UTE-T2* mapping. Additionally, the finding that a more posterior KCOR in the ACLR knee correlated with UTE-T2* values in the lateral tibia that were lower than the contralateral knee further suggests that the UTE-T2* metric may reflect early changes in cartilage health. When interpreted within the context of prior work showing that a posterior shift in KCOR from 2 to 4 years post-surgery correlated with improved clinical outcomes at 8 years, the observed lower UTE-T2* with a more posterior KCOR, which is reflective of improved quadriceps recruitment, suggests positive cartilage matrix properties. In spite of the limitations of this cross-sectional and exploratory study, and the difficulty accounting for changes in the contralateral knee, these results support future studies of the relationship between UTE-T2* and KCOR to provide new insight into predicting the risk for OA after ACLR.
Listed In: Biomechanical Engineering, Biomechanics, Gait, Mechanical Engineering, Orthopedic Research, Sports Science

INTRODUCTION. Increased age is associated with changes in gait mechanics and decreased muscle function. As the knee extensors (KE) are prime movers in gait, altered KE function (strength, power, fatigability) could alter knee mechanics. This study aimed to determine whether a bout of exercise induces KE fatigue and changes in knee mechanics in two older groups with different physical activity levels: sedentary adults and runners. METHODS. Adults aged 55-70 who were either runners (≥15 miles/wk) or sedentary (≤3x30 min exercise bouts/wk) completed gait and strength testing before and after a 30 minute treadmill walk (30MTW). Joint kinematics were calculated using the point cluster technique. Externally-referenced moments were calculated using inverse dynamics. KE power and isometric strength were assessed via isokinetic dynamometry. Changes in KE power and knee mechanics were calculated; within-group changes were examined using paired t-tests (p<0.1). RESULTS. Sedentary adults displayed a drop in KE power at 6/8 contraction velocities vs. 2/8 in runners (poster Figure 2). Both groups showed an increase in knee flexion angle at heel strike and runners displayed decreased knee flexion moments post-30MTW (poster Figure 3). CONCLUSIONS. Vigorous physical activity may allow older adults to maintain fatigue resistance. Sensitivity of knee mechanics to KE fatigue remains unclear as few changes were seen even in a fatigued group. Global, rather than discrete, measures of joint function may provide more sensitive measures of the response of gait mechanics to muscle fatigue and may allow for a more complete picture of the impact of muscle function on gait.
Listed In: Biomechanics, Gait

Multisensory integration is driven by a process of sensory reweighting during which each input is assigned a weight depending on the current functional state of a particular sensory system, the task itself and the context in which it is being performed. The primary aim of this study was to determine which of the two inputs between ankle proprioception and vision is upweighed during a postural control task when the two inputs provide conflicting information pertaining to direction of body sway. Achilles tendon vibration and visual flow were used to create sensory conflict, which produced center of pressure (COP) sway in opposite directions when applied independently. The baseline conditions (1) consisted of eyes open quiet stance condition, eyes closed with vibration applied on the Achilles tendons (2) and eyes open with visual flow (3). The experimental condition simultaneously combined vibration and visual flow. COP excursions were recorded in 10 healthy young adults to evaluate the magnitude and direction of sway produced by vibration and/or visual flow. Additionally, lower body joint kinematics were evaluated to understand the multi-segmental strategies and their adaptation to the various sensory manipulations. The results showed that visual flow moderated the extent of backward COP and ankle angular displacement produced when vibration was applied independently. Additionally, visual flow was also found to reduce the extent of predominant hip strategy generated by ankle vibration. The findings show that visual input plays a significant role in maintaining stability and that ankle proprioception is downweighed during conflicts between vision and proprioception. This has important implication for balance training using controlled visual flow in patients with balance disorders and elderly.
Listed In: Biomechanics, Neuroscience, Posturography

Chronic ankle instability (CAI) patients show various sensorimotor deficits, which may be related to the chronic nature of instability. Ultimately, an intervention should focus on deficits which may perpetuate the problem, but an understanding of successful sensorimotor function may best come from those who sprained their ankles with no problematics outcome (copers). PURPOSE: To examine sagittal ankle angles, moments, tibialis anterior and medial gastrocnemius EMG activation during a single-leg maximal vertical side-cutting jump task. METHODS: 66 subjects (M=42, F=24; 22.2±2 yrs, 173.8±8 cm, 71.4±11 kg) consisted of 22 CAI (77.1±15.3% FAAM ADL, 62.5±20.4% FAAM Sports, 4.1±2.8 sprains), 22 Copers (100% FAAM ADL & Sports, 2.0±1.1 sprains), and 22 healthy controls. Subjects performed 10 jumps, consisting of a max vertical jump, landing on a force plate, and transitioning immediately to a side-cutting jump, while the dependent variables were collected during stance. Functional linear models (α=.05) were used to detect mean difference between groups. If functions and associated 95% confidence intervals did not cross the zero, then significant differences existed. RESULTS: Figure 1 shows that copers and AI exhibited up to 2.5° less dorsiflexion angle during 30-75% of stance, relative to controls. While copers exhibited similar neuromechanics to controls in sagittal ankle moment, tibialis anterior and medial gastrocnemius EMG activation, those with CAI demonstrated up to 0.5 Nm/kg less plantarflexion moment, 2.5% less tibialis anterior and 47% less medial gastrocnemius EMG activation. CONCLUSION: Copers show neuromechanics similar to healthy controls at times, and similar to those with CAI at others. Reduced plantarflexion moment and medial gastrocnemius EMG activation suggest that those with CAI may rely more on static stabilizers (e.g., bones) than dynamic stabilizers (e.g., muscles), which could increase impact loads on tibiotalar cartilage surface.

Listed In: Biomechanics, Sports Science

In the following project, we explored the relationships between age, vestibulopathy and stability control, in order to determine the age and vestibulopathy-related effects on stability control, and to establish if a relationship existed between static and dynamic stability task performance. The first study examined the response to repeated trip perturbations of healthy middle aged adults and vestibulopathy patients, the second examined feedforward adaptation of gait in young, middle aged and older adults to a sustained mechanical perturbation and the third examined the relationship between standing balance and recovery following a tripping perturbation in vestibulopathy patients. The results showed that vestibulopathy is related to a diminished ability to control and recover gait stability after an unexpected perturbation, and to a deficient reactive adaptation potential. With ageing, the ability to recalibrate locomotor commands to control stability is preserved, although this recalibration may be slower in old age compared to middle and young age. Given that a decline in vestibular function is seen with increasing age, we suggest that assessment of vestibular function may be necessary when investigating locomotor stability and falls risk in both research and clinical settings. Finally, despite static balance tasks and parameters being commonly used in clinical settings, we did not find a consistent relationship between static and dynamic stability task performance, indicating the importance of dynamic stability tests when assessing falls risk in clinical settings.
Listed In: Biomechanics, Gait, Posturography