Sports Science

Bilateral assessment of cartilage with UTE-T2* quantitative MRI and associations with knee center of rotation following anterior cruciate ligament reconstruction

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


SINGLE LEG LANDING STRATEGY IS ALTERED IN MALE PROFESSIONAL RUGBY UNION PLAYERS WHO DEVELOP ACHILLES TENDINOPATHY COMPARED TO INJURY FREE CONTROLS

Analysis of lower limb biomechanics during jumping and landing tasks are often used to assess lower limb injury risk in research and applied practice within professional team sports. However, there are limited instances of these movements being incorporated into research focusing on Achilles tendinopathy development. PURPOSE: To investigate whether differences existed in lower limb motion and moments during jumping and landing between individuals who develop Achilles tendinopathy and those who remain injury free. METHODS: Male professional Rugby Union players without lower limb injury (n = 43) were compared to players who sustained Achilles tendinopathy (n = 8). Five single-leg drop vertical jumps per leg were performed at the start of their pre-season training. Motion of the lower limbs were recorded synchronously with ground reaction force. RESULTS: Players who sustained Achilles tendinopathy demonstrated significantly increased rear-foot inversion-eversion range of motion (p = 0.03), a reduction in dorsi-plantarflexion range of motion (p = 0.01) and knee flexion-extension range of motion (p = 0.03). Peak dorsiflexion velocity (p = 0.02) and peak knee flexion velocity were also reduced in those with Achilles tendinopathy (p = 0.03). No differences in hip joint kinematics were observed. Controls displayed slightly larger peak plantarflexion moments; however this difference was not statistically significant (p = 0.15, g = 0.60). CONCLUSIONS: The findings indicated that players who subsequently developed Achilles tendinopathy displayed an altered single leg landing strategy when compared to players who did not sustain injury; with motion of the ankle joint and rear-foot most influenced.


Listed In: Biomechanics, Sports Science


THE ASSESSMENT OF STRIDE FREQUENCY IN RUNNING USING A SINGLE ACCELEROMETER

Accelerometers have become extremely popular in the measurement of stride frequency as well as other related stride variables with current sensors capable of recording both accelerations and electromyography. The purpose of this preliminary investigation was to assess the estimation of stride frequency during running using a single tri-axial accelerometer compared to a commonly used infrared device the OptojumpTM system. Five healthy participants wore a Delsys Trigno tri-axial accelerometer attached to the right anterior shin and participants repeatedly ran at a submaximal pace through a four metre section of OptojumpTM. Stride frequency was calculated as stride time divided by one. For the OptojumpTM, stride time was the sum of contact and flight times from two consecutive steps. For the accelerometer, stride time was calculated as the time between two consecutive foot contacts on the right side. Foot contact was identified by local maxima in the Y (medial-lateral) acceleration trace. Estimates of stride frequency were compared using paired samples t- tests, intraclass correlation coefficients (ICCs) and Bland and Altman 95% limits of agreement (LOA) with significance set at p < 0.05. The mean difference between estimates was 0.01 Hz (95% LOA: -0.05-0.07 Hz) with single and average ICCs for stride frequency of 0.93 and 0.96 respectively. The results suggest that an accelerometer attached to the shin can accurately estimate stride frequency in running. Discrepancies in stride frequencies can be partially explained by differences in device sampling rates i.e. 137.15 Hz versus 1,000 Hz
Listed In: Biomechanics, Gait, Sports Science


Ankle Sprain Copers Demonstrate Unique Lower Extremity Neuromechanics Compared to Healthy Controls and Chronic Ankle Instability Subjects

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


Matching participants for triceps surae muscle-tendon unit mechanical properties eliminates age-related differences in drop jump performance

In the current study, we aimed to determine if differences in drop jump height or motor task execution strategy between young and middle-aged adults exist, when triceps surae MTU capacities (muscle strength and tendon stiffness) were matched. The triceps surae MTU biomechanical properties of 29 middle-aged and 26 younger adults were assessed during isometric voluntary ankle plantarflexion contractions of the dominant leg using a custom-made dynamometer and ultrasonography simultaneously. The 12 young adults with the lowest triceps surae muscle strength and the 12 middle-aged adults with the greatest muscle strength then completed a series of drop jumps from different heights. Ground contact time, average vertical ground reaction force, average mechanical power and jumping height were recorded. Younger and middle-aged adults attained comparable jumping heights independent of the drop jump height. There were significant age effects on ground contact time and average vertical ground reaction force during ground contact phase, with the middle-aged adults showing higher ground contact times but lower forces, leading to a significant age effect on mechanical power. Significant correlations were found between triceps surae MTU capacities and drop jump height. The results of the current study demonstrate that when triceps surae MTU capacities are matched, young and middle-aged adults show comparable performance of a jumping task, despite having different motor strategies. Finally, the results suggest that neuromuscular factors other than maximum isometric strength and tendon stiffness may influence motor task execution strategy during jumping.
Listed In: Biomechanics, Sports Science


Effects of an 8-week cadence gait training program on knee loading in individuals following ACL reconstruction

While normalization of gait is a primary goal of early rehabilitation, between limb asymmetries in knee extensor moment can persist 6-24 months later and previous literature assessing gait interventions is limited. The purpose of this study was to assess the influence of subject-specific cadence gait training program on knee loading mechanics following ACLr. Nine individuals completed an 8-week cadence training program (20min, 3x/week; Table1) and nine sex- and surgery-matched individuals served as controls. All eighteen participants received standard physical therapy and were tested at 1 and 3 months post-op. Kinematic and kinetic data were collected during walking at a self-selected speed. Repeated measures ANOVAs were used for comparisons; significance α≤0.05. Main effects of limb and time were observed: knee ROM (kROM;p<0.001;p=0.044;Fig.1) and knee extensor moment (kEXT;p=0.003;p=0.002) in the cadence and control groups, respectively. No main effects of group for kROM (p=0.136) or kEXT (p=0.229) were found. A trend toward a significant group x time x limb interaction was observed in kEXT (p=0.092), but not kROM (p=0.412). Post-hoc analyses of kEXT (Fig.2) revealed a significant time x limb interaction for the cadence group (p=0.053) but not the control group (p=0.884). In the cadence group, the time x limb interaction was driven by a 131% increase in kEXT in the surgical limb versus a 42% increase in the non-surgical limb between T1 and T2. Consistent with previous findings, these pilot data show promising results as the cadence intervention resulted in improvements in sagittal plane knee loading compared to controls.


Listed In: Biomechanics, Gait, Orthopedic Research, Physical Therapy, Sports Science


EFFECTS OF BODY POSITION AND SADDLE TYPE ON BICYCLE-RIDER INTERFACE FORCES: ROAD VS. TRIATHLON

While the popularity of triathlon is increasing, the underlying biomechanics of the various bicycling positions and saddle types are not yet understood. PURPOSE: To determine how bicycle rider position and saddle type (road vs. triathlon) affect the bicycle-rider interface forces (BRIFs) at a standardized power and cadence. METHODS: A stationary cycling ergometer was modified to include force transducers at the saddle, bottom bracket, and stem. Anatomical measurements were made in order to fine-tune rider fit on the ergometer. 9 subjects completed riding trials in all combinations of road position, road saddle, triathlon position, and triathlon saddle. Riding trials were 6 minutes, at a standardized power output of 2 Watts per kilogram (W/kg) and 90 Revolutions per Minute (RPM). RESULTS: Analysis was broken into three categories: Road Saddle, Road Position (RR) vs. Triathlon Saddle, Road Position (TR), Road Saddle, Triathlon Position (RT) vs. Triathlon Saddle, Triathlon Position (TT), and Road Saddle, Road Position vs. Triathlon Saddle, Triathlon Position. Surprisingly, there were no significant differences in saddle vertical forces between either body positions or saddle type. However, there were significant differences at the handlebar; 8.4% more body weight supported at the handlebar in the triathlon position compared to the road position while using a triathlon saddle. CONCLUSION: Across cycling positions, there is a significant change in saddle and stem vertical forces. However, within a cycling position, saddle type does not change the amount of vertical force seen at the saddle.
Listed In: Biomechanical Engineering, Biomechanics, Sports Science


Prolonged Cycling&#039;s Effect on Transition Run Mechanics in Triathletes

A period of incoordination and fatigue is commonly associated with the transition run in triathletes, in which running mechanics are thought to be altered. Few studies have examined the changes in ground reaction forces and vertical loading rate during the transition run. Our purpose was to assess the changes that occur in ground reaction forces during a fatigued transition run in triathletes. 13 recreational male triathletes (34 ± 4.2 years) performed an incremental cycling test and a cycle to run transition on separate testing sessions. A 15-camera Vicon motion capture system collecting at 200 Hz and an AMTI force instrumented treadmill collecting at 2000 Hz were used in conjunction with a modified Plug-In Gait marker to collect trajectory and analog data for pre and post-cycling running trials. Ground reaction forces and temporal spatial parameters were assessed during stance of all running trials using Visual 3D software. Peak vertical ground reaction force and step length decreased significantly from pre-cycling to immediate post-cycling measures (p=.003, p<.001), no difference existed for either variable for pre-cycling vs. 10min post-cycling. Instantaneous peak vertical loading rate (IVLR) and step rate increased significantly from pre-cycling to immediate post-cycling measures (p=.05, p<.001), no difference existed for stride rate for pre-cycling vs. 10min post-cycling. IVLR remained significantly increased at the 10 min post-cyling (p=.035). The study findings suggest that fatigue from prolonged cycling can negatively impact triathletes’ ability to attenuate ground reaction forces in subsequent running.
Listed In: Biomechanics, Gait, Sports Science


Modeling 3D Ground Reaction Forces During Walking Using Nanocomposite Piezo-Responsive Foam Sensors

This study presents a new technique for acquiring ground reaction forces from novel, nanocomposite piezo-responsive foam (NCPF) sensors. A shoe was fitted with four NCPF sensors located at the heel, arch, ball, and toe positions. Running data was collected simultaneously from both the shoe sensors and from a force-sensing treadmill. A portion (30 randomly selected stance phases) of the treadmill data was used to develop a predictive stochastic model of GRF based on the sensor inputs. The stochastic model was then used to predict GRF for the remaining shoe sensor data, which was then benchmarked against the treadmill data. The results indicated that this model was able to predict forces in the x-axis (anterior-posterior) with 2.38% error, forces in the y-axis (medial-lateral) with 6.01% error, and forces in the z-axis (vertical) with 2.43% error. These novel sensors hold potential to dramatically improve both the ease and expense associated with GRF data, as well as allow unprecedented ability to measure GRF during real world applications outside of the laboratory.
Listed In: Biomechanical Engineering, Gait, Mechanical Engineering, Sports Science


Movement and Loading Symmetry Changes when Wearing a Functional Knee Brace Following ACL Reconstruction

Asymmetries in discrete measures following anterior cruciate ligament reconstruction (ACL-R) during landing have been reported to be risk factors for secondary ACL injuries. Our purpose was to examine the impact of functional brace wear on kinematic and kinetic inter-limb movement symmetry during landing in ACL-R patients. 20 adolescent athletes (15.8 ± 1.2 years) (7 male, 13 female) 6 months following ACL reconstruction performed 5 trials of a stop-jump task in both a braced (B) and non-braced (NB) condition, with the first landing being analyzed. A custom fit functional knee brace (DJO, Vista, CA) was worn on the ACL reconstructed limb (AL) during the B trials. Mean curves were created for each limb (AL and unaffected limb (UL)) for the vertical (vGRF) and anterior-posterior ground reaction forces (apGRF) and frontal and sagittal knee angles and moments. Coefficients of multiple determination (CMD) between the AL and UL curves were compared between B and NB conditions with students’ t-tests (p≤0.05). No significant differences existed for movement and loading symmetry between B and NB conditions among all subjects. Secondary analysis revealed significant differences in apGRF (p=0.014), vGRF (p=0.011) and sagittal knee angles (p=0.003) in subjects with improved sagittal knee angle symmetry in the B condition. The data show that brace wear improves loading symmetry in adolescent patients that also exhibit improved sagittal knee angle symmetry while braced 6 months following ACL-R. Identifying factors that affect inter-limb movement and loading response to brace wear could assist in determining each patient’s need for a brace.


Listed In: Biomechanics, Sports Science