Contribution of tibiofemoral joint contact to net loads at the knee in gait

Walter, Jonathan P.; Can, Nuray Korkmaz; Fregly, Benjamin J.; Pandy, Marcus G.

doi:10.1002/jor.22845

Cited by 20 publications

(21 citation statements)

References 43 publications

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“…Nevertheless the impact of frontal‐plane stability and co‐activation on muscle forces is not well established. Up to 16% of frontal‐plane stability may be contributed by muscles in varus mal‐aligned individuals, but this is highly variable, with some individuals demonstrating almost no muscular contribution . By applying OA‐type activation patterns, Brandon et al found higher quadriceps forces, yet Adouni et al, who included frontal‐plane internal torques in a geometry‐based contact model with ligaments, did not.…”

Section: Discussionmentioning

confidence: 99%

Musculoskeletal loading in the symptomatic and asymptomatic knees of middle‐aged osteoarthritis patients

Sritharan

Lin

Richardson

et al. 2016

Journal Orthopaedic Research

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This study quantified the contributions by muscles, gravity, and inertia to the tibiofemoral compartment forces in the symptomatic (SYM) and asymptomatic (ASYM) limbs of varus mal-aligned medial knee osteoarthritis (OA) patients, and compared the results with healthy controls (CON). Muscle forces and tibiofemoral compartment loads were calculated using gait data from 39 OA patients and 15 controls aged 49 ± 7 years. Patients exhibited lower knee flexion angle, higher hip abduction, and knee adduction angles, lower internal knee flexion torque but higher external knee adduction moment. Muscle forces were highest in CON except hamstrings, which was highest in SYM. ASYM muscle forces were lowest for biceps femoris short head and gastrocnemius but otherwise intermediate between SYM and CON. In all subjects, vasti, hamstrings, gastrocnemius, soleus, gluteus medius, gluteus maximus, and gravity were the largest contributors to medial compartment force (MCF). Inertial contributions were negligible. Highest MCF was found in SYM throughout stance. Small increases in contributions from hamstrings, gluteus maximus, gastrocnemius, and gravity at the first peak; soleus and rectus femoris at the second peak; and soleus, gluteus maximus, gluteus medius, and gravity during mid-stance summed to produce significantly higher total MCF. Compared to CON, the ASYM limb exhibited similar peak MCF but higher mid-stance MCF. In patients, diminished non-knee-spanning muscle forces did not produce correspondingly diminished MCF contributions due to the influence of mal-alignment. Our findings emphasize consideration of muscle function, lower-limb alignment, and mid-stance loads in developing interventions for OA, and inclusion of the asymptomatic limb in clinical assessments. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:321-330, 2017.

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Section: Discussionmentioning

confidence: 99%

Musculoskeletal loading in the symptomatic and asymptomatic knees of middle‐aged osteoarthritis patients

Sritharan

Lin

Richardson

et al. 2016

Journal Orthopaedic Research

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“…Medial tibiofemoral contact force (MTFF) is due to a combination of externally applied knee loads [2, 3] and muscles forces [2, 4–6]. Increased external knee adduction moment (KAM), which is related to increased MTFF [7], has been associated with fast progression of medial knee OA [8], development of chronic knee pain [9], progression of articular tissue pathologies [10], and poor outcomes after high tibial osteotomy surgery [2, 11].…”

Section: Introductionmentioning

confidence: 99%

“…The KAM has been positively correlated with the shape of MTFF during walking [7, 39], but this is not always the case [3, 4, 37, 40]. Studies based on instrumented tibiofemoral prostheses [41] have shown that decreases in the KAM do not necessarily result in decreases to MTFF [37], and that only small changes occurred in the MTFF for gait patterns designed 1to reduce KAM [42].…”

Section: Introductionmentioning

confidence: 99%

“…Studies based on instrumented tibiofemoral prostheses [41] have shown that decreases in the KAM do not necessarily result in decreases to MTFF [37], and that only small changes occurred in the MTFF for gait patterns designed 1to reduce KAM [42]. The KAM-MTFF relationship probably breaks down due to large muscular contributions to MTFF that are similar in magnitude to the contributions from external loads [4, 6]. Thus, it is essential to consider both external joint moments and muscle forces in order to estimate MTFF accurately [4, 6].…”

Section: Introductionmentioning

confidence: 99%

“…The KAM-MTFF relationship probably breaks down due to large muscular contributions to MTFF that are similar in magnitude to the contributions from external loads [4, 6]. Thus, it is essential to consider both external joint moments and muscle forces in order to estimate MTFF accurately [4, 6]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Biofeedback for Gait Retraining Based on Real-Time Estimation of Tibiofemoral Joint Contact Forces

Pizzolato

Reggiani

Saxby

et al. 2017

IEEE Trans. Neural Syst. Rehabil. Eng.

102

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Biofeedback assisted rehabilitation and intervention technologies have the potential to modify clinically relevant biomechanics. Gait retraining has been used to reduce the knee adduction moment, a surrogate of medial tibiofemoral joint loading often used in knee osteoarthritis research. In this study we present an electromyogram-driven neuromusculoskeletal model of the lower-limb to estimate, in real-time, the tibiofemoral joint loads. The model included 34 musculotendon units spanning the hip, knee, and ankle joints. Full-body inverse kinematics, inverse dynamics, and musculotendon kinematics were solved in real-time from motion capture and force plate data to estimate the knee medial tibiofemoral contact force (MTFF). We analyzed 5 healthy subjects while they were walking on an instrumented treadmill with visual biofeedback of their MTFF. Each subject was asked to modify their gait in order to vary the magnitude of their MTFF. All subjects were able to increase their MTFF, whereas only 3 subjects could decrease it, and only after receiving verbal suggestions about possible gait modification strategies. Results indicate the important role of knee muscle activation patterns in modulating the MTFF. While this study focused on the knee, the technology can be extended to examine the musculoskeletal tissue loads at different sites of the human body.

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Changes and Associations Between Gait Biomechanics and Knee Inflammation After Aspiration and Glucocorticoid Injection for Knee Osteoarthritis

Pinto

Birmingham

Philpott

et al. 2023

Arthritis Care & Research

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Objective Although knee inflammation is thought to adversely affect joint function in patients with knee osteoarthritis (OA), the effects of reducing knee inflammation on gait biomechanics and strength are unknown. Our objectives were to compare ultrasound (US) measures of knee inflammation, gait biomechanics, knee extension and flexion strength, and pain before and after knee aspiration and glucocorticoid injection, and to explore associations among changes. Methods Forty‐nine patients (69 knees) with symptomatic knee OA and synovitis were tested before and 3–4 weeks after US‐guided knee aspiration and glucocorticoid injection. At each visit, participants completed US assessments for inflammatory features of knee OA, 3D gait analysis, isokinetic knee extension and flexion strength tests, and Knee Osteoarthritis Outcome Score (KOOS) pain subscales. Linear and polynomial mixed‐effects regression models were used to investigate changes and their associations. Results Changes were observed for the synovitis score (unstandardized β [post‐injection minus pre‐injection] –0.55/9 [95% confidence interval (95% CI) –0.97, –0.12]), effusion depth (–1.05 mm [95% CI –1.07, –0.39]), KOOS pain (unstandardized β 5.91/100 [95% CI 1.86, 9.97]), peak external knee flexion and extension moments (KFM; 3.33 Nm [95% CI 0.45, 6.22]), KEM (–2.99 Nm [95% CI –5.93, –0.05]), and knee extension strength (4.70 Nm [95% CI 0.39, 9.00]) and flexion strength (3.91 Nm [95% CI 1.50, 6.81]). The external KFM increased during 13–38% and 76–89% of stance post‐injection. When controlled for time, greater synovitis was associated with lower knee extension strength, while lower pain was associated with increased knee extension and flexion strength. Conclusion In patients with knee OA and synovitis, reduced inflammation and pain after aspiration and glucocorticoid injection are associated with changes in knee gait biomechanics and strength.

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Contribution of tibiofemoral joint contact to net loads at the knee in gait

Cited by 20 publications

References 43 publications

Musculoskeletal loading in the symptomatic and asymptomatic knees of middle‐aged osteoarthritis patients

Musculoskeletal loading in the symptomatic and asymptomatic knees of middle‐aged osteoarthritis patients

Biofeedback for Gait Retraining Based on Real-Time Estimation of Tibiofemoral Joint Contact Forces

Changes and Associations Between Gait Biomechanics and Knee Inflammation After Aspiration and Glucocorticoid Injection for Knee Osteoarthritis

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