The coupled effects of crouch gait and patella alta on tibiofemoral and patellofemoral cartilage loading in children

Brandon, Scott C.E.; Thelen, Darryl G.; Cr, Smith; Novacheck, Tom F.; Schwartz, Michael H.; Lenhart, Rachel L.

doi:10.1016/j.gaitpost.2017.12.005

Cited by 14 publications

(17 citation statements)

References 42 publications

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“…23 Furthermore, subtle changes in quadriceps force production, neuromuscular coordination, and associated movement kinematics can significantly increase knee cartilage loads during activities such as walking and running. 4,13,14,35,42 The altered running biomechanics that we observed throughout the initial year after ACLR likely have a significant effect on tibiofemoral 3,32 and patellofemoral cartilage loading. 3,10,37 However, previous studies in this area are of cross-sectional design, which limits our understanding of how knee cartilage loading changes over time.…”

Section: Discussionmentioning

confidence: 85%

Running Biomechanics Before Injury and 1 Year After Anterior Cruciate Ligament Reconstruction in Division I Collegiate Athletes

et al. 2021

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Background: Preinjury running biomechanics are an ideal comparator for quantifying recovery after anterior cruciate ligament (ACL) reconstruction (ACLR), allowing for assessments within the surgical and nonsurgical limbs. However, availability of preinjury running biomechanics is rare and has been reported in case studies only. Purpose/Hypothesis: The purpose of this study was to determine if running biomechanics return to preinjury levels within the first year after ACLR among collegiate athletes. We hypothesized that (1) surgical knee biomechanics would be significantly reduced shortly after ACLR and would not return to preinjury levels by 12 months and (2) nonsurgical limb mechanics would change significantly from preinjury. Study Design: Cohort study; Level of evidence, 2. Methods: Thirteen Division I collegiate athletes were identified between 2015 and 2020 (6 female; mean ± SD age, 20.7 ± 1.3 years old) who had whole body kinematics and ground-reaction forces recorded during treadmill running (3.7 ± 0.6 m/s) before sustaining an ACL injury. Running analyses were repeated at 4, 6, 8, and 12 months (4M, 6M, 8M, 12M) after ACLR. Linear mixed effects models were used to assess differences in running biomechanics between post-ACLR time points and preinjury within each limb, reported as Tukey-adjusted P values. Results: When compared with preinjury, the surgical limb displayed significant deficits at all postoperative assessments ( P values <.01; values reported as least squares mean difference [SE]): peak knee flexion angle (4M, 13.2° [1.4°]; 6M, 9.9° [1.4°]; 8M, 9.8° [1.4°]; 12M, 9.0° [1.5°]), peak knee extensor moment (N·m/kg; 4M, 1.32 [0.13]; 6M, 1.04 [0.13]; 8M, 1.04 [0.13]; 12M, 0.87 [0.15]; 38%-57% deficit), and rate of knee extensor moment (N·m/kg/s; 4M, 22.7 [2.4]; 6M, 17.9 [2.3]; 8M, 17.5 [2.4]; 12M, 16.1 [2.6]; 33%-46% deficit). No changes for these variables from preinjury ( P values >.88) were identified in the nonsurgical limb. Conclusion: After ACLR, surgical limb knee running biomechanics were not restored to the preinjury state by 12M, while nonsurgical limb mechanics remained unchanged as compared with preinjury. Collegiate athletes after ACLR demonstrate substantial deficits in running mechanics as compared with preinjury that persist beyond the typical return-to-sport time frame. The nonsurgical knee appears to be a valid reference for recovery of the surgical knee mechanics during running, owing to the lack of change within the nonsurgical limb.

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Section: Discussionmentioning

confidence: 85%

Running Biomechanics Before Injury and 1 Year After Anterior Cruciate Ligament Reconstruction in Division I Collegiate Athletes

et al. 2021

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“…This finding demonstrated that the PTA group was close to the walking pattern of healthy individuals in the postoperative period, while the NoPTA group continued to have a crouch gait pattern. Brandon et al indicated that knee flexion moment decreased as the severity of crouch gait diminished [ 12 ]. Boyer et al reported that peak knee extensor moment significantly increased in patients having SEMLS with PTA than those who were not subjected to PTA [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…All these studies have shown that joint kinematics, especially knee joint kinematics, improved postoperatively (please see Figure A1 ). Brandon et al reported that knee flexion moment significantly increased with the proportion of severity of crouch gait [ 12 ]. Boyer et al showed that patients subjected to distal femoral extension osteotomy (DFEO) + PTA had higher peak knee extensor moment than those who were not managed with DFEO + PTA [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Patellar Tendon Advancement on Knee Joint Moment and Muscle Forces in Patients with Cerebral Palsy

Karabulut

Arslan

Götze

et al. 2021

Life

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Background: Patellar tendon advancement (PTA) is performed for the treatment of crouch gait in patients with cerebral palsy (CP). In this study, we aimed to determine the influence of PTA in the context of single-event multilevel surgery (SEMLS) on knee joint moment and muscle forces through musculoskeletal modeling; Methods: Gait data of children with CP and crouch gait were retrospectively analyzed. Patients were included if they had a SEMLS with a PTA (PTA group, n = 18) and a SEMLS without a PTA (NoPTA group, n = 18). A musculoskeletal model was used to calculate the pre- and postoperative knee joint moments and muscle forces; Results: Knee extensor moment increased in the PTA group postoperatively (p = 0.016), but there was no statistically significant change in the NoPTA group (p > 0.05). The quadriceps muscle forces increased for the PTA group (p = 0.034), while there was no difference in the NoPTA group (p > 0.05). The hamstring muscle forces increased in the PTA group (p = 0.039), while there was no difference in the NoPTA group (p > 0.05); Conclusions: PTA was found to be an effective surgery for the treatment of crouch gait. It contributes to improving knee extensor moment, decreasing knee flexor moment, and enhancing the quadriceps and hamstring muscle forces postoperatively.

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“…Cartilage contact area decreases with patella alta in both walking and static knee postures [14,70,98]. While there has been no difference found in cartilage contact stress or patellofemoral joint reaction force for normal walking [14,99], patella alta has been associated with increased cartilage contact stress for fast walking [14]. Additionally, contact stress and joint reaction force have been found to increase with alta in static knee postures for knee flexion angles greater than 80° [100,101].…”

Section: Patella Altamentioning

confidence: 99%

Patellofemoral Mechanics: a Review of Pathomechanics and Research Approaches

Wheatley

Rainbow

Clouthier

2020

Curr Rev Musculoskelet Med

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Purpose of ReviewThe patellofemoral joint is a complicated articulation of the patella and femur that is prone to pathologies. The purpose of this review is to report on the current methods of investigating patellofemoral mechanics, factors that affect joint function, and future directions in patellofemoral joint research with emerging technologies and techniques. Recent Findings While previous hypotheses have suggested that the patella is only a moment arm extender, recent literature has suggested that the patella influences the control of knee moments and forces acting on the tibia as well as contributes to various aspects of patellar function with minimal neural input. With advancements in simulating a six-degrees-of-freedom patellofemoral joint, we have gained a better understanding of patella motion and have shown that geometry and muscle activations impact patella mechanics. Research into influences on patella mechanics from other joints such as the hip and foot has become more prevalent. Summary In this review, we report current in vivo, in vitro, and in silico approaches to studying the patellofemoral joint. Kinematic and anatomical factors that affect patellofemoral joint function such as patella alta and tilt or bone morphology and ligaments are discussed. Moving forward, we suggest that advanced in vivo dynamic imaging methods coupled to musculoskeletal simulation will provide further understanding of patellofemoral pathomechanics and allow engineers and clinicians to design interventions to mitigate or prevent patellofemoral pathologies.

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The coupled effects of crouch gait and patella alta on tibiofemoral and patellofemoral cartilage loading in children

Cited by 14 publications

References 42 publications

Running Biomechanics Before Injury and 1 Year After Anterior Cruciate Ligament Reconstruction in Division I Collegiate Athletes

Running Biomechanics Before Injury and 1 Year After Anterior Cruciate Ligament Reconstruction in Division I Collegiate Athletes

The Impact of Patellar Tendon Advancement on Knee Joint Moment and Muscle Forces in Patients with Cerebral Palsy

Patellofemoral Mechanics: a Review of Pathomechanics and Research Approaches

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