Search results for: dynamic knee valgus

Authors: Mohamadreza Hatefi, Malihe Hadadnezhad

Abstract:

It is well established that jump-landing-related biomechanical deficiencies, such as dynamic knee valgus (DKV), can be improved by using various forms of feedback; However, the effectiveness of these interventions synchronously on athletes' jumping performance remains unknown. Twenty-one recreational athletes with DKV performed countermovement jump (CMJ) and drop vertical jump (DVJ) tasks before and after feedback intervention while the kinematic, force plate and electromyography data of the lower extremity were synchronously captured. The athletes’ jumping performance was calculated by using the reactive strength index-modified (RSIₘₒ𝒹). The athletes at the post-intervention exhibited significantly less hip adduction and more tibial internal rotation during both CMJ and DVJ tasks and maximum knee flexion just during DVJ task. Moreover, athletes exhibited increased time to take-off and consequently decreased RSIₘₒ𝒹 during DVJ task, but no difference was observed in CMJ task. Feedback immediately improved DKV without disturbing the athletes’ jumping height during both tasks, But athletes exhibited increased time to take-off and consequently decreased RSIₘₒ𝒹 only during DVJ task, which suggests that the results may differ according to the nature of jumping task. Nevertheless, the effectiveness of landing-related biomechanical deficiencies improvement on athletes' jumping performance must be investigated in the long-term as a new movement pattern.

Keywords: reactive strength index, feedback, biomechanics, dynamic knee valgus

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Authors: D. Pogliana, A. Maso, N. Milani, D. Panzin, S. Rivaroli, J. Konin

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This case aims to identify the role of movement quality during the final stage of return to sport (RTS) in a male amateur football player 13 years old after passing the acute phase of the bilateral Osgood-Schlatter disease (OSD). The patient, after a year from passing the acute phase of OSD with the abstention of physical activity, reports bilateral anterior knee pain at the beginning of the football sport activity. Interventions: After the orthopedist check, who recommended physiotherapy sessions for the correction of motor patterns and the isometric reinforcement of the muscles of the quadriceps, the rehabilitation intervention was developed in 7 weeks through 14 sessions of neuro-motor training (NMT) with a frequency of two weekly sessions and six sessions of muscle-strengthening with a frequency of one weekly session. The sessions of NMT were carried out through free body exercises (or with overloads) with visual bio-feedback with the help of two cameras (one with anterior vision and one with lateral vision of the subject) and a big touch screen. The aim of these sessions of NMT was to modify the dysfunctional motor patterns evaluated by the 2D motion analysis test. The test was carried out at the beginning and at the end of the rehabilitation course and included five movements: single-leg squat (SLS), drop jump (DJ), single-leg hop (SLH), lateral shuffle (LS), and change of direction (COD). Each of these movements was evaluated through the video analysis of dynamic valgus knee, pelvic tilt, trunk control, shock absorption, and motor strategy. A free image analysis software (Kinovea) was then used to calculate scores. Results: Baseline assessment of the subject showed a total score of 59% on the right limb and 64% on the left limb (considering an optimal score above 85%) with large deficits in shock absorption capabilities, the presence of dynamic valgus knee, and dysfunctional motor strategies defined “quadriceps dominant.” After six weeks of training, the subject achieved a total score of 80% on the right limb and 86% on the left limb, with significant improvements in shock absorption capabilities, the presence of dynamic knee valgus, and the employment of more hip-oriented motor strategies on both lower limbs. The improvements shown in dynamic knee valgus, greater hip-oriented motor strategies, and improved shock absorption identified through six weeks of the NMT program can help a teenager amateur football player to manage the anterior knee pain during sports activity. In conclusion, NMT was a good choice to help a 13 years old male amateur football player to return to performance without pain after OSD and can also be used with all this type of athletes of the other teams' sports.

Keywords: movement analysis, neuro-motor training, knee pain, movement strategies

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Authors: Anuj Pathare, Aleksandra Birn-Jeffery

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Background: The Anterior Cruciate Ligament(ACL) helps stabilize the knee joint minimizing tibial anterior translation. Anterior Cruciate Ligament (ACL) injury is common in racquet sports and often occurs due to sudden acceleration, deceleration or changes of direction. This mechanism in badminton most commonly occurs during landing after an overhead stroke. Knee biomechanics during dynamic movements such as walking, running and stair negotiation, do not return to normal for more than a year after an ACL reconstruction. This change in the biomechanics may lead to re-injury whilst performing non-steady movements during sports, where these injuries are most prevalent. Aims: To compare if the knee kinetics and kinematics in ACL injury recovered athletes return to the same level as those from an uninjured cohort during standard movements used for clinical assessment and badminton shots. Objectives: The objectives of the study were to determine: Knee valgus during the single leg squat, vertical drop jump, net shot and drop shot; Degree of internal or external rotation during the single leg squat, vertical drop jump, net shot and drop shot; Maximum knee flexion during the single leg squat, vertical drop jump and net shot. Methods: This case-control study included 14 participants with three ACL injury recovered athletes and 11 uninjured participants. The participants performed various functional tasks including vertical drop jump, single leg squat; the forehand net shot and the forehand drop shot. The data was analysed using the two-way ANOVA test, and the reliability of the data was evaluated using the Intra Class Coefficient. Results: The data showed a significant decrease in the range of knee rotation in ACL injured participants as compared to the uninjured cohort (F₇,₅₅₆=2.37; p=0.021). There was also a decrease in the maximum knee flexion angles and an increase in knee valgus angles in ACL injured participants although they were not statistically significant. Conclusion: There was a significant decrease in the knee rotation angles in the ACL injured participants which could be a potential cause for re-injury in these athletes in the future. Although the results for decrease in maximum knee flexion angles and increase in knee valgus angles were not significant, this may be due to a limited sample of ACL injured participants; there is potential for it to be identified as a variable of interest in the rehabilitation of ACL injuries. These changes in the knee biomechanics could be vital in the rehabilitation of ACL injured athletes in the future, and an inclusion of sports based tasks, e.g., Net shot along with standard protocol movements for ACL assessment would provide a better measure of the rehabilitation of the athlete.

Keywords: ACL, biomechanics, knee injury, racquet sport

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Authors: Ahmed Fawzy, Khaled Ayad, Gh. M. Koura, W. Reda

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The knee joint complex is one of the most commonly injured areas of the body in athletes. Excessive frontal plane knee excursion is considered a risk factor for multiple knee pathologies such as anterior cruciate ligament and patellofemoral joint injuries, however, little is known about the biomechanical factors that contribute to this loading pattern. Objectives: The purpose of this study was to investigate if there is a relationship between hip abductors isometric strength and the value of FPPA during single leg landing tasks in normal male subjects. Methods: One hundred (male) subjects free from lower extremity injuries for at least six months ago participated in this study. Their mean age was (23.25 ± 2.88) years, mean weight was (74.76 ± 13.54) (Kg), mean height was (174.23 ± 6.56) (Cm). The knee frontal plane projection angle was measured by digital video camera using single leg landing task. Hip abductors isometric strength were assessed by portable hand-held dynamometer. Muscle strength had been normalized to the body weight to obtain more accurate measurements. Results: The results demonstrated that there was no significant relationship between hip abductors isometric strength and the value of FPPA during single leg landing tasks in normal male subjects. Conclusion: It can be concluded that there is no relationship between hip abductors isometric strength and the value of FPPA during functional activities in normal male subjects.

Keywords: 2-dimensional motion analysis, hip strength, kinematics, knee injuries

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Authors: Alireza Moghtaderi, Negin Khakpour

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Hallux Valgus is a kind of Toes aberration where the Metatarsophalangeal joint that connects the big toe to the foot, leading to the inner side and a protrusion on the inner surface of toe arise. This study aimed to determine the effect of botulinum toxin A injection to reduce pain and deviation angle of the thumb in Hallux Valgus and to increase outcomes of treatment as an adjuvant therapy. Randomized clinical study was performed on 18 patients at the Clinic of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences. In this study the Halgvs valgus angle (HVA) between the metatarsals (IMA) and cartilage distal metatarsal angle (DMAA) and pain were assessed before and after injection. Average of Hallux Valgus angle before and after Botox injections were 28/89 ± 10/21 and 21/56 ± 8/22 degrees and the angle deviation in the 6 months after treatment was significantly improved (p <0.001). Injection of botulinum toxin A is a suitable and acceptable method to reform the skeleton deformities and also to reduce the pain in patients with Hallux valgus.

Keywords: metatasal, hallux valgus, pain, botulinum toxuin

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Authors: Yaser Kazemzadeh, Keyvan Molanoruzy, Mojtaba Izady

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The balance is the key component of motor skills to maintain postural control and the execution of complex skills. The present study was designed to evaluate the impact of soft knee pads on static and dynamic balance of male athletes. For this aim, thirty young athletes in different sport fields with 3 years professional sport training background and thirty healthy young men nonathletic (age: 24.5 ± 2.9, 24.3 ± 2.4, weight: 77.2 ± 4.3 and 80/9 ± 6/3 and height: 175 ± 2/84, 172 ± 5/44 respectively) as subjects selected. Then, subjects in two manner (without knee and with soft knee pads made of neoprene) execute standard error test (BESS) to assess static balance and star test to assess dynamic balance. For analyze of data, t-tests and one-way ANOVA were significant 05/0 ≥ α statistical analysis. The results showed that the use of soft knee significantly reduced error rate in static balance test (p ≥ 0/05). Also, use a soft knee pads decreased score of athlete group and increased score of nonathletic group in star test (p ≥ 0/05). These findings, indicates that use of knees affects static and dynamic balance in athletes and nonathletic in different manner and may increased athletic performance in sports that rely on static balance and decreased performance in sports that rely on dynamic balance.

Keywords: static balance, dynamic balance, soft knee, athletic men, non athletic men

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Authors: Ahmed Fawzy, Khaled Ayad, Gh. M. Koura, W. Reda

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The excessive frontal plane motion of the lower extremity during sports activities is thought to be a contributing factor to many traumatic and overuse injuries of the knee joint, little is known about the biomechanical factors that contribute to this loading pattern. Objectives: The purpose of this study was to investigate if there is a relationship between hip external rotators isometric strength and the value of frontal plane projection angle (FPPA) during single leg landing tasks in normal male subjects. Methods: One hundred (male) subjects free from lower extremity injuries for at least six months ago participated in this study. Their mean age was (23.25 ± 2.88) years, mean weight was (74.76 ± 13.54) (Kg), mean height was (174.23 ± 6.56) (Cm). The knee frontal plane projection angle was measured by digital video camera using single leg landing task. Hip external rotators isometric strength were assessed by portable hand held dynamometer. Muscle strength had been normalized to the body weight to obtain more accurate measurements. Results: The results demonstrated that there was no significant relationship between hip external rotators isometric strength and the value of FPPA during single leg landing tasks in normal male subjects. Conclusion: It can be concluded that there is no relationship between hip external rotators isometric strength and the value of FPPA during functional activities in normal male subjects.

Keywords: 2-dimensional motion analysis, hip strength, kinematics, knee injuries

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Authors: Geum Yeon Sim, Tyler Pigott, Julio Vasquez

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A 38-year-old obese female with no apparent past medical history presented with left knee pain. Six months ago, she sustained a left knee dislocation in a motor vehicle accident that was managed with a skin graft over the left lower extremity without any reconstructive surgery. She developed persistent pain and stiffness in her left knee that worsened with walking and stair climbing. Examination revealed healed extensive skin graft over the left lower extremity, including the left knee. Palpation showed moderate tenderness along the superior border of the patella, exquisite tenderness over MCL, and mild tenderness on the tibial tuberosity. There was normal sensation, reflexes, and strength in her lower extremities. There was limited active and passive range of motion of her left knee during flexion. There was instability noted upon the valgus stress test of the left knee. Left knee magnetic resonance imaging showed high-grade (grade 2-3) injury of the proximal superficial fibers of the MCL and diffuse thickening and signal abnormality of the cruciate ligaments, as well as edema-like subchondral marrow signal change in the anterolateral aspect of the lateral femoral condyle weight-bearing surface. There was also notable extensive scarring and edema of the skin, subcutaneous soft tissues, and musculature surrounding the knee. The patient was managed with left knee immobilization for five months, which was complicated by limited knee flexion. Physical therapy consisting of quadriceps, hamstrings, gastrocnemius stretching and strengthening, range of motion exercises, scar/soft tissue mobilization, and gait training was given with marked improvement in pain and range of motion. The patient experienced a further reduction in pain as well as an improvement in function with home exercises consisting of continued strengthening and stretching.

Keywords: ligamentous injury, trauma, rehabilitation, knee pain

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Authors: Masoumeh Shojaei, Natalie Gedayloo, Amir Sarshin

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The purpose of the present study was to investigate the effect of Isokinetic fatigue of muscles around the ankle, knee, and hip on the indicators of dynamic postural stability. Therefore, 15 female university students (age 19.7± 0.6 years old, weight 54.6± 9.4 kg, and height 163.9± 5.6 cm) participated in within-subjects design for 5 different days. In the first session, the postural stability indices (time to stabilization after jump-landing) without fatigue were assessed by force plate and in each next sessions, one of muscle groups of the lower limb including the muscles around ankles, knees, and hip was randomly exhausted by Biodex Isokinetic dynamometer and the indices were assessed immediately after the fatigue of each muscle group. The method involved landing on a force plate from a dynamic state, and transitioning balance into a static state. Results of ANOVA with repeated measures indicated that there was no significant difference between the time to stabilization (TTS) before and after Isokinetic fatigue of the muscles around the ankle, knee and hip in medial – lateral direction (p > 0.05), but in the anterior – posterior (AP) direction, the difference was statistically significant (p < 0.05). Least Significant Difference (LSD) post hoc test results also showed that there was significant difference between TTS in knee and hip muscles before and after isokinetic fatigue in AP direction. In the other hand knee and hip muscles group were affected by isokinetic fatigue only in AP surface (p < 0.05).

Keywords: dynamic balance, fatigue, lower limb muscles, postural control

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Authors: Jobin Varghese, V. M. Akhil, P. K. Rajendrakumar, K. S. Sivanandan

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The major contributor to the human locomotion is the knee flexion and extension. During heel strike, a huge amount of energy is transmitted through the leg towards knee joint, which in fact is damped at heel and leg muscles. During high shocks, although it is damped to a certain extent, the balance force transmits towards knee joint which could damage the knee. Due to the vital function of the knee joint, it should be protected against damage due to additional load acting on it. This work concentrates on the development of spring mass damper system which exactly replicates the stiffness at the heel and muscles and the objective function is optimized to minimize the force acting at the knee joint. Further, the data collected using force plate are put into the model to verify its integrity and are found to be in good agreement.

Keywords: spring, mass, damper, knee joint

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Authors: Renee Moten

Abstract:

Introduction: Knee pain becomes chronic because the therapy used focuses only on the symptoms of knee pain and not the causes of knee pain. Preventing knee injuries is not in the toolbox of the traditional practitioner. This research was done to show that we must reduce the inflammation (holistically), reduce the swelling and regain flexibility before considering any type of exercise. This method of performing the correct exercise stops the bowing of the knee, corrects the walking gait, and starts to relieve knee, hip, back, and shoulder pain. Method: The holistic method that is used to heal knees is called the Knee Pain Recipe. It’s a six step system that only uses alternative medicine methods to reduce, relieve and restore knee joint mobility. The system is low cost, with no hospital bills, no physical therapy, and no painkillers that can cause damage to the kidneys and liver. This method has been tested on 200 women with knee, back, hip, and shoulder pain. Results: All 200 women reduce their knee pain by 50%, some by as much as 90%. Learning about ankle and foot flexibility, along with understanding the kinetic chain, helps improve the walking gait, which takes the pressure off the knee, hip and back. The knee pain recipe also has helped to reduce the need for a cortisone injection, stem cell procedures, to take painkillers, and surgeries. What has also been noted in the research was that if the women's knees were too far gone, the Knee Pain Recipe helped prepare the women for knee replacement surgery. Conclusion: It is believed that the Knee Pain Recipe, when performed by men and women from around the world, will give them a holistic alternative to drugs, injections, and surgeries.

Keywords: knee, surgery, healing, holistic

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Authors: Pengfan Wu, Xiaoan Chen, Ye He, Tianchi Chen

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This paper introduces the design of an unpowered knee exoskeleton to assist human walking by redistributing the moment of the knee joint during stair descent (SD). Considering the knee moment varying with the knee joint angle and the work of the knee joint is all negative, the custom-built spring was used to convert negative work into the potential energy of the spring during flexion, and the obtained energy work as assistance during extension to reduce the consumption of lower limb muscles. The human-machine adaptability problem was left by traditional rigid wearable due to the knee involves sliding and rotating without a fixed-axis rotation, and this paper designed the two-direction grooves to follow the human-knee kinematics, and the wire spring provides a certain resistance to the pin in the groove to prevent extra degrees of freedom. The experiment was performed on a normal stair by healthy young wearing the device on both legs with the surface electromyography recorded. The results show that the quadriceps (knee extensor) were reduced significantly.

Keywords: unpowered exoskeleton, stair descent, knee compliant joint, energy redistribution

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Authors: K. Zehouani, I. Oldal

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Purpose: In the human knee joint, degenerative joint disease may happen with time. The standard treatment of this disease is the total knee replacement through prosthesis implanting. The reason lies in the fact that this phenomenon causes different material abrasion as compare to pure sliding or rolling alone. This study focuses on developing a knee prosthesis geometry, which fulfills the mechanical and kinematical requirements. Method: The MSC ADAMS program is used to describe the rotation of the human knee joint as a function of flexion, and to investigate how the flexion and rotation movement changes between the condyles of a multi-body model of the knee prosthesis as a function of flexion angle (in the functional arc of the knee (20-120º)). Moreover, the multi-body model with identical boundary conditions is constituted, and the numerical simulations are carried out using the MSC ADAMS program system. Results: It is concluded that the use of the multi-body model reduces time and cost since it does not need to manufacture the tibia and the femur as it requires for the knee prosthesis of the test machine. Moreover, without measuring or by dispensing with a test machine for the knee prosthesis geometry, approximation of the results of our model to a human knee is carried out directly. Conclusion: The pattern obtained by the multi-body model provides an insight for future experimental tests related to the rotation and flexion of the knee joint concerning the actual average and friction load.

Keywords: biomechanics, knee joint, rotation, flexion, kinematics, MSC ADAMS

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Authors: Alexander Hendricks, Sean Nevin, Clayton Wikoff, Melissa Dougherty, Jacob Orlita, Rafiqul Noorani

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Knee orthotics play an important role in aiding in the recovery of those with knee injuries, especially athletes. However, structural knee orthotics is often very expensive, ranging between $300 and $800. The primary reason for this project was to answer the question: can 3D printed orthotics represent a viable and cost-effective alternative to present structural knee orthotics? The primary objective for this research project was to design a knee orthotic for athletes with knee injuries for a low-cost under $100 and evaluate its effectiveness. The initial design for the orthotic was done in SolidWorks, a computer-aided design (CAD) software available at Loyola Marymount University. After this design was completed, finite element analysis (FEA) was utilized to understand how normal stresses placed upon the knee affected the orthotic. The knee orthotic was then adjusted and redesigned to meet a specified factor-of-safety of 3.25 based on the data gathered during FEA and literature sources. Once the FEA was completed and the orthotic was redesigned based from the data gathered, the next step was to move on to 3D-printing the first design of the knee brace. Subsequently, physical therapy movement trials were used to evaluate physical performance. Using the data from these movement trials, the CAD design of the brace was refined to accommodate the design requirements. The final goal of this research means to explore the possibility of replacing high-cost, outsourced knee orthotics with a readily available low-cost alternative.

Keywords: 3D printing, knee orthotics, finite element analysis, design for additive manufacturing

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Authors: Bergun Meric Bingul, Yezdan Cinel, Murat Son, Cigdem Bulgan, Mensure Aydin

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The aim of this study was to determination of the effects of knee and hip isokinetic performance during the training with the special designed roller-shoes. 30 soccer players participated as subjects and these subjects were divided into 3 groups randomly. Training groups were; with the dynamic training shoes group, without the dynamic training shoes group and control group. Subjects were trained speed strength trainings during 8 weeks (3 days a week and 1 hour a day). 6 exercises were focused on the knee flexors and extensors, also hip adductor and abductor muscles were chosen and performed in 3x30secs at each sets. Control group was not paticipated to the training program. Before and after the training programs knee flexor and extensor muscles and hip abductor and adductor muscles’ peak torques were measured by Biodex III isokinetic dynamometer. Isokinetic strength data were analyzed by using SPSS program. A repeated measures analysis of variance (ANOVA) was used to determine differences among the peak torque values for three groups. The results indicated that soccer players’ peak torque values that the group of using the dynamic training shoes, were found higher. Also, hip adductor and abductor peak torques that the group of using the dynamic training shoes, were obtained better than the other groups. In conclusion, the ground friction forces are an important role of increasing strength. With these shoes, using rollers, soccer players were able to move easily because of the friction forces were reduced and created more range of motion. So, exercises were performed faster than before and strength movements in all angles, it ensured that the active state. This was resulted in a better use of force.

Keywords: isokinetic, soccer, dynamic training shoes, training

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Authors: N. Zhang, J. S. Kuang, S. Mogili

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To investigate seismic performance of beam-column knee joints, four full-scale reinforced concrete beam-column knee joints, which were fabricated to simulate those in as-built RC frame buildings designed to ACI 318-14 and ACI-ASCE 352R-02, were tested under reversed cyclic loading. In the experimental programme, particular emphasis was given to the effect of horizontal reinforcement (in format of inverted U-shape bars) on the shear strength and ductility capacity of knee joints. Test results are compared with those predicted by four seismic design codes, including ACI 318-14, EC8, NZS3101 and GB50010. It is seen that the current design codes of practice cannot accurately predict the shear strength of seismically designed knee joints.

Keywords: large-scale tests, RC beam-column knee joints, seismic performance, shear strength

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Authors: Mariam A. Abu-Alim

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The purpose of this study was to validate muscle activation amplitudes of two field base dynamic balance tests that are used as strengthen and motor control exercises too in the activation of selected hip and knee stabilizer muscles. Methods: Eighteen college-age females students (21±2 years; 65.6± 8.7 kg; 169.7±8.1 cm) who participated at least for 30 minutes in physical activity most days of the week volunteered. The wireless BIOPAC (MP150, BIOPAC System. Inc, California, USA) surface electromyography system was used to validate the activation of the Gluteus Medius and the Adductor Magnus of hip stabilizer muscles; and the Hamstrings, Quadriceps, and the Gastrocnemius of the knee stabilizer muscles. Surface electrodes (EL 503, BIOPAC, System. Inc) connected to dual wireless EMG BioNormadix Transmitters were place on selected muscles of participants dominate side. Manual muscle testing was performed to obtain the maximal voluntary isometric contraction (MVIC) in which all collected muscle activity data during the three reaching direction: anterior, posteromedial, posterolateral of the Star Excursion Balance Test (SEBT) and the Y-balance Test (YBT) data could be normalized. All participants performed three trials for each reaching direction of the SEBT and the YBT. The domanial leg trial for each participant was selected for analysis which was also the standing leg. Results: the selected hip stabilizer muscles (Gluteus Medius, Adductor Magnus) were both greater than 100%MVIC during the performance of the SEBT and in all three directions. Whereas, selected knee stabilizer muscles had greater activation 0f 100% MVIC and were significantly more activated during the performance of the YBT test in all three reaching directions. The results showed that the posterolateral and the postmedial reaching directions for both dynamic balance tests had greater activation levels and greater than 200%MVIC for all tested muscles expect of the hamstrings. Conclusion: the results of this study showed that the SEBT and the YBT had validated high levels of muscular activity for the hip and the knee stabilizer muscles; which can be used to represent the improvement, strength, control and the decreasing in the injury levels. Since these selected hip and knee stabilizer muscles, represent 35% of all athletic injuries depending on the type of sport.

Keywords: dynamic balance tests, electromyography, hip stabilizer muscles, nee stabilizer muscles

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Authors: Raouf Mbarki, Fadi Al Khatib, Malek Adouni

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Knee collateral ligaments play a significant role in restraining excessive frontal motion (varus/valgus rotations). In this investigation, a multiscale frame was developed based on structural hierarchies of the collateral ligaments starting from the bottom (tropocollagen molecule) to up where the fibred reinforced structure established. Experimental data of failure tensile test were considered as the principal driver of the developed model. This model was calibrated statistically using Bayesian calibration due to the high number of unknown parameters. Then the model is scaled up to fit the real structure of the collateral ligaments and simulated under realistic boundary conditions. Predications have been successful in describing the observed transient response of the collateral ligaments during tensile test under pre- and post-damage loading conditions. Collateral ligaments maximum stresses and strengths were observed near to the femoral insertions, a results that is in good agreement with experimental investigations. Also for the first time, damage initiation and propagation were documented with this model as a function of the cross-link density between tropocollagen molecules.

Keywords: multiscale model, tropocollagen, fibrils, ligaments commas

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Authors: G. Espriú-Pérez, F. A. Vargas-Oviedo, I. Zenteno-Aguirrezábal, M. D. Moya-Bencomo

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One of the injuries with a higher incidence among university-level athletes in the North of Mexico is presented in the knee. This injury generates absenteeism in training and competitions for at least 8 weeks. There is no active quantitative methodology, or protocol, that directly contributes to the clinical evaluation performed by the medical personnel at the prevalence of knee injuries. The main objective is to contribute with a quantitative tool that allows further development of preventive and corrective measures to these injuries. The study analyzed 55 athletes for 6 weeks, belonging to the disciplines of basketball, volleyball, soccer and swimming. Using a motion capture system (Nexus®, Vicon®), a three-dimensional analysis was developed that allows the measurement of the range of movement of the joint. To focus on the performance of the lower limb, eleven different movements were chosen from the Functional Performance Test, Functional Movement Screen, and the Cincinnati Jump Test. The research identifies the profile of the natural movement of a healthy knee, with the use of medical guidance, and its differences between each sport. The data recovered by the single-leg crossover hop managed to differentiate the type of knee movement among athletes. A maximum difference of 60° of offset was found in the adduction movement between male and female athletes of the same discipline. The research also seeks to serve as a guideline for the implementation of protocols that help identify the recovery level of such injuries.

Keywords: Cincinnati jump test, functional movement screen, functional performance test, knee, motion capture system

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Authors: C. Copilusi, C. Ploscaru

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This paper addresses attention to a research regarding the design of a knee orthosis in a modular form used on children walking rehabilitation. This research is focused on the human lower limb kinematic analysis which will be used as input data on virtual simulations and prototype validation. From this analysis, important data will be obtained and used as input for virtual simulations of the knee modular orthosis. Thus, a knee orthosis concept was obtained and validated through virtual simulations by using MSC Adams software. Based on the obtained results, the modular orthosis prototype will be manufactured and presented in this article.

Keywords: human lower limb, children orthoses, kinematic analysis, knee orthosis

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Authors: Ali H.Alyami, Hussam Darraj, Faisal Hakami, Mohammed Awaf, Sulaiman Hamdi, Nawaf Bakri, Abdulaziz Saber, Khalid Hakami, Almuhanad Alyami, Mohammed khashab

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Introduction: Adolescents frequently self-report pain, according to epidemiological research. The knee is one of the sites where the pain is most common. One of the main factors contributing to the number of years people spend disabled and having substantial personal, societal, and economic burdens globally are musculoskeletal disorders. Adolescents may have knee pain due to an abrupt, traumatic injury or an insidious, slowly building onset that neither the adolescent nor the parent is aware of. Objectives: The present study’s authors aimed to estimate the prevalence of knee pain in Saudi adolescents. Methods: This cross-sectional survey, carried out from June to November 2022, included 676 adolescents ages 10 to 18. Data are presented as frequencies and percentages for categorical variables. Analysis of variance (ANOVA) was used to compare means between groups, while the chi-square test was used for the comparison of categorical variables. Statistical significance was set at P< 0.05.Result: Adolescents were invited to take part in the study. 57.5% were girls, and 42.5% were males,68.8% were 676 aged between 15 and 18. The prevalence of knee pain was considerably high among females (26%), while it was 19.2% among males. Moreover, age was a significant predictor for knee pain; also BMI was significant for knee pain. Conclusion: Our study noted a high rate of knee pain among adolescents, so we need to raise awareness about risk factors. Adolescent knee pain can be prevented with conservative methods and some minor lifestyle/activity modifications.

Keywords: knee pain, prevalence of knee pain, exercise training, physical activity

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Authors: Nasir Mustafa

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One of the prerequisites required for an efficient diagnosis in a medical practice is to have a strong command of both functional and clinical anatomy. In this study, we introduce a new collaborative approach to the effective teaching of the knee and hip joints. In the present teaching model, anatomists, orthopedists and physical therapists present the anatomy of the hip and knee joints in small groups. Courses for the hip and knee joints were scheduled during the early stages of the medical curriculum. Students of nursing and physical therapy were grouped together to sensitize to the importance of a collaborative effort. The study results clearly demonstrate that nursing students and physical therapy students appreciated this teaching approach. The collaborative approach further proved to be a suitable method to teach both functional and clinical anatomy of the hip and knee joints. Aside from this training, a collaborative approach between medical students and physical therapy students was also successful for a healthcare organization.

Keywords: hip and knee joint anatomy, collaborative, Anatomy teaching, Nursing students, Physiotherapy students

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Authors: Ahmed R. Z. Baghdadi,  Mona H. Gamal Eldein

Abstract:

Background: With the perceived pain and poor function experienced following knee arthroplasty, patients usually feel unsatisfied. Yet, a controversy still persists on the appropriate operative technique that doesn’t affect proprioception much. Purpose: This study compared the effects of Cruciate Retaining (CR) and Posterior Stabilized (PS) total knee arthroplasty (TKA on dynamic balance, pain and functional performance following rehabilitation. Methods: Thirty patients with CRTKA (group I), thirty with PSTKA (group II) and fifteen indicated for arthroplasty but weren’t operated on yet (group III) participated in the study. The mean age was 54.53±3.44, 55.13±3.48 and 55.33±2.32 years and BMI 35.7±3.03, 35.7±1.99 and 35.73±1.03 kg/m2 for group I, II, and III respectively. The Berg Balance Scale (BBS), WOMAC pain subscale and Timed-Up-and-Go (TUG) and Stair-Climbing (SC) tests were used for assessment. Assessments were conducted four weeks pre- and post-operatively, three, six and twelve months post-operatively with the control group being assessed at the same time intervals. The post-operative rehabilitation involved hospitalization (1st week), home-based (2nd-4th weeks), and outpatient clinic (5th-12th weeks) programs, follow-up to all groups for twelve months. Results: The Mixed design MANOVA revealed that group I had significantly lower pain scores and SC time compared with group II three, six and twelve months post-operatively. Moreover, the BBS scores increased significantly and the pain scores and TUG and SC time decreased significantly six months post-operatively compared with four weeks pre- and post-operatively and three months post-operatively in group I and II with the opposite being true four weeks post-operatively. But no significant differences in BBS scores, pain scores and TUG and SC time between six and twelve months post-operatively in group I and II. Interpretation/Conclusion: CRTKA is preferable to PSTKA, possibly due to the preserved human proprioceptors in the un-excised PCL.

Keywords: dynamic balance, functional performance, knee arthroplasty, long-term

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Authors: Eman Ahmed Ahmed, Ghada Abdelmoneim Mohamed, Hamada Ahmed Hamada, Nagui Sobhi Nassif

Abstract:

Impaired skeletal muscle endurance may be an important causal factor in the development of patellofemoral pain syndrome (PFPS). However, there is lack of information regarding the effect of hip versus knee muscle fatigue on isokinetic parameters, and myoelectric activity of hip and knee muscles in these patients. Purpose: The study was conducted to investigate the effect of hip abductors versus knee extensors fatigue protocol on knee proprioception, hip and knee muscle strength and their myoelectric activity in patients with PFPS. Methods: Fifteen female patients with PFPS participated in the study. They were tested randomly under two fatiguing conditions; hip abductors and knee extensors fatigue protocols. Isolated muscle fatigue of two muscles was induced isokinetically on the affected side in a two separate sessions with a rest interval of at least three days. After determining peak torque, patients performed continuous maximal concentric-eccentric contraction of the selected muscle until the torque output dropped below 50% of peak torque value for 3 consecutive repetitions. Knee proprioception, eccentric hip abductors' peak torque, eccentric knee extensors' peak torque, EMG ratio of vastus medialis obliquus (VMO) / vastus lateralis (VL), and EMG activity of gluteus medius (GM) muscle, were recorded before and immediately after each fatigue protocol using the Biodex Isokinetic system and EMG Myosystem. Results: Two-way within subject MANOVA revealed that eccentric knee extensors’ peak torque decreased significantly after hip abductors fatigue protocol compared to pre fatigue condition (p<0.05). On the other hand, there was no statistically significant difference in the eccentric hip abductors’ peak torque after admitting knee extensors fatigue protocol (p > 0.05). Moreover, no significant difference was found in knee proprioception, EMG ratio of VMO/VL, and EMG activity of GM muscle, after either hip or knee fatigue protocol (p>0.05). Conclusion: A hip focused rehabilitation program may be beneficial in improving knee function through correcting faulty kinematics and hence decrease knee loading in patients with PFPS.

Keywords: electromyography, knee proprioception, mechanical responses, muscle fatigue, patellofemoral pain syndrome

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Authors: Basuki Supartono, Nunuk Nugrohowati, Ryan Gamma Andiraldi

Abstract:

Osteoarthritis of the knee can occur due to scoliosis. The purpose of this study is to determine the effect of scoliosis cause secondary osteoarthritis on the knee. This research use an analytic cross-sectional design. The total sample of 92 athletes scoliosis taken by simple random sampling technique. The data obtained were analyzing with Chi-square test, Fisher and Prevalence Ratio. The results of analysis show that there are influences on the incidence of scoliosis secondary osteoarthritis on the knee in athletes at the National Sports Hospital. Based on the criteria in the Cobbs angle had the results (p = 0.022 (p <0.05)), moderate Cobbs angle degree were 7.5 times more at risk of causing secondary osteoarthritis on the knee than a mild degree. While the shape of the curve scoliosis is getting results (p = 0.038 (p <0.05)), the shape of the S curve scoliosis 3.2 times more at risk of causing secondary osteoarthritis on the knee than the curve C. It can be concluded that there is significant influence between the Cobbs angle, shape of the curve scoliosis on the incidence of secondary osteoarthritis on the knee in National Sports Cibubur Hospital on July 2013- April 2014

Keywords: Cobbs angle, curve shape scoliosis, secondary osteoarthritis on the knee, analytic cross-sectional design

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Authors: Pabitra Sahu, M. Manohari, S. Priyadharshini, R. Santhanam, S. Chandrasekaran, B. Venkatraman

Abstract:

Radiation workers of reprocessing plants have a potential for internal exposure due to actinides and fission products. Radionuclides like Americium, lead, Polonium and Europium are bone seekers and get accumulated in the skeletal part. As the major skeletal content is in the skull (13%) and knee (22%), measurements of old intake have to be carried out in the skull and knee. At the Indira Gandhi Centre for Atomic Research, a twin HPGe-based actinide monitor is used for the measurement of actinides present in bone. Efficiency estimation, which is one of the prerequisites for the quantification of radionuclides, requires anthropomorphic phantoms. Such phantoms are very limited. Hence, in this study, efficiency curves for a Twin HPGe-based actinide monitoring system are established theoretically using the FLUKA Monte Carlo method and ICRP adult male voxel phantom. In the case of skull measurement, the detector is placed over the forehead, and for knee measurement, one detector is placed over each knee. The efficiency values of radionuclides present in the knee and skull vary from 3.72E-04 to 4.19E-04 CPS/photon and 5.22E-04 to 7.07E-04 CPS/photon, respectively, for the energy range 17 to 3000keV. The efficiency curves for the measurement are established, and it is found that initially, the efficiency value increases up to 100 keV and then starts decreasing. It is found that the skull efficiency values are 4% to 63% higher than that of the knee, depending on the energy for all the energies except 17.74 keV. The reason is the closeness of the detector to the skull compared to the knee. But for 17.74 keV the efficiency of the knee is more than the skull due to the higher attenuation caused in the skull bones because of its greater thickness. The Minimum Detectable Activity (MDA) for 241Am present in the skull and knee is 9 Bq. 239Pu has a MDA of 950 Bq and 1270 Bq for knee and skull, respectively, for a counting time of 1800 sec. This paper discusses the simulation method and the results obtained in the study.

Keywords: FLUKA Monte Carlo Method, ICRP adult male voxel phantom, knee, Skull.

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Authors: Che Hsiu Chen, Kuo Wei Tseng, Zih Jian Huang, Hon Wen Cheng

Abstract:

A typical warm-up contains both stretching exercises and jogging. The static stretching prior to training or competition may cause detrimental effects to athletic performance. However, it is unclear whether different types of dynamic stretching exercises had different acute effects on knee flexors stiffness, flexibility, and strength. The purpose of this study was to analyze the knee flexors stiffness, flexibility, and strength gains after dynamic straight leg raise (DSLR) and dynamic modified toe-touch (MTT) stretching. Sixteen healthy university active men (height 176.27 ± 4.03 cm; weight 72.27 ± 8.90 kg; age 22.09 ± 2.31 years). After 5 minutes (8km/h) of running subjects performed 2 randomly ordered stretching protocols: DSLR and MTT stretching protocols. There were a total of six, 30 seconds bouts of dynamic stretching (15 repetitions) with 30seconds rest between bouts. The outcome measures were maximal voluntary isokinetic concentric hamstring strength (60°/s), muscle flexibility test by passive straight leg raise (PSLR), active straight leg raise (ASLR), and muscle stiffness using ultrasound Acoustic Radiation Forced Impulse (ARFI) elastography before and immediately after stretching. The muscle stiffness and concentric strength decreased significantly (p < .05), the flexibility no significant change after DSLR protocol (p > .05). The concentric strength decreased significantly (p < .05), the flexibility and muscle stiffness no significant change after MTT protocol (p > .05), whereas no significant differences were found for the DSLR and MTT. Our findings suggest that dynamic stretching (30s x 6 bouts) resulted in change in muscle stiffness or may be induced slack in the musculotendinous unit thereby, reducing force production. Therefore, 30s x 6 bouts of dynamic stretching adversely affects efforts of hamstring muscle maximal concentric strength.

Keywords: sport injury, ultrasound, eccentric exercise, performance

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Authors: Parya Salimitari, Farhad Tabatabai Ghomsheh, Siyamak Khorramymehr, Hossein Taghadosi, Mohammad Hossein Dashti

Abstract:

The aim of this study was to evaluate the effect of heel height on the knee joint direction in Genu recurvatum patients compared to normal state. The test was performed on a patient with Genu recurvatum and a healthy person with similar and match biomechanical conditions. Subjects were tested under six different positions of shoes with heels 0, 1, 2, 3, 4 and 5 cm after marking during the gate. The results of the spatial temporal geometry obtained from Vicon Motion System (six-camera T10 model, Oxford Metrics Ltd., Oxford, UK), and were used to compute and analyze the kinematic results. In this study, we tried to determine the effect of shoe heel intervention on knee joint direction correction. The results indicate that the 1 cm heel has been optimized and significantly improved in knee joint flexion and flexion-extension angle so that the difference in knee flexion-extension angle between the patient and the healthy person at some stages of walking has reached zero (good posture). The 3 cm heel compared with the 0 cm heel has reduced the knee recurvatum index (KRI) by up to 21.74% in the patient (from 219.233 mm to 47.6714 mm). According to the findings of this study, it can be concluded that heel increase is effective in correcting knee joints in Genu recurvatum and the optimum heel height is 1 cm.

Keywords: joint alignment of knee, gait analysis, genu recurvatum, heel lift, kinematics, motion-analysis

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Authors: Nabil A. A. Mohamed, Alaa A. A. Balbaa, Khaled E. Ayad

Abstract:

Osteoarthritis (OA) of the knee is the most common form of arthritis and leads to more activity limitations (e.g., disability in walking and stair climbing) than any other disease, especially in the elderly. Recently, impaired proprioceptive accuracy of the knee has been proposed as a local factor in the onset and progression of radiographic knee OA (ROA). Purpose: To compare the clinical and radiological findings in healthy with that of knee OA. Also, to determine if there is a correlation between the clinical and radiological findings in patients with knee OA. Subjects: Fifty one patients diagnosed as unilateral or bilateral knee OA with age ranged between 35-70 years, from both gender without any previous history of knee trauma or surgery, and twenty one normal subjects with age ranged from 35 - 68 years. METHODS: peak torque/body weight (PT/BW) was recorded from knee extensors at isokinetic isometric mode at angle of 45 degree. Also, the Absolute Angular Error was recorded at 45O and 30O to measure joint position sense (JPS). They made anteroposterior (AP) plain X-rays from standing semiflexed knee position and their average score of Timed Up and Go test(TUG) and WOMAC were recorded as a measure of knee pain, stiffness and function. Comparison between the mean values of different variables in the two groups was performed using unpaired student t test. The P value less or equal to 0.05 was considered significant. Results: There were significant differences between the studied variables between the experimental and control groups except the values of AAE at 30O. Also, there were no significant correlation between the clinical findings (pain, function, muscle strength and proprioception) and the severity of arthritic changes in X-rays. CONCLUSION: From the finding of the current study we can conclude that there were a significant difference between the both groups in all studied parameters (the WOMAC, functional level, quadriceps muscle strength and the joint proprioception). Also this study did not support the dependency on radiological findings in management of knee OA as the radiological features did not necessarily indicate the level of structural damage of patients with knee OA and we should consider the clinical features in our treatment plan.

Keywords: joint position sense, peak torque, proprioception, radiological knee osteoarthritis

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Authors: O. Casasayas, M. Vigo, R. Navarro, P. Ragazzi, P. Alvarez, A. Perez-Bellmunt

Abstract:

Introduction: The blood flow restriction training (BFR) is a method of muscle training that allows increasing the stress of muscle tissue to enhance the muscle cross-section and strength. This type of training has clear benefits in the rehabilitation field since it can improve muscle strength using low mechanical loads. The aim of this study is to know in which knee pathologies BFR has been used, what methodology was used and what were the obtained results. Study design: We performed a systematic literature search using strategies for the concepts of “blood flow restriction OR blood flow restriction training AND knee” in Medline. Articles were screened by authors and included if they used the blood flow restriction training in pathology of the knee. Results: The pathology more frequently treated by BFR was knee osteoarthritis and the variables most analyzed were strength and pain. The vascular occlusion used was 80% in the major part of studies. The groups of BFR obtained an increase of strength with less pain but not always the results are statistically significant. The evidence levels are poor in the high number of studies because in some cases there is not a control group or the evaluators were not blinded. Conclusion: The use of BFR is useful to improve muscle strength in knee pathology since it does not increase the pain, but more studies are needed to see (comprehend) if this type of treatment obtains better results than a conventional therapy. No studies have been found that compare the different occlusion effects in both the strength improvement and the pain reduction. Neither studies that analyse the effects of BFR on the muscle contractile parameters have been found.

Keywords: blood flow restriction training, knee, arthroscopy knee, physical therapy

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