Search results for: knee rehabilitation

Authors: Rakkrit Duangsoithong, Jermphiphut Jaruenpunyasak, Alba Garcia

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The use of foot recognition can be applied in many medical fields such as the gait pattern analysis and the knee exercises of patients in rehabilitation. Generally, a camera-based foot recognition system is intended to capture a patient image in a controlled room and background to recognize the foot in the limited views. However, this system can be inconvenient to monitor the knee exercises at home. In order to overcome these problems, this paper proposes to use the deep learning method using Convolutional Neural Networks (CNNs) for foot recognition. The results are compared with the traditional classification method using LBP and HOG features with kNN and SVM classifiers. According to the results, deep learning method provides better accuracy but with higher complexity to recognize the foot images from online databases than the traditional classification method.

Keywords: foot recognition, deep learning, knee rehabilitation, convolutional neural network

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Authors: Jing Fang, Yao Cui, Mingming Wang, Shengli She, Jianping Yuan

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Wearable robotics is a potential solution in aiding gait rehabilitation of lower limbs dyskinesia patients, such as knee osteoarthritis or stroke afflicted patients. Many wearable robots have been developed in the form of rigid exoskeletons, but their bulk devices, high cost and control complexity hinder their popularity in the field of gait rehabilitation. Thus, the development of a portable, compliant and low-cost wearable robot for gait rehabilitation is necessary. Inspired by Chinese traditional folding fans and balloon inflators, the authors present an inflatable, foldable and variable stiffness knee exosuit (IFVSKE) in this paper. The pneumatic actuator of IFVSKE was fabricated in the shape of folding fans by using thermoplastic polyurethane (TPU) fabric materials. The geometric and mechanical properties of IFVSKE were characterized with experimental methods. To assist the knee joint smartly, an intelligent control profile for IFVSKE was proposed based on the concept of full-cycle energy management of the biomechanical energy during human movement. The biomechanical energy of knee joints in a walking gait cycle of patients could be collected and released to assist the joint motion just by adjusting the inner pressure of IFVSKE. Finally, a healthy subject was involved to walk with and without the IFVSKE to evaluate the assisting effects.

Keywords: biomechanical energy management, knee exosuit, gait rehabilitation, wearable robotics

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Authors: Pedro Ferraz-Gameiro

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Introduction: The Pellegrini-Stieda lesion is the result of post-traumatic calcification and/or ossification on the medial collateral ligament (MCL) of the knee. When this calcification is accompanied by gonalgia and limitation of knee flexion, it is called Pellegrini-Stieda syndrome. The pathogenesis is probably the calcification of a post-traumatic hematoma at least three weeks after the initial trauma or secondary to repetitive microtrauma. On anteroposterior radiographs, a Pellegrini-Stieda lesion is a linear vertical ossification or calcification of the proximal portion of the MCL and usually near the medial femoral condyle. Patients with Pellegrini-Stieda syndrome present knee pain associated with loss of range of motion. The treatment is usually conservative with analgesic and anti-inflammatory drugs, either systemic or intra-articular. Physical medicine and rehabilitation techniques associated with shock wave therapy can be a way of reduction of pain/inflammation. Patients who maintain instability with significant limitation of knee mobility may require surgical excision. Methods: Research was done using PubMed central using the terms Pellegrini-Stieda syndrome. Discussion/conclusion: Medical treatment is the rule, with initial rest, anti-inflammatory, and physiotherapy. If left untreated, this ossification can potentially form a significant bone mass, which can compromise the range of motion of the knee. Physical medicine and rehabilitation techniques associated with shock wave therapy are a way of reduction of pain/inflammation.

Keywords: knee, Pellegrini-Stieda syndrome, rehabilitation, shock waves therapy

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Authors: Ahmed Torad

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Background: Knee osteoarthritis (OA) is a prevalent musculoskeletal condition characterized by pain and functional impairment. While various rehabilitation approaches have been employed, the effectiveness of high-intensity interval training (HIIT) compared to traditional rehabilitation exercises remains unclear. Objective: This randomized controlled trial aimed to compare the effects of HIIT and traditional rehabilitation exercises on pain reduction, functional improvement, and quality of life in individuals with knee OA. Methods: A total of 120 participants diagnosed with knee OA were randomly allocated into two groups: the HIIT group (n=60) and the traditional rehabilitation group (n=60). The HIIT group participated in a 12-week supervised program consisting of high-intensity interval exercises, while the traditional rehabilitation group followed a conventional physiotherapy regimen. Outcome measures included visual analog scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 Health Survey (SF-36) at baseline and after the intervention period. Results: Both groups showed significant improvements in pain scores, functional outcomes (WOMAC), and quality of life (SF-36) after 12 weeks of intervention. However, the HIIT group demonstrated superior pain reduction (p<0.001), functional improvement (p<0.001), and physical health-related quality of life (p=0.002) compared to the traditional rehabilitation group. No significant differences were observed in mental health-related quality of life between the two groups. Conclusion: High-intensity interval training appears to be a more effective rehabilitation approach than traditional exercises for individuals with knee osteoarthritis, resulting in greater pain reduction, improved function, and enhanced physical health-related quality of life. These findings suggest that HIIT may represent a promising intervention strategy for managing knee OA and enhancing the overall well-being of affected individuals.

Keywords: knee osteoarthritis, high-intensity interval training, traditional rehabilitation exercises, randomized controlled trial, pain reduction, functional improvement, quality of life

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

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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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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: B. A. Alwahaby

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Background: The number of Total Knee Replacement (TKR) and Anterior Cruciate Ligament Reconstruction (ACLR) performed every year is increasing. The main aim of physiotherapy early recovery rehabilitation after these surgeries is to control pain and edema and regain Range of Motion (ROM) and physical activity. All of these outcomes need to be managed by safe and effective modalities. Kinesiotaping (KT) is an elastic non-invasive therapeutic tape that has become recognised in different physiotherapy situation as injury prevention, rehabilitation, and performance enhancement and been used with different conditions. However, there is still clinical doubt regarding the effectiveness of KT due to inconclusive supporting evidence. The aim of this systematic review is to collate all the available evidence on the effectiveness of KT in the early rehabilitation of ACLR and TKR patients and analyse whether the use of KT combined with standard rehabilitation would facilitate recovery of postoperative outcome than standard rehabilitation alone. Methodology: A systematic review was conducted. Medline, EMBASE, Scopus, AMED PEDro, CINAHL, and Web of Science databases were searched. Each study was assessed for inclusion and methodological quality appraisal was undertaken by two reviewers using the JBI critical appraisal tools. The studies were then synthesised qualitatively due to heterogeneity between studies. Results: Five moderate to low quality RCTs were located. All five studies demonstrated statistically significant improvements in pain, swelling, ROM, and functional outcomes (p < 0.05). Between group comparison, KT combined with standardised rehabilitation were shown to be significantly more effective than standardised rehabilitation alone for pain and swelling (p < 0.05). However, there were inconstant findings for ROM, and no statistically significant differences reported between groups for functional outcomes (p > 0.05). Conclusion: Research in the area is generally low quality; however, there is consistent evidence to support the use of KT combined with standardised post-operative rehabilitation for reducing pain and swelling. There is also some evidence that KT may be effective in combination with standardised rehabilitation to regain knee extension ROM faster than standardised rehabilitation alone, but further primary research is required to confirm this.

Keywords: anterior cruciate ligament reconstruction, ACLR, kinesio taping, KT, postoperative, total knee replacement, TKR

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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: 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: 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

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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: Mina Beheshti, Vida Shams, Mojtaba Esfandiari, Farzaneh Abdollahi, Abdolreza Ohadi

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Most of the people who survive a stroke need rehabilitation tools to regain their mobility. The core function of these devices is a brake actuator. The goal of this study is to design and control a magnetorheological brake which can be used as a rehabilitation tool. In fact, the fluid used in this brake is called magnetorheological fluid or MR that properties can change by variation of the magnetic field. The braking properties can be set as control by using this feature of the fluid. In this research, different MR brake designs are first introduced in each design, and the dimensions of the brake have been determined based on the required torque for foot movement. To calculate the brake dimensions, it is assumed that the shear stress distribution in the fluid is uniform and the fluid is in its saturated state. After designing the rehabilitation brake, the mathematical model of the healthy movement of a healthy person is extracted. Due to the nonlinear nature of the system and its variability, various adaptive controllers, neural networks, and robust have been implemented to estimate the parameters and control the system. After calculating torque and control current, the best type of controller in terms of error and control current has been selected. Finally, this controller is implemented on the experimental data of the patient's movements, and the control current is calculated to achieve the desired torque and motion.

Keywords: rehabilitation, magnetorheological fluid, knee, brake, adaptive control, robust control, neural network control, torque control

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

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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: Elham Ghandali, Saeed Talebian Moghadam, Mohammad Reza Hadian, Gholamreza Olyaei, Shohreh Jalaie, Elaheh Sajjadi

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Purpose: A few studies have examined the effect of Tai Chi on balance in elderly patients with knee osteoarthritis (OA). The aim of this study was to determine the balance measures in elderly patients with knee OA after Tai Chi exercises. For this purpose, 14 females and 6 males with knee OA were chosen. The area and mean velocity of the center of pressure movements (CoP) were measured by force plate in standing positions (on foam and rigid surfaces). The measurements of area and mean velocity of CoP were performed before and after 60 min of Tai Chi sessions (twice a week for 8 weeks). Results: The results showed that the area of CoP in a standing position on a rigid surface was significantly decreased (P < 0.01) after Tai Chi exercises. Furthermore, the mean velocity of CoP was significantly decreased after Tai Chi exercises on both rigid and foam surfaces (P < 0.001). Our study also indicated that changes in surfaces (rigid and foam) would cause significant differences regarding the area of CoP in standing positions. How- ever, similar findings were not found regarding the mean velocity of CoP. Considering the effects of Tai Chi on the mean velocity of CoP, it might be concluded that motor control and Postural stability improvements have occurred. Conclusions: Therefore, based on these results, Tai Chi exercises could be recommended for elderly patients with knee OA as part of their rehabilitation and physical therapy protocols.

Keywords: Tai Chi, balance, knee osteoarthritis, elderly patients, different surfaces

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Authors: S. Daneshi, G. Shahcheraghi, F. Ghaffarinejad

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Back ground: Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people around the world during the aging process. Knee joint proprioception sense decrease with OA and Total Knee Arthroplasty (TKA) surgery may affect them. We investigated two parameters of proprioception sense (the joint position sense and kinesthesia) and standing balance in affected limbs before and after TKA, in patient with Knee OA. Methods and Materials: In this Analytic study, 10 patients who were candidate for TKA during two months in Dena Hospital of Shiraz, selected for further analysis. All of cases were female in range of 55-70 years old. Participants assessed before and two weeks after TKA using three instruments: electrogoniometer and continuous passive motion (CPM) to assess Knee joint position sense and kinesthesia in 20 and 45 degrees; and chronometer to assess duration of standing balance on affected leg with open and closed eyes. Results: To examine differences between before and after of TKA scorings Willcoxon Signed Rank and Mann-Whitney was performed which indicated no significant differences between knee joint position sense and kinesthesia in 20 and 45 degrees (P>0.05) and no significant differences between Standing Balance in a patient with knee OA before and after TKA (P>0.05). Conclusion: The study indicates that, OA can affect proprioception sense and standing balance but TKA doesn’t have any effect on these parameters. Intra articular structures such as cruciate ligaments and mines are responsible for proprioception sense in normal knee joint. Since in severe knee OA the number of mechanoreceptors in these intra articular structures decrease and their function reduce more than normal knee joint, so the anterior cruciate ligaments (ACL) become defected, thus after TKA surgery which this ligament is removed no significant change was found in proprioception sense. As a result of involving proprioception sense, muscles strength and the function of vestibular system in balance, standing balance did not show significant difference before and after TKA.

Keywords: knee joint, proprioception sense, standing balance, rehabilitation sciences

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Authors: R. Ranjith Kumar

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Computer modeling and simulation of human movement is playing an important role in sports and rehabilitation. Accurate modeling and analysis of human knee join is more complex because of complicated structure whose geometry is not easily to represent by a solid model. As part of this project, from the number of CT scan images of human knee join surface reconstruction is carried out using 3D slicer software, an open source software. From this surface reconstruction model, using mesh lab (another open source software) triangular meshes are created on reconstructed surface. This final triangular mesh model is imported to Solid Works, 3D mechanical CAD modeling software. Finally this CAD model is imported to ABAQUS, finite element analysis software for analyzing the knee joints. The results obtained are encouraging and provides an accurate way of modeling and analysis of biological parts without human intervention.

Keywords: solid works, CATIA, Pro-e, CAD

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Authors: Thuraya Ahmed Al Shidhani, Yahya Al Farsi, Alya Al Husni, Samir Al Adawi

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Background: Knee osteoarthritis (knee OA) represents a major public health burden worldwide, particularly among older adults. However, little has been documented from Arabian Gulf countries, which have left an information gap. Objective: This study describes the socio-demographic, clinical risk factors, and use of herbal medicine among men and women seeking consultation for knee OA at two secondary healthcare facilities in Muscat, Oman. Methods: A cross-sectional study was conducted among 213 Omani adults with knee OA attending a referral polyclinic in Muscat, Oman, over 12 months from January to December. Socio-demographic data were collected from the participants who are seeking consultation for knee OA. Results: Among the 213 study participants, 171 were females and 42 males. The females were comparatively older than the males, had lower education and lower-income, and more overweight. The majority of the participants were normal weight or underweight. About one-third of participants reported OA in other joints as well. Most participants recalled that they had knee OA for less than a year. About 12% reported a history of trauma. The majority (63%) concurrently had other chronic illnesses, and 33% reported having at least one complication. About 22% were using herbal medicines. About 77% are using herbal local applications in form of powder and creams. Conclusion: This study, to our knowledge, is the first to explore socio-demographic characteristics, clinical risk factors and use of herbal medicine among sufferers of knee OA in Oman. Knee OA tended to occur among our participants at younger ages than reported elsewhere, while obesity appeared orthogonal to the severity of knee OA. Women were more affected than men. About one quarter of Omani patients are using herbal medicine. More studies are needed to understand the causal factors and development of knee OA in Oman. Targeted health education and rehabilitation programs are needed, particularly among Omani women, to improve their physical quality of life.

Keywords: knee joint, osteoarthritis, herbal medicine, Oman

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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: 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: S. Alireza Mirghasemi, Javad Parvizi, Narges R. Gabaran, Shervin Rashidinia, Mahdi M. Bijanabadi, Dariush G. Savadkoohi

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Background: The anterior cruciate ligament is one of the most frequent ligament to be disrupted. Surgical reconstruction of the anterior cruciate ligament is a common practice to treat the disability or chronic instability of the knee. Several factors associated with success or failure of the ACL reconstruction including preoperative laxity of the knee, selection of the graft material, surgical technique, graft tension, and postoperative rehabilitation. We aimed to examine the biomechanical properties of any graft type and initial graft tensioning during ACL reconstruction using 3-dimensional computational finite element simulation. Methods: In this paper, 3-dimensional model of the knee was constructed to investigate the effect of graft tensioning on the knee joint biomechanics. Four different grafts were compared: 1) Bone-patellar tendon-bone graft (BPTB) 2) Hamstring tendon 3) BPTB and a band of gracilis4) Hamstring and a band of gracilis. The initial graft tension was set as “0, 20, 40, or 60N”. The anterior loading was set to 134 N. Findings: The resulting stress pattern and deflection in any of these models were compared to that of the intact knee. The obtained results showed that the combination of a band of gracilis with the former graft (BPTB or Hamstring) increases the structural stiffness of the knee. Conclusion: Required pretension during surgery decreases significantly by adding a band of gracilis to the proper graft.

Keywords: ACL reconstruction, deflection, finite element simulation, stress pattern

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Authors: Raheel Shakoor Siddiqui, Calvin Mathias, Manikandar Srinivas Cheruvu, Bobin Varghese

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A 58 year old gentleman presented to accident and emergency at the district general hospital with worsening shortness of breath and a non-productive cough over a period of five days. He was initially admitted under the medical team for suspicion of SARS-CoV-2 (COVID-19) pneumonitis. Subsequently, upon deterioration of observations and a positive COVID-19 PCR, he was taken to intensive care for invasive mechanical ventilation. He required frequent proning, inotropic support and was intubated for thirty-three days. After successful extubation, he developed myopathy with a limited range of motion to his right knee and right shoulder. Plain film imaging of these limbs demonstrated an unusual formation of heterotopic ossification without any precipitating trauma or surgery. Current literature demonstrates limited case series portraying heterotopic ossification post-COVID-19. There has been negligible evidence of heterotopic ossification in the ipsilateral knee and shoulder post-prolonged immobility secondary to a critical illness. Physiotherapy and rehabilitation are post-intensive care can be prolonged due to the formation of heterotopic ossification around joints. Prolonged hospital stays may lead to a higher risk of developing infections of the chest, urine and pressure sores. This raises the question of whether a severe systemic inflammatory immune response from the SARS-CoV-2 virus results in histopathological processes leading to the formation of heterotopic ossification not previously seen, requiring prolonged physiotherapy.

Keywords: orthopaedics, rehabilitation, physiotherapy, heterotopic ossification, COVID-19

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

Abstract:

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

Abstract:

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: Loveneet Kaur

Abstract:

Introduction: Osteoarthritis (OA) is one of the leading causes of disability, and the knee is the most commonly affected joint in the body. The last resort for treatment of knee OA is Total Knee Replacement (TKR) surgery. Despite numerous advances in prosthetic design, patients do not reach normal function after surgery. Current surgical decisions are made on 2D radiographs and patient interviews. Aims: The aim of this study was to compare knee kinematics pre and post-TKR surgery using computer-animated images of patient-specific models under everyday conditions. Methods: 7 subjects were recruited for the study. Subjects underwent 3D gait analysis during 4 everyday activities and medical imaging of the knee joint pre- and one-month post-surgery. A 3D model was created from each of the scans, and the kinematic gait analysis data was used to animate the images. Results: Improvements were seen in a range of motion in all 4 activities 1-year post-surgery. The preoperative 3D images provide detailed information on the anatomy of the osteoarthritic knee. The postoperative images demonstrate potential future problems associated with the implant. Although not accurate enough to be of clinical use, the animated data can provide valuable insight into what conditions cause damage to both the osteoarthritic and prosthetic knee joints. As the animated data does not require specialist training to view, the images can be utilized across the fields of health professionals and manufacturing in the assessment and treatment of patients pre and post-knee replacement surgery. Future improvements in the collection and processing of data may yield clinically useful data. Conclusion: Although not yet of clinical use, the potential application of 3D animations of the knee joint pre and post-surgery is widespread.

Keywords: Orthoporosis, Ortharthritis, knee replacement, TKR

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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: Milad Pirali, Sohrab Keyhani, Mohhamad Ali Sanjari, Ali Ashraf Jamshidi

Abstract:

Purpose: The effect of hamstring antagonist activity on the knee extensors torque of the Anterior Cruciate Ligament reconstruction (ACLR) is not clear and persistent muscle weakness is common after ACLR. Hamstring activation when acting as antagonist is considered very important for knee strengths. Therefore the purpose of this study was to examine hamstring antagonist coactivation during maximal effort of the isokinetic knee extension in ACLR athletes with hamstring autograft. Materials and Methods: We enrolled 20 professional athletes who underwent primary ACLR (hamstring tendon autograft)with 6-24 months postoperative and 20 healthy subjects as control group. Each subjects performed maximal effort isokinetic knee extension and flexion in 60/˚ s and 180/˚ s velocities for the involved and uninvolved limb. Synchronously, surface electromyography (EMG) was recorded of vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF) and biceps femoris (BF). The antagonist integrated EMG (IEMG) values were normalized to the IEMG of the same muscle during maximal isokinetic eccentric effort at the same velocities and ROM. Results: A one-way analysis of variance designs shows significantly greater IEMG coactivation of hamstring and decreased activation of Vm in ACLR when compared to uninvolved and control group leg in 60/˚ s and 180/˚ s velocities. Likewise peak torque to body weight was decreased in ACLR compared to uninvolved and control group during knee extension in both velocities (p < 0.05). Conclusions: Decreased extensors moment caused by decreased quadriceps inhibition and increased hamstring coactivation. In addition, these result indicated to decrease of motor unit recruitment in the VM (as a kinesiologicmonitore of the knee). It is appearing that strengthening of the quadriceps to be an important for rehabilitation program after ACLR for preparation in athletes endeavors. Therefore, we suggest that having more emphasis and focus on quadriceps strength and less emphasis on hamstring following ACLR.

Keywords: ACLR-coactivation, dynamometry, electromyography, isokinetic

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