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Background: Haglund exostosis–related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists. Methods: Fifteen patients (15 feet) with Haglund exostosis–related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed. Results: Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as "helped" or "helped a lot" (Global Treatment Outcome). Conclusion: In this relatively small cohort, we found that patients treated for Haglund exostosis–related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up. Level of Evidence: Level II, observational prospective cohort study. [ABSTRACT FROM AUTHOR]

The success of kinematic analysis that relies on inertial measurement units (IMUs) heavily depends on the performance of the underlying algorithms. Quantifying the level of uncertainty associated with the models and approximations implemented within these algorithms, without the complication of soft-tissue artefact, is therefore critical. To this end, this study aimed to assess the rotational errors associated with controlled movements. Here, data of six total knee arthroplasty patients from a previously published fluoroscopy study were used to simulate realistic kinematics of daily activities using IMUs mounted to a six-degrees-of-freedom joint simulator. A model-based method involving extended Kalman filtering to derive rotational kinematics from inertial measurements was tested and compared against the ground truth simulator values. The algorithm demonstrated excellent accuracy (root-mean-square error ≤ 0.9 °, maximum absolute error ≤ 3.2 °) in estimating three-dimensional rotational knee kinematics during level walking. Although maximum absolute errors linked to stair descent and sit-to-stand-to-sit rose to 5.2° and 10.8°, respectively, root-mean-square errors peaked at 1.9° and 7.5°. This study hereby describes an accurate framework for evaluating the suitability of the underlying kinematic models and assumptions of an IMU-based motion analysis system, facilitating the future validation of analogous tools. [ABSTRACT FROM AUTHOR]

Measuring joint kinematics is a key requirement for a plethora of biomechanical research and applications. While x-ray based systems avoid the soft-tissue artefacts arising in skin-based measurement systems, extracting the object's pose (translation and rotation) from the x-ray images is a time-consuming and expensive task. Based on about 106'000 annotated images of knee implants, collected over the last decade with our moving fluoroscope during activities of daily living, we trained a deep-learning model to automatically estimate the 6D poses for the femoral and tibial implant components. By pretraining a single stage of our architecture using renderings of the implant geometries, our approach offers personalised predictions of the implant poses, even for unseen subjects. Our approach predicted the pose of both implant components better than about 0.75 mm (in-plane translation), 25 mm (out-of-plane translation), and 2° (all Euler-angle rotations) over 50% of the test samples. When evaluating over 90% of test samples, which included heavy occlusions and low contrast images, translation performance was better than 1.5 mm (in-plane) and 30 mm (out-of-plane), while rotations were predicted better than 3−4°. Importantly, this approach now allows for pose estimation in a fully automated manner. [ABSTRACT FROM AUTHOR]

The aim o f this study was to quantify how step length and the front tibia angle influence joint angles and loading conditions during the split squat exercise. Eleven subjects performed split squats with an additional load of 25% body weight applied using a barbell. Each subject’s movements were recorded using a motion capture system, and the ground reaction force was measured under each foot. The joint angles and loading conditions were calculated using a cluster-based kinematic approach and inverse dynamics modeling respectively. Increases in the tibia angle resulted in a smaller range of motion (ROM) of the front knee and a larger ROM of the rear knee and hip. The external flexion moment in the front knee/hip and the external extension moment in the rear hip decreased as the tibia angle increased. The flexion moment in the rear knee increased as the tibia angle increased. The load distribution between the legs changed < 25% when split squat execution was varied. Our results describing the changes in joint angles and the resulting differences in the moments of the knee and hip will allow coaches and therapists to adapt the split squat exercise to the individual motion and load demands of athletes. [ABSTRACT FROM AUTHOR]

Background: Paradoxical anterior translation in midflexion is reduced in total knee arthroplasties (TKAs) with a gradually reducing femoral radius, when compared to a 2-radii design. This reduction has been shown in finite element model simulations, in vitro tests, intraoperatively, and recently also in vivo during a lunge and unloaded flexion-extension. However, TKA kinematics are task dependent and this reduction has not been tested for gait activities.Methods: Thirty good outcome subjects (≥1 year postoperatively) with a unilateral cruciate-retaining TKA with a gradually reducing (n = 15) or dual (n = 15) femoral radius design were assessed during 5 complete cycles of level walking, stair descent (0.18-m steps), deep knee bend, and sitting down onto and standing up from a chair, using a moving fluoroscope (25 Hz, 1 ms shutter time). Kinematic data were extracted by 2D/3D image registration.Results: Tibiofemoral ranges of motion for flexion-extension, abduction-adduction, internal-external rotation, and anteroposterior (AP) translation were similar for both groups, whereas the pattern of AP translation-flexion-coupling differed. The subjects with the dual-radii design showed a sudden change in direction of AP translation around 30° of flexion, which was not present in the subjects with the gradually reducing femoral radius design.Conclusion: Through the unique ability of moving fluoroscopy, the present study confirmed that the gradually reducing femoral radii eliminated the paradoxical sudden anterior translation at 30° present in the dual-radii design in vivo during daily activities, including gait and stair descent. [ABSTRACT FROM AUTHOR]

This research assessed the influence of various heel elevation conditions on spinal kinematic and kinetic data during loaded (25% and 50% of body weight) high-bar back squats. Ten novice (mass 67.6 ± 12.4 kg, height 1.73 ± 0.10 m) and ten regular weight trainers (mass 66.0 ± 10.7 kg, height 1.71 ± 0.09 m) completed eight repetitions at each load wearing conventional training shoes standing on the flat level floor (LF) and on an inclined board (EH). The regular weight training group performed an additional eight repetitions wearing weightlifting shoes (WS). Statistical parametric mapping (SPM1D) and repeated measures analysis of variance were used to assess differences in spinal curvature and kinetics across the shoe/floor conditions and loads. SPM1D analyses indicated that during the LF condition the novice weight trainers had greater moments around L4/L5 than the regular weight trainers during the last 20% of the lift (P < 0.05), with this difference becoming non-significant during the EH condition. This study indicates that from a perspective of spinal safety, it appears advantageous for novice weight trainers to perform back squats with their heels slightly elevated, while regular weight trainers appear to realize only limited benefits performing back squats with either EH or WS. [ABSTRACT FROM AUTHOR]

Joint stability is a primary concern in total knee joint replacement. The GMK Sphere prosthesis was specifically designed to provide medial compartment anterior–posterior (A–P) stability, while permitting rotational freedom of the joint through a flat lateral tibial surface. The objective of this study was to establish the changes in joint kinematics introduced by the GMK Sphere prosthesis during gait activities in comparison to conventional posterior‐stabilized (PS) fixed‐bearing and ultra‐congruent (UC) mobile‐bearing geometries. The A–P translation and internal/external rotation of three cohorts, each with 10 good outcome subjects (2.9 ± 1.6 years postop), with a GMK Sphere, GMK PS or GMK UC implant were analysed throughout complete cycles of gait activities using dynamic videofluoroscopy. The GMK Sphere showed the smallest range of medial compartment A–P translation for level walking, downhill walking, and stair descent (3.6 ± 0.9 mm, 3.1 ± 0.8 mm, 3.9 ± 1.3 mm), followed by the GMK UC (5.7 ± 1.0 mm, 8.0 ± 1.7 mm, 8.7 ± 1.9 mm) and the GMK PS (10.3 ± 2.2 mm, 10.1 ± 2.6 mm, 11.6 ± 1.6 mm) geometries. The GMK Sphere exhibited the largest range of lateral compartment A–P translation (12.1 ± 2.2 mm), and the largest range of tibial internal/external rotation (13.2 ± 2.2°), both during stair descent. This study has shown that the GMK Sphere clearly restricts A–P motion of the medial condyle during gait activities while still allowing a large range of axial rotation. The additional comparison against the conventional GMK PS and UC geometries, not only demonstrates that implant geometry is a key factor in governing tibio‐femoral kinematics, but also that the geometry itself probably plays a more dominant role for joint movement than the type of gait activity. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2337–2347, 2019 [ABSTRACT FROM AUTHOR]

Before conclusions can be drawn with respect to the quality of adaptations in human gait, the day-to-day consistency of the variables of interest must be known. The present study estimated the day-to-day consistency of kinematic variables collected during barefoot walking and running. Sixteen healthy subjects performed two gait analysis sessions based on skin markers. Test sessions were at least 1 week apart. In total, 48 ranges of motion were monitored for the hip, knee, ankle, and midfoot joint. Based on differences between the repeated gait analysis sessions, the day-to-day consistency was estimated. It was found that the day-to-day consistency was of the magnitude of 3 to 4 degrees for almost all ranges of motion independently of the test condition, the investigated joints, or the cardinal body plane. It was concluded that future studies on effects of interventions or on the characterization of pathological versus normative gait should consider the provided values of day-to-day consistency to improve their interpretation and conclusions. [ABSTRACT FROM AUTHOR]

The human hand is the most frequently used body part in activities of daily living. With its complex anatomical structure and the small size compared to the body, assessing the functional capability is highly challenging. The aim of this review was to provide a systematic overview on currently available 3D motion analysis based on skin markers for the assessment of hand function during activities of daily living. It is focused on methodology rather than results. A systematic review according to the PRISMA guidelines was performed. The systematic search yielded 1349 discrete articles. Of 147 articles included on basis of title, 123 were excluded after abstract review, and 24 were included in the full-text analysis with 13 key articles. There is still limited knowledge about hand and finger kinematics during activities of daily living. A standardization of the task is required in order to overcome the nonrepetitive nature and high variability of upper limb motion and ensure repeatability of task performance. To yield a progress in the analysis of human hand movements, an assessment of human kinematics including fingers, wrist, and thumb and an identification of relevant parameters that characterize a healthy motion pattern during functional tasks are needed. [ABSTRACT FROM AUTHOR]

Force plates are common assessment tools used in biomechanics to measure ground reaction forces during motion capture or strength exercises. While the accuracy of the resulting kinetic data is critical for accurate gait analysis, factors such as plate mounting are thought to influence the measured point of force application (PFA) of the ground reaction forces. The aim of this study was therefore to present an accurate in-situ PFA calibration method. In addition, the approach was evaluated by examining the required PFA corrections over a period of ten years, which included plate remounting and a change of foundation. The in-situ PFA calibration was performed on six plates by assessing the locations of up to 98 points of force application per plate using an instrumented pole. Application of the in-situ PFA calibration approach reduced the root mean square errors by up to approximately 60% compared to the manufacturers calculation. Correction coefficients were strongly dependent on the individual platform as well as the location of the applied force on the plate. Remounting of the plates altered the plate coefficient corrections considerably, while changes over time were notable but not as extensive. We therefore recommend that plates should be recalibrated after remounting, but also at least every 5 years, in order to ensure the preservation of an accurate PFA. [ABSTRACT FROM AUTHOR]

The purpose of this study was to measure alterations in sensorimotor skills and balance resulting from slackline training and conventional balance training. Forty-three physically fit subjects were randomized into three groups. Two groups practiced three times a week for 15 minutes, including at least once supervised session, on the slackline or perform conventional balance training for 6 weeks. The control group was not allowed to perform any balance training. Before and after the intervention, the subjects underwent sensorimotor and strength tests. The results of our intra-class correlation analysis showed that the stability parameters from the multifunctional training device (MFT, 0.7), the height during the countermovement jump (CMJ, 0.95) and the maximum force (0.88) during leg press showed excellent reliability. A post hoc comparison indicated a larger effect of conventional training (almost 11% reduction in MFT stability) compared with slackline training in group-wide comparisons of the pre- to the post-training measurements. The factor analysis showed that stability and sensorimotor assessment using MFT were correlated, as were height during CMJ and maximal force during leg press, which represented dynamic strength. Because CMJ had the highest intra-class correlation value, it was chosen over maximum force from leg press. For these reasons, only two out of nine measured parameters, namely MFT stability and CMJ, were analysed across groups. The only observed difference between the two groups was MFT stability (slackline - 1.5%, conventional - 13%), whereas the improvement of CMJ was the same (slackline + 3%, conventional + 3%). It can be concluded that slacklining is partly complementary to conventional sensorimotor training. [ABSTRACT FROM AUTHOR]

Soft tissue artefact affects the determination of skeletal kinematics. Thus, it is important to know the accuracy and limitations of kinematic parameters determined and modelled based on skin marker data. Here, the curvature angles, as well as the rotations of the lumbar and thoracic segments, of seven healthy subjects were determined in the sagittal plane using a skin marker set and compared to measurements taken in an open upright MRI scanner in order to understand the influence of soft tissue artefact at the back. The mean STA in the flexed compared to the extended positions were 10.2±6.1 mm (lumbar)/9.3±4.2 mm (thoracic) and 10.7±4.8 mm (lumbar)/9.2±4.9 mm (thoracic) respectively. A linear regression of the lumbar and thoracic curvatures between the marker-based measurements and MRI-based measurements resulted in coefficients of determination, R2, of 0.552 and 0.385 respectively. Skin marker measurements therefore allow for the assessment of changes in the lumbar and thoracic curvature angles, but the absolute values suffer from uncertainty. Nevertheless, this marker set appears to be suitable for quantifying lumbar and thoracic spinal changes between quasi-static whole body postural changes. [ABSTRACT FROM AUTHOR]

Injuries to the shoulder are very common in sports that involve overhead arm or throwing movements. Strength training of the chest muscles has the potential to protect the shoulder from injury. Kinematic and kinetic data were acquired in 20 healthy subjects (age: 24.9 ± 2.7 years) using motion capture, force plates for the bench press exercises and load cells in the cable for the cable pulley exercises with 15% and 30% of body weight (BW). Joint ranges of motion (RoM) and joint moments at the shoulder, elbow and wrist were derived using an inverse dynamics approach. The maximum absolute moments at the shoulder joint were significantly larger for the cable pulley exercises than for the bench press exercises. The cable cross-over exercise resulted in substantially different joint angles and loading patterns compared to most other exercises, with higher fluctuations during the exercise cycle. The present results indicate that a combination of bench press and cable pulley exercises are best to train the full RoM and, thus, intra-muscular coordination across the upper limbs. Care has to be taken when performing cable cross-over exercises to ensure proper stabilisation of the joints during exercise execution and avoid joint overloading. [ABSTRACT FROM AUTHOR]

The article presents information on a study on the measurement of kinematics of the lower leg, trunk, and spine during squats. The study was conducted on a total of 30 players who performed unrestricted and restricted barbell squats. It was found that the subjects showed significantly increased in range of motion (ROM) for thoracic curvature during the restricted squats.

Background In order to improve training performance, as well as avoid overloading during prevention and rehabilitation exercises in patients, the aim of this study was to understand the biomechanical differences in the knee, hip and the back between the exercises "Goodmornings" (GMs) and "Deadlifts" (DLs). Methods The kinetics and kinematics of 13 subjects, performing GMs and DLs with an additional 25% (GMs), 25% and 50% (DLs) body weight (BW) on the barbell were analysed. Using the kinetic and kinematic data captured using a 3D motion analysis and force plates, an inverse approach with a quasi-static solution was used to calculate the sagittal moments and angles in the knee, hip and the trunk. The maximum moments and joint angles were statistically tested using ANOVA with a Bonferroni adjustment. Results The observed maximal flexion angle of the knee was 5.3 ± 6.7° for GMs and 107.8 ± 22.4° and 103.4 ± 22.6° for DLs with 25% and 50% BW respectively. Of the hip, the maximal flexion angle was 25% smaller during GMs compared to DLs. No difference in kinematics of the trunk between the two exercises was observed. For DLs, the resulting sagittal moment in the knee was an external flexion moment, whereas during GMs an external extension moment was present. Importantly, no larger sagittal knee joint moments were observed when using a heavier weight on the barbell during DLs, but higher sagittal moments were found at the hip and L4/L5. Compared to GMs, DLs produced a lower sagittal moment at the hip using 25% BW while generating the same sagittal moment at L4/L5. Conclusions The two exercises exhibited different motion patterns for the lower extremities but not for the trunk. To strengthen the hip while including a large range of motion, DLs using 50% BW should be chosen. Due to their ability to avoid knee flexion or a knee flexion moment, GMs should be preferentially chosen over DLs as ACL rupture prevention exercises. Here, in order to shift the hamstring to quadriceps ratio towards the hamstrings, GMs should be favoured ahead of DLs using 50% BW before DLs using 25% BW. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to quantify the three dimensional kinematics of a total ankle arthroplasty during the stance phase of level and slope walking using single plane videofluoroscopy. Researchers found that single plane videofluroscopy enabled accurate estimation of the three dimensional arthroplasty kinematics in vivo without being limited by skin movement artifacts and isolated from subtalar motion.

Gait analysis is an important instrument to investigate foot and ankle biomechanics in the field of footwear design. Results of this method should be objective and comparable. The purpose of this study was to compare two different approaches to quantify ankle joint kinematics: Functionally determined joint centres/axes (FA) versus a predictive model (PA). A single comprehensive marker set was defined. Twenty-two subjects were analysed, and distinctive gait variables were averaged across five trials. Agreement between methods was quantified according to Bland & Altman (Bland and Altman 1986. Lancet, i (8476), 307). Outcome variables differed remarkably between FA and PA at the talocrural (2-9°) and subtalar joints (1-6°). Considerable differences between variables describing motion of the ankle joint complex were primarily related to the use of different rotational axes and definitions of foot segments. This should be considered when studies using different foot models are compared. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to quantify kinetic and kinematic effects during the stance phase of walking using three different foot orthoses. All test subjects were measured under five test conditions with 10 repetitions each. The test conditions included: neutral orthosis (tested twice) and three different orthoses (posting, molding and posting combined, proprioceptive). Whereas most previous studies rely on healthy subjects to describe effects of orthoses during gait, the present study used eight patients (all pes valgus). Standard gait analysis was used with force plates (KISTLER) and an optoelectric measuring system (VICON). The results show that the combined molding and posting foot orthosis significantly reduced eversion and eversion moments during walking compared to a posting type and a proprioceptive orthosis in several test parameters. EMG measurements with fine wire electrodes on three of the test subjects revealed that the activity pattern of the tibialis posterior muscle can considerably change between subjects but may not be used to explain apparent individual effects. The results suggest that for subjects with pes valgus a combined molding and posting orthoses reduces eversion best and that individual variations may be due to subject dependent proprioception, internal foot mechanics and/or a combination of both. [Copyright &y& Elsevier]