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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]

Featured Application: Potential applications of the presented motion analysis protocol are clinical evaluations of joint function, e.g., for comparisons between different treatment regiments or evaluation of pre–postoperative improvements. Furthermore, the provided repeatability measures serve as a base for meaningful data interpretation as well as for comparison with different biomechanical hand models. The purpose of this study was to develop a motion analysis protocol that allows the simultaneous assessment of all hand and finger joint movements. The objective was to demonstrate repeatability for future clinical applications in functional assessments. This study includes selection of marker positions, movement tasks, kinematic approaches and a comparison of the two most commonly used finger marker sets. By using a test–retest measurement of the range of motion in twenty healthy volunteers, the repeatability of the developed protocol was validated. Estimated errors of the presented method ranged from 1.2° to 6.4°. Finger joint angles derived from the marker set with two markers per segment showed better repeatability (3.7°) than with markers located on the joints (5.1°). Given the high repeatability found, the presented method appears to be suitable for clinical applications. For the fingers, measurement repeatability can be improved by using at least two markers per segment. Within this study, advanced kinematic approaches, such as functional determination of joint centers and axes, are applied to the analysis of hand movements. The provided standard values and estimate of the minimal detectable differences provide a valuable basis for meaningful data interpretation and may be used for future comparison with other protocols. [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]

Video-fluoroscopic analysis can provide important insights for the evaluation of outcome and functionality after total knee arthroplasty, allowing the in vivo assessment of tibiofemoral kinematics without soft tissue artefacts. To enable measurement of the knee throughout activities of daily living such as gait, robotic systems like the moving fluoroscope have been developed that follow the knee movement and maintain the joint in front of the image intensifier. Since it is unclear whether walking while being accompanied by moving fluoroscope affects normal gait, the objective of this study was to investigate its influence on gait characteristics in healthy subjects. In addition, the impact of the motors’ noise was analysed. By means of skin markers analysis (VICON MX system, Oxford Metrics Group, UK) and simultaneous measurement of ground reaction forces (Kistler force plates, Kistler, Switzerland), gait characteristics when walking with and without the moving fluoroscope as well as with and without ear protectors in combination with the moving fluoroscope, were obtained in young (n = 10, 24.5y ± 3.0y) and elderly (n = 9, 61.6y ± 5.3y) subjects during level gait and stair descent. Walking with the moving fluoroscope significantly decreased gait velocity in level gait and stair descent over the respective movement without the fluoroscope. Statistical analysis, including gait velocity as a covariate, resulted in no differences on the ground reaction force parameters. However, some kinematic parameters (ankle, knee and hip ranges of motion, minimal knee angle in late stance phase, maximal knee angles in stance and swing phase) seemed to be modified by the presence of the moving fluoroscope, but statistical comparison was limited due to velocity differences between the conditions. Wearing ear protectors to avoid the influence of motor sound during walking with the moving fluoroscope caused no significant difference. Walking with the moving fluoroscope has been shown to decrease gait velocity and small alterations in kinematic parameters were observed. Therefore, gait and movement alterations due to the moving fluoroscope cannot completely be excluded. However, based on the absence of differences in ground reaction force parameters (when adjusted for velocity within ANCOVA), as well as based on the comparable shape of the angular curves to the slow control condition, it can be concluded that changes in gait when walking with the moving fluoroscope are small, especially in comparison to natural slow walking. In order to allow assessment of joint replacement with the moving fluoroscope, including an understanding of the effects of joint pain, clinical analyses can only be compared to gait activities showing similarly reduced velocities. Importantly, the reduced gait speeds observed in this study are similar to those observed after total knee arthroplasty, suggesting that analyses in such subjects are appropriate. However, the moving fluoroscope would likely need to be optimized in order to detect natural gait characteristics at the higher gait velocities of healthy young subjects. The moving fluoroscope can be applied for comparisons between groups measured with the moving fluoroscope, but care should be taken when comparing data to subjects walking at self-selected speed without the moving fluoroscope. [ABSTRACT FROM AUTHOR]

Videofluoroscopy has been shown to provide essential information in the evaluation of the functionality of total knee arthroplasties. However, due to the limitation in the field of view, most systems can only assess knee kinematics during highly restricted movements. To avoid the limitations of a static image intensifier, a moving fluoroscope has been presented as a standalone system that allows tracking of the knee during multiple complete cycles of level- and downhill-walking, as well as stair descent, in combination with the synchronous assessment of ground reaction forces and whole body skin marker measurements. Here, we assess the ability of the system to keep the knee in the field of view of the image intensifier. By measuring ten total knee arthroplasty subjects, we demonstrate that it is possible to maintain the knee to within 1.8 ± 1.4 cm vertically and 4.0 ± 2.6 cm horizontally of the centre of the intensifier throughout full cycles of activities of daily living. Since control of the system is based on real-time feedback of a wire sensor, the system is not dependent on repeatable gait patterns, but is rather able to capture pathological motion patterns with low inter-trial repeatability. [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]

Background: The posterior cruciate ligament (PCL) is the strongest ligament of the knee, serving as one of the major passive stabilizers of the tibio-femoral joint. However, despite a number of experimental and modelling approaches to understand the kinematics and kinetics of the ligament, the normal loading conditions of the PCL and its functional bundles are still controversially discussed. Objectives: This study aimed to generate science-based evidence for understanding the functional loading of the PCL, including the anterolateral and posteromedial bundles, in the healthy knee joint through systematic review and statistical analysis of the literature. Data sources: MEDLINE, EMBASE and CENTRAL Eligibility criteria for selecting studies: Databases were searched for articles containing any numerical strain or force data on the healthy PCL and its functional bundles. Studied activities were as follows: passive flexion, flexion under 100N and 134N posterior tibial load, walking, stair ascent and descent, body-weight squatting and forward lunge. Method: Statistical analysis was performed on the reported load data, which was weighted according to the number of knees tested to extract average strain and force trends of the PCL and identify deviations from the norms. Results: From the 3577 articles retrieved by the initial electronic search, only 66 met all inclusion criteria. The results obtained by aggregating data reported in the eligible studies indicate that the loading patterns of the PCL vary with activity type, knee flexion angle, but importantly also the technique used for assessment. Moreover, different fibres of the PCL exhibit different strain patterns during knee flexion, with higher strain magnitudes reported in the anterolateral bundle. While during passive flexion the posteromedial bundle is either lax or very slightly elongated, it experiences higher strain levels during forward lunge and has a synergetic relationship with the anterolateral bundle. The strain patterns obtained for virtual fibres that connect the origin and insertion of the bundles in a straight line show similar trends to those of the real bundles but with different magnitudes. Conclusion: This review represents what is now the best available understanding of the biomechanics of the PCL, and may help to improve programs for injury prevention, diagnosis methods as well as reconstruction and rehabilitation techniques. [ABSTRACT FROM AUTHOR]

ABSTRACT Understanding the mechanical loading environment and resulting joint mechanics for activities of daily living in total knee arthroplasty is essential to continuous improvement in implant design. Although survivorship of these devices is good, a substantial number of patients report dissatisfaction with the outcome of their procedure. Knowledge of in vivo kinematics and joint loading will enable improvement in preclinical assessment and refinement of implant geometry. The purpose of this investigation was to describe the mechanics of total knee arthroplasty during a variety of activities of daily living (gait, walking down stairs, and chair rise/sit). Estimates of muscle forces, tibial contact load, location, and pressure distribution was performed through a combination of mobile fluoroscopy data collection, musculoskeletal modeling, and finite element simulation. For the activities evaluated, joint compressive load was greatest during walking down stairs; however, the highest contact pressure occurred during chair rise/sit. The joint contact moment in the frontal plane was mainly varus for gait and walking down stairs, while it was valgus during chair rise/sit. Excursion of the center of pressure on the tibial component was similar during each activity and between the medial and lateral sides. The main determinants of center of pressure location were internal-external rotation, joint load, and tibial insert conformity. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1576-1587, 2016. [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]

This study aimed to understand the ability of fixed-bearing posterior cruciate ligament (PCL)-retaining implants to maintain functionality of the PCL in vivo. To achieve this, elongation of the PCL was examined in six subjects with good clinical and functional outcomes using 3D kinematics reconstructed from video-fluoroscopy, together with multibody modelling of the knee. Here, length-change patterns of the ligament bundles were tracked throughout complete cycles of level walking and stair descent. Throughout both activities, elongation of the anterolateral bundle exhibited a flexion-dependent pattern with more stretching during swing than stance phase (e.g., at 40° flexion, anterolateral bundle experienced 3.9% strain during stance and 9.1% during swing phase of stair descent). The posteromedial bundle remained shorter than its reference length (defined at heel strike of the level gait cycle) during both activities. Compared with loading patterns of the healthy ligament, postoperative elongation patterns indicate a slackening of the ligament at early flexion followed by peak ligament lengths at considerably smaller flexion angles. The reported data provide a novel insight into in vivo PCL function during activities of daily living that has not been captured previously. The findings support previous investigations reporting difficulties in achieving a balanced tension in the retained PCL. [ABSTRACT FROM AUTHOR]

Background: The measurement of finger and wrist range of motion (ROM) is of great importance to clinicians when assessing functional outcomes of therapeutic interventions and surgical procedures. The purpose of the study was to assess the repeatability of ROM measurements of the hand joints with manual goniometer and 3D motion capture system and to calculate the minimal detectable difference for both methods. Methods: Active finger and wrist joints ROM of 20 healthy volunteers were assessed using a manual goniometer and 3D motion capture system. Minimal detectable difference (MDD) and standard error of measurement (SEM) were calculated for both measurement systems and compared within the same task. Maximal ROM of all joints was registered twice on two different days to evaluate the test-retest repeatability. The intraclass correlation coefficients (ICC) was calculated and examined to determine if reliability ≥ 0.70 existed. Results: MDD for the 3D motion capture was between 5 and 12° except for the metacarpophalangeal joint (MCP) 1, interphalangeal joint (IP), and MCP5. SEM values lay between 2 and 4° for all joints except for the MCP5, IP, and MCP1. For the goniometric measurements, MDD and SEM were between 12–30° and 4–11°, respectively. The reliability criterion (ICC > 0.7) was achieved for the ROM measurement with the 3D motion capture system for 94% of the joints and in only 65% of the joints with the manual goniometer. Conclusions: Joint ROM assessed with 3D motion analysis showed higher test-retest agreement demonstrating overall better repeatability for this method. Because of the smaller measurement error, the 3D motion capture system has a smaller MDD. Only individual test-rest differences bigger than the MDD can be considered as real changes, and therefore, in an experimental situation, the use of a more precise measurement method can greatly reduce the number of subjects needed for a statistical significance. Goniometer measurements of some joints should be carefully interpreted, due to a low repeatability and reliability. Trial registration: This study is approved by the Ethical Committee Zurich (Kek-ZH-Nr: 2015-0395). [ABSTRACT FROM AUTHOR]

Background: Internal and external rotation exercises of the shoulder are frequently performed to avoid injury and pain. Knowledge about the motion and loadings of the upper extremities during these exercises is crucial for the development of optimal training recommendations. However, a comparison of the angles and corresponding moments in the upper extremities that are achieved during internal and external rotation exercises for the shoulder by using different resistance types has not yet been performed. Therefore, the aim of the study was to examine upper extremity kinetics and kinematics in 3D of the internal and external rotation exercises. Methods: The kinematics and kinetics of 12 participants while they performed 10 different exercises with a constant and with an elastic external load corresponding to 2% body mass was assessed. The motion of the upper extremities was recorded three-dimensionally with a motion capture system, using a newly developed marker set and joint coordinate systems with 28 markers. The applied external load was measured with a load cell placed in series with the external resistance, and moments were calculated using an inverse dynamics approach. Results: The range of motion and the joint loading was highly dependent on the exercises. The range of motion in the glenohumeral joint did not differ significantly between the two resistance types, whereas internal/external rotation moments were significantly higher with constant resistance than those with elastic resistance. Conclusions: Larger or lower moments can, therefore, be achieved through selection of the appropriate resistance type, while the range of motion can be altered through the selection of exercise type. Therefore, the loading motion patterns identified in this study can help to choose suitable shoulder exercises dependent on the training objective. [ABSTRACT FROM AUTHOR]

An abstract of the article "How Well Can Skin Marker Analysis Detect the Kinematics of a Total Ankle Arthroplasty? - A Comparison to Videofluoroscopy," by Renate List, Hans Gerber, Mauro Foresti, Silvio Lorenzetti, Pascal Rippstein, and Edgar Stüssi is presented.

Background: Instrumented treadmills are potentially useful tools for the assessment of gait parameters in orthopaedic clinical settings, but their measurement properties remain uncertain.Research Question: What is the discriminant validity and reproducibility of spatiotemporal and kinetic gait parameters measured by a pressure-instrumented treadmill at different speeds and inclinations in patients with knee osteoarthritis (KOA)?Methods: A total of 54 patients with unilateral KOA and 23 healthy controls took part in the study. Step length, single-limb support duration and ground reaction force were recorded during level and uphill walking at 3 and 4 km/h using a commercially-available treadmill instrumented with an integrated pressure platform. We examined discriminant validity (difference between involved and uninvolved side as well as against healthy controls) and test-retest reproducibility (reliability and agreement).Results: Significant side differences were observed for single-limb support duration and ground reaction force at touchdown in all conditions (P < 0.05). All the investigated gait parameters showed acceptable reliability and agreement, except step length at 4 km/h uphill.Significance: We conclude that the pressure-instrumented treadmill used in this study may have good clinical utility for quantitative gait analysis in patients with KOA under different experimental conditions. [ABSTRACT FROM AUTHOR]

A comparison of natural versus replaced tibio-femoral kinematics in vivo during challenging activities of daily living can help provide a detailed understanding of the mechanisms leading to unsatisfactory results and lay the foundations for personalised implant selection and surgical implantation, but also enhance further development of implant designs towards restoring physiological knee function. The aim of this study was to directly compare in vivo tibio-femoral kinematics in natural versus replaced knees throughout complete cycles of different gait activities using dynamic videofluoroscopy. Twenty-seven healthy and 30 total knee replacement subjects (GMK Sphere, GMK PS, GMK UC) were assessed during multiple complete gait cycles of level walking, downhill walking, and stair descent using dynamic videofluoroscopy. Following 2D/3D registration, tibio-femoral rotations, condylar antero-posterior translations, and the location of the centre of rotation were compared. The total knee replacement groups predominantly experienced reduced tibial internal/external rotation and altered medial and lateral condylar antero-posterior translations compared to natural knees. An average medial centre of rotation was found for the natural and GMK sphere groups in all three activities, whereas the GMK PS and UC groups experienced a more central to lateral centre of rotation. Each total knee replacement design exhibited characteristic motion patterns, with the GMK Sphere most closely replicating the medial centre of rotation found for natural knees. Despite substantial similarities between the subject groups, none of the implant geometries was able to replicate all aspects of natural tibio-femoral kinematics, indicating that different implant geometries might best address individual functional needs. • Each total knee replacement design exhibited characteristic motion patterns. • GMK Sphere closest replicated the medial centre of rotation found in natural knees. • No implant was able to replicate all aspects of natural tibio-femoral kinematics. [ABSTRACT FROM AUTHOR]

Background: Prevalence of knee osteoarthritis increases because life expectancy continues to rise with an active patient population. Hence, the concept of unicompartmental knee arthroplasty (UKA) has regained popularity as a treatment option for unicompartmental knee osteoarthritis. Anterior cruciate ligament (ACL) deficiency is widely considered as a contraindication for UKA, however, there are conflicting reports. If otherwise indicated, some surgeons consider UKA for ACL-deficient patients using a modified surgical technique, with a reduction of posterior tibial slope.Research Question: The purpose of this study was to evaluate outcomes in UKA patients with ACL deficiency in comparison to a conventional UKA group (intact ACL) by the measurement of knee kinematics and kinetics.Methods: Ten patients with conventional UKA and an intact ACL and eight patients with an ACL-deficient UKA and a reduced posterior tibial slope relative to the native knee were recruited. Three-dimensional joint kinematics of the knee were measured, using skin markers and an infrared optical motion capture system. Ground reaction forces (GRF) were measured with force plates in all three directions. Level walking, ramp descent and stair descent were analyzed, comparing implanted and contralateral native knees and the two UKA groups.Results: No significant differences in kinetics and kinematics were observed between conventional UKA and ACL-deficient UKA groups for any of the activities. However, some asymmetries in GRF between the implanted and contralateral side were present for the ACL-deficient group, during level walking (unloading rate) and stair descent (stance time).Significance: Promising outcomes of the ACL-deficient UKA group suggest that ACL deficiency may not always be a contraindication. Therefore, ACL-deficient UKA could be an alternative treatment option to total knee arthroplasty for an appropriate surgeon selected patient population. [ABSTRACT FROM AUTHOR]

Background: Regular infant carrying might be a contributing factor for the development and progression of low back and pelvic girdle pain in mothers after childbirth. However, the neuromechanical adaptations of the spine due to different sling-based carrying techniques are not sufficiently well understood in order to provide evidence-based carrying recommendations.Research Question: What are the immediate effects of different sling-based infant carrying techniques on trunk neuromechanics?Methods: Using a Vicon motion capture and a wireless surface electromyography system, three-dimensional pelvis and spinal kinematics as well as activation patterns of eight trunk muscles were derived from fifteen healthy young women during upright standing and level walking without carrying a load and while carrying a 6 kg-dummy with a sling in front and on either side. Data were analyzed using Statistical Parametric Mapping, allowing group comparisons of discrete parameters (standing) as well as continuous data (walking). To distinguish between clinically relevant and clinically not relevant kinematic findings, statistically significant differences were only considered in case of ≥5°.Results: Compared to unloaded walking, carrying the dummy in front was mainly associated with increased lumbar lordosis (standing: (Δ8.8°, p = 0.006; walking: (Δ ≥ 8.2°, 1-100% of gait cycle [%GC], p < 0.001). When carrying the dummy on the preferred side, increased thoracic kyphosis (standing: ≥6.4°, p ≤ 0.003; walking: Δ ≥ 5.6°, 1-100%GC, p < 0.001) and axial rotation towards the ipsilateral side (standing: Δ5.3°, p = 0.003; walking: Δ ≥ 5.0°, 46-58%GC, p = 0.002) were observed. All three conditions entailed increased paraspinal muscle activity during walking, although only unilaterally in side carrying (lumbar, preferred condition: Δ ≥ 13.2%maxMVIC, 49-57%GC, p < 0.001; thoracic, non-preferred condition: Δ ≥ 5.3%maxMVIC, 47-58%GC, p < 0.001).Significance: Carrying an infant alternating on both sides using a sling could be advantageous for preventing musculoskeletal pain resulting from excessive lumbar hyperextension and paraspinal muscle hyperactivation in women after childbirth. [ABSTRACT FROM AUTHOR]

Background: The goal of this review is to summarise and discuss the reported influence of muscle-tendon forces on anterior cruciate ligament (ACL) loading during the jump-landing task by means of biomechanical analyses of the healthy knee. Methods: A systematic review of the literature was conducted using different combinations of the terms "knee", "ligament'', "load'', "tension ", "length", "strain'', "elongation'' and "lengthening''. 26 original articles (n=16 in vitro studies; n=10 in situ studies) were identified which complied with all inclusion/exclusion criteria. Results: No apparent trend was found between ACL loading and the ratio between hamstrings and quadriceps muscle-tendon forces prior to or during landing. Four in vitro studies reported reduced peak ACL strain if the quadriceps force was increased; while one in vitro study and one in situ study reported reduced ACL loading if the hamstrings force was increased. A meta-analysis of the reported results was not possible because of the heterogeneity of the confounding factors. Conclusion: The reported results suggest that increased hip flexion during landing may help in reducing ACL strain by lengthening the hamstrings, and thus increasing its passive resistance to stretch. Furthermore, it appears that increased tensile stiffness of the quadriceps may help in stabilising the knee joint during landing, and thus protecting the passive soft-tissue structures from overloading. Level of evidence: Ib. [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.