Multiplane Loading of the Extensor Mechanism Alters the Patellar Ligament Force/Quadriceps Force Ratio

2010 ◽  
Vol 132 (2) ◽  
Author(s):  
Christopher M. Powers ◽  
Yu-Jen Chen ◽  
Irving S. Scher ◽  
Thay Q. Lee
Keyword(s):  
Knee Flexion ◽  
Loading Condition ◽  
Contact Point ◽  
Axial Loading ◽  
Quadriceps Tendon ◽  
Quadriceps Muscle ◽  
Patellar Ligament ◽  
Force Ratio ◽  
Patella Ligament ◽  
Quadriceps Force

Since the direction of the quadriceps force and location of the patellofemoral contact point likely differ between axial and multiplane loadings, the force and moment balance solutions for a multiplane loading condition may not yield the same patella ligament force/quadriceps force ratio (FPL/FQ ratio) when compared with an axial loading condition. The purpose of this study was to compare the effects of an axial loading condition and an anatomical, multiplane loading condition on the FPL/FQ ratio at various knee flexion angles. Ten cadaver knees were used in this investigation. Each was mounted on a custom jig that was fixed to an Instron frame. Quadriceps muscle loads were applied with same resultant force magnitudes under two force directions, as follows: (1) axial loading (central quadriceps tendon loading parallel to the femoral axis), and (2) an anatomically based, multiplane loading condition (individual vasti loaded, taking into consideration physiologic muscle fiber orientation). Patellar ligament tension was measured using a buckle transducer. The patellar ligament force/quadriceps force ratio (FPL/FQ ratio) was calculated for both loading conditions at 0 deg, 20 deg, 40 deg, and 60 deg of knee flexion. Across the range of knee motion evaluated, the FPL/FQ ratio for the axial loading condition was significantly greater than the FPL/FQ ratio for the multiplane loading condition. Our results suggest that loading orientation affects the transfer of forces from the quadriceps tendon to the patellar ligament.

scholarly journals Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training

2020 ◽  
pp. 036354652098007
Author(s):  
Elanna K. Arhos ◽  
Jacob J. Capin ◽  
Thomas S. Buchanan ◽  
Lynn Snyder-Mackler
Keyword(s):  
Knee Flexion ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Sport Training ◽  
Gait Biomechanics ◽  
Peak Knee

Background: After anterior cruciate ligament (ACL) reconstruction (ACLR), biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with preoperative gait asymmetries and postoperative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to preoperative and early rehabilitation time points before return-to-sport training. Purpose/Hypothesis: The purpose was to determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after ACLR. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics, including tibiofemoral joint loading during gait. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Of 79 athletes enrolled in the ACL-SPORTS Trial, 76 were participants in this study after completing postoperative rehabilitation and 10 return-to-sport training sessions (mean ± SD, 7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value / uninvolved limb value × 100). The biomechanical variables of interest included peak knee flexion angle, peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and midstance, quadriceps muscle force at peak knee flexion angle, and peak medial compartment contact force. Spearman rank correlation (ρ) coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable; alpha was set to .05. Results: Of the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n = 23) or >110% (n = 4) (range, 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle; 68% and 83% in knee excursion during weight acceptance and midstance, respectively; 74% in internal peak knee extension moment; 57% in medial compartment contact force; and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable after return-to-sport training ( P > .129). Conclusion: Among those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.

scholarly journals Relationship between Quadriceps Tendon Young’s Modulus and Maximum Knee Flexion Angle in the Swing Phase of Gait in Patients with Severe Knee Osteoarthritis

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 437
Author(s):  
Bungo Ebihara ◽  
Takashi Fukaya ◽  
Hirotaka Mutsuzaki
Keyword(s):  
Young’S Modulus ◽  
Gait Speed ◽  
Knee Flexion ◽  
Young's Modulus ◽  
Quadriceps Tendon ◽  
Swing Phase ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Knee Oa ◽  
Analysis System

Background and objectives: Decreased knee flexion in the swing phase of gait can be one of the causes of falls in severe knee osteoarthritis (OA). The quadriceps tendon is one of the causes of knee flexion limitation; however, it is unclear whether the stiffness of the quadriceps tendon affects the maximum knee flexion angle in the swing phase. The purpose of this study was to clarify the relationship between quadriceps tendon stiffness and maximum knee flexion angle in the swing phase of gait in patients with severe knee OA. Materials and Methods: This study was conducted from August 2018 to January 2020. Thirty patients with severe knee OA (median age 75.0 (interquartile range 67.5–76.0) years, Kellgren–Lawrence grade: 3 or 4) were evaluated. Quadriceps tendon stiffness was measured using Young’s modulus by ShearWave Elastography. The measurements were taken with the patient in the supine position with the knee bent at 60° in a relaxed state. A three-dimensional motion analysis system measured the maximum knee flexion angle in the swing phase. The measurements were taken at a self-selected gait speed. The motion analysis system also measured gait speed, step length, and cadence. Multiple regression analysis by the stepwise method was performed with maximum knee flexion angle in the swing phase as the dependent variable. Results: Multiple regression analysis identified quadriceps tendon Young’s modulus (standardized partial regression coefficients [β] = −0.410; p = 0.013) and gait speed (β = 0.433; p = 0.009) as independent variables for maximum knee flexion angle in the swing phase (adjusted coefficient of determination = 0.509; p < 0.001). Conclusions: Quadriceps tendon Young’s modulus is a predictor of the maximum knee flexion angle. Clinically, decreasing Young’s modulus may help to increase the maximum knee flexion angle in the swing phase in those with severe knee OA.

scholarly journals In vivo stiffness assessment of patellar and quadriceps tendons by strain ultrasound elastography

2021 ◽  
pp. 1-10
Author(s):  
Surangika Wadugodapitiya ◽  
Makoto Sakamoto ◽  
Sayaka Suzuki ◽  
Yusuke Morise ◽  
Koichi Kobayashi
Keyword(s):  
Knee Flexion ◽  
Quadriceps Tendon ◽  
Strain Ratio ◽  
Ultrasound Elastography ◽  
Return To Sports ◽  
Target Tissue ◽  
Relative Stiffness ◽  
Extension Mechanism ◽  
Significant Difference

BACKGROUND: The patellar and quadriceps tendons are responsible for the extension mechanism of the knee joint and frequently become inflamed during sports. Diagnosis and determination of when an athlete can return to sports following these injuries are usually performed by assessing morphological features and functional outcomes. Nevertheless, mechanical properties are not being assessed. OBJECTIVE: To describe the stiffness characteristics of these two tendons over the range of knee flexion and to test the feasibility of using strain ultrasound elastography (SE). METHODS: SE with an acoustic coupler as the reference was performed for nine healthy males. Relative stiffness measurements were obtained using the strain ratio (SR = target tissue strain/reference strain) by placing the knee in five different flexion angles. Lower SR indicates higher relative stiffness. RESULTS: This study showed reliable measurement with good intra- and inter-rater agreement for SR at 30°. SR of the quadriceps tendon decreases as knee flexion increases, indicating increased relative stiffness. In the patellar tendon, no significant difference was observed between 30° and 60°. Beyond 60°, relative stiffness increased constantly. CONCLUSIONS: SE is a reproducible and feasible tool to monitor relative stiffness of the patellar and quadriceps tendons in routine clinical settings.

Short-Term Blood Flow Restriction Training Enhances Hamstrings/Quadriceps Force Ratio in Professional Soccer Players

2014 ◽  
Vol 46 ◽  
pp. 955
Author(s):  
Sérgio R. a. Camarda ◽  
Felipe B. Dias de Oliveira ◽  
Leandro Ribeiro ◽  
Camila C. Greco ◽  
Benedito S. Denadai
Keyword(s):  
Blood Flow ◽  
Blood Flow Restriction ◽  
Soccer Players ◽  
Short Term ◽  
Flow Restriction ◽  
Professional Soccer ◽  
Force Ratio ◽  
Quadriceps Force

Fatigue Behavior and Damage Mechanism of a Cast Aluminum Alloy in Very High Cycle Regime

2011 ◽  
Vol 264-265 ◽  
pp. 706-711
Author(s):  
Hong Qian Xue ◽  
E. Bayraktar ◽  
Claude Bathias
Keyword(s):  
Aluminum Alloy ◽  
Fatigue Crack ◽  
Fatigue Fracture ◽  
Loading Condition ◽  
Fatigue Behavior ◽  
Axial Loading ◽  
Cast Aluminum Alloy ◽  
Cast Aluminum ◽  
Fatigue Fracture Surface ◽  
Very High

An improved understanding of fatigue behavior of a cast aluminum alloy (2-AS5U3G-Y35) in very high cycle regime was developed through ultrasonic fatigue test in axial and torsion loading, cyclic loading in axial and torsion at 35 Hz and 20kHz with R=-1 was used respectively to demonstrate the effect of loading condition. S-N curves obtained show that fatigue failure occurred in range of 105 -1010 cycles in axial or torsion loading, the asymptote of S-N curve is inclined gently, but no fatigue limit under torsion and axial loading condition. Fatigue fracture surface shows fatigue crack essentially initiated from the surface of the specimens subjected to cyclic torsion load, it is different from the fatigue fracture characteristic in axial loading which fatigue crack initiate from subsurface defect in very high cycle regime. Fatigue initiation is on the maximum shear plane, the overall crack orientation is observed on a typical spiral 45° to the fracture plane, which is the maximum principle stress plane, however, shear strip are very clear in the torsion fatigue fracture surface, the torsion fracture is actually in shear fracture.

scholarly journals Differences in the Flexion and Extension Phases during Kneeling Investigated by Kinematic and Contact Point Analyses: A Cross-sectional Study

2021 ◽  
Author(s):  
Yusuke Nakazoe ◽  
Akihiko Yonekura ◽  
Hiroyuki Takita ◽  
Takeshi Miyaji ◽  
Narihiro Okazaki ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Contact Point ◽  
Knee Extension ◽  
Cross Sectional Study ◽  
Extension Phase ◽  
3D Registration ◽  
Cross Sectional ◽  
Registration Method ◽  
Computed Tomography Images ◽  
Flexion And Extension

Abstract Background: Kneeling is necessary for certain religious and ceremonial occasions, crouching work, and gardening, which many people take part in worldwide. However, there have been few reports regarding kneeling activities. The purpose of this study was to clarify the kinematics of kneeling.Methods: The subjects were 15 healthy young males. Kneeling activity was analysed within a knee flexion angle from 100° to maximum flexion (maxflex, mean ± SD = 161.3 ± 3.2°). The kinematic and contact point (CP) analyses were performed using a 2D/3D registration method, in which a 3D bone model created from computed tomography images was matched to knee lateral fluoroscopic images and analysed on a personal computer.Results: In the kinematic analysis, the femur translated 37.5 mm posteriorly and rotated 19.8° externally relative to the tibia during the knee flexion phase. During the knee extension phase, the femur translated 36.4 mm anteriorly, which was almost the same amount as in the knee flexion phase. However, the femur rotated only 7.4° internally during the knee extension phase. In the CP analysis, the amount of anterior translation of the CP in the knee extension phase was greater in the medial CP and smaller in the lateral CP than that of posterior translation in the knee flexion phase.Conclusions: In kneeling, there was a difference in the rotational kinematics between the flexion phase and the extension phase. The kinematic difference between the flexion and extension phases may have some effect on the meniscus and articular cartilage.

scholarly journals Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis

2021 ◽  
Vol 8 ◽  
Author(s):  
Chris A. McGibbon ◽  
Scott Brandon ◽  
Emily L. Bishop ◽  
Chris Cowper-Smith ◽  
Edmund N. Biden
Keyword(s):  
Knee Joint ◽  
Knee Flexion ◽  
Sagittal Plane ◽  
Weight Bearing ◽  
Knee Injuries ◽  
Statistical Parameter ◽  
Quadriceps Tendon ◽  
Biomechanical Study ◽  
Contact Forces ◽  
Joint Force

Objective: Off-loader knee braces have traditionally focused on redistributing loads away from either the medial or lateral tibiofemoral (TF) compartments. In this article, we study the potential of a novel “tricompartment unloader” (TCU) knee brace intended to simultaneously unload both the patellofemoral (PF) and TF joints during knee flexion. Three different models of the TCU brace are evaluated for their potential to unload the knee joint.Methods: A sagittal plane model of the knee was used to compute PF and TF contact forces, patellar and quadriceps tendon forces, and forces in the anterior and posterior cruciate ligaments during a deep knee bend (DKB) test using motion analysis data from eight participants. Forces were computed for the observed (no brace) and simulated braced conditions. A sensitivity and validity analysis was conducted to determine the valid output range for the model, and Statistical Parameter Mapping was used to quantify the effectual region of the different TCU brace models.Results: PF and TF joint force calculations were valid between ~0 and 100 degrees of flexion. All three simulated brace models significantly (p &lt; 0.001) reduced predicted knee joint loads (by 30–50%) across all structures, at knee flexion angles &gt;~30 degrees during DKB.Conclusions: The TCU brace is predicted to reduce PF and TF knee joint contact loads during weight-bearing activity requiring knee flexion angles between 30 and 100 degrees; this effect may be clinically beneficial for pain reduction or rehabilitation from common knee injuries or joint disorders. Future work is needed to assess the range of possible clinical and prophylactic benefits of the TCU brace.

Tibiofemoral Contact After Conventional and High-Flexion Posterior Cruciate-Retaining Total Knee Arthroplasty

2003 ◽  
Author(s):  
Ephrat Most ◽  
Guoan Li ◽  
Harry E. Rubash
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Contact Point ◽  
Knee Kinematics ◽  
Testing System ◽  
High Flexion ◽  
Human Knee ◽  
Contact Points ◽  
Total Knee

The human knee is capable of flexing up to 160°, yet most patients do not achieve more than 120° after total knee arthroplasty (TKA). The translation of the tibiofemoral contact points with flexion is important in the overall understanding of knee kinematics and knee stability, particularly in high flexion. In this study, cadaveric knees were used in conjunction with a robotic testing system and TekScan® film to quantify the tibiofemoral contact between 0°–150° for two TKA designs. We found that, for both TKAs, with increasing knee flexion, the peak contact point moved posteriorly and that the contact area decreased with increasing knee flexion.

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