Predictions of Condylar Contact During Normal and Medial Thrust Gait

2012 ◽  
Author(s):  
Kurt Manal ◽  
Thomas S. Buchanan
Keyword(s):  
Knee Extensor ◽  
Frontal Plane ◽  
Musculoskeletal Model ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Force Sensing ◽  
Joint Loading ◽  
Knee Oa ◽  
Surrogate Measure ◽  
Direct Measures

The medial compartment of the knee is the joint most often affected in those with osteoarthritis (OA). The knee adduction moment is a widely used surrogate measure of joint loading as direct measures are not possible except for a few individuals fitted with a force sensing prosthesis. A reduction in the frontal plane moment is believed to be associated with reduced joint compression. As such, treatments and/or gait alterations to reduce the magnitude of the adduction moment have been sought for those with knee OA. Walking with a medial thrust gait has been shown to reduce the magnitude of the knee adduction moment. The purpose of this paper is to apply our EMG-driven musculoskeletal model of the knee to predict muscle forces and condylar loading during normal and medial thrust gait for an individual fitted with an instrumented knee. It was anticipated that walking with a medial thrust gait would produce a reduced knee adduction moment. We propose however that a reduced knee adduction moment may not necessarily be associated with a decrease in medial compartment loading, and importantly, one must consider how the knee extensor moment changes before making inferences about joint loading.

Reduction in the Medial Compartment Force Correlates With the Reduction in Knee Adduction Moment Using a Variable-Stiffness Shoe With an Instrumented Knee

2009 ◽  
Author(s):  
Jennifer C. Erhart ◽  
Chris Dyrby ◽  
Darryl D. D’Lima ◽  
Clifford W. Colwell ◽  
Thomas P. Andriacchi
Keyword(s):  
Treatment Outcome ◽  
Variable Stiffness ◽  
Lateral Compartment ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Joint Loading ◽  
Knee Oa ◽  
Total Knee ◽  
Joint Loads

Osteoarthritis (OA) of the knee affects an estimated 20–40% of individuals over the age of 65 [1], and is nearly 10 times more common in the medial compartment than the lateral compartment [2]. Many studies have reported the effectiveness of footwear modifications using laterally-wedged insoles [3,4] and more recently, variable-stiffness soles [5] in reducing the adduction moment at the knee in patients with medial compartment knee OA. The adduction moment is known to be associated with the progression [6] and treatment outcome [7] of medial compartment knee OA, and has been shown to be correlated with medial compartment joint loading [8]. However, the exact changes in medial compartment joint loading in vivo with the variable-stiffness shoe remain unknown. The development of an instrumented total knee implant which has the ability to directly measure tibial forces, and can differentiate between medial and lateral joint loads in vivo during walking [9], allows the testing of changes in the medial compartment loading with an intervention shoe.

scholarly journals Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Margit Biehl ◽  
Philipp Damm ◽  
Adam Trepczynski ◽  
Stefan Preiss ◽  
Gian Max Salzmann
Keyword(s):  
Gait Analysis ◽  
Measurement Data ◽  
Frontal Plane ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
In Vivo Measurement ◽  
Force Ratio ◽  
Leg Alignment ◽  
Alignment Angle

Abstract Purpose Despite practised for decades, the planning of osteotomy around the knee, commonly using the Mikulicz-Line, is only empirically based, clinical outcome inconsistent and the target angle still controversial. A better target than the angle of frontal-plane static leg alignment might be the external frontal-plane lever arm (EFL) of the knee adduction moment. Hypothetically assessable from frontal-plane-radiograph skeleton dimensions, it might depend on the leg-alignment angle, the hip-centre-to-hip-centre distance, the femur- and tibia-length. Methods The target EFL to achieve a medial compartment force ratio of 50% during level-walking was identified by relating in-vivo-measurement data of knee-internal loads from nine subjects with instrumented prostheses to the same subjects’ EFLs computed from frontal-plane skeleton dimensions. Adduction moments derived from these calculated EFLs were compared to the subjects’ adduction moments measured during gait analysis. Results Highly significant relationships (0.88 ≤ R2 ≤ 0.90) were found for both the peak adduction moment measured during gait analysis and the medial compartment force ratio measured in vivo to EFL calculated from frontal-plane skeleton dimensions. Both correlations exceed the respective correlations with the leg alignment angle, EFL even predicts the adduction moment’s first peak. The guideline EFL for planning osteotomy was identified to 0.349 times the epicondyle distance, hence deducing formulas for individualized target angles and Mikulicz-Line positions based on full-leg radiograph skeleton dimensions. Applied to realistic skeleton geometries, widespread results explain the inconsistency regarding correction recommendations, whereas results for average geometries exactly meet the most-consented “Fujisawa-Point”. Conclusion Osteotomy outcome might be improved by planning re-alignment based on the provided formulas exploiting full-leg-radiograph skeleton dimensions.

Quantifying Achievable Levels of Improvement in Knee Joint Biomechanics During Gait After Total Knee Arthroplasty Relative to Osteoarthritis Severity

2020 ◽  
pp. 1-9
Author(s):  
Jereme B. Outerleys ◽  
Michael J. Dunbar ◽  
Glen Richardson ◽  
Cheryl L. Hubley-Kozey ◽  
Janie L. Astephen Wilson
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Frontal Plane ◽  
Knee Adduction Moment ◽  
Patient Specific ◽  
Knee Biomechanics ◽  
Knee Oa ◽  
Joint Biomechanics ◽  
Total Knee

Total knee arthroplasty (TKA) surgery improves knee joint kinematics and kinetics during gait for most patients, but a lack of evidence exists for the level and incidence of improvement that is achieved. The objective of this study was to quantify patient-specific improvements in knee biomechanics relative to osteoarthritis (OA) severity levels. Seventy-two patients underwent 3-dimensional (3D) gait analysis before and 1 year after TKA surgery, as well as 72 asymptomatic adults and 72 with moderate knee OA. A combination of principal component analysis and discriminant analyses were used to categorize knee joint biomechanics for patients before and after surgery relative to asymptomatic, moderate, and severe OA. Post-TKA, 63% were categorized with knee biomechanics consistent with moderate OA, 29% with severe OA, and 8% asymptomatic. The magnitude and pattern of the knee adduction moment and angle (frontal plane features) were the most significant contributors in discriminating between pre-TKA and post-TKA knee biomechanics. Standard of care TKA improves knee biomechanics during gait to levels most consistent with moderate knee OA and predominately targets frontal plane features. These results provide evidence for the level of improvement in knee biomechanics that can be expected following surgery and highlight the biomechanics most targeted by surgery.

Changes in Tibiofemoral Kinematics and Kinetics During Stair Ascent After Partial Medial Meniscectomy

2008 ◽  
Author(s):  
Nathan A. Netravali ◽  
Thomas P. Andriacchi
Keyword(s):  
Cruciate Ligament ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Ligament Injury ◽  
Medial Meniscectomy ◽  
Surrogate Measure ◽  
Anterior Cruciate ◽  
Tibiofemoral Kinematics ◽  
Kinematics And Kinetics

Meniscectomy is a well-known risk factor for osteoarthritis (OA) in humans. It has been reported that total meniscectomy increases the risk of developing osteoarthritis radiographically by 14 times after 21 years [1] and that partial meniscectomy increases the risk of developing radiographic evidence of osteoarthritis within 16 years by a factor of four [2]. Two possible functional measures have been suggested as mechanisms for the development and progression of premature knee osteoarthritis: alterations in either kinematics or kinetics. Changes in kinematics, such as a shift in internal-external (IE) rotation after anterior cruciate ligament injury, have been suggested as a basis for an increased rate of cartilage thinning [3]. The other possible reason for the development of premature OA post-meniscectomy is a change in kinetics, the mechanical loading that occurs, particularly in the medial compartment [4]. The knee adduction moment has been associated with the rate of progression of osteoarthritis [5] and it has thus been suggested that the knee adduction moment is a good surrogate measure for in vivo load on the medial compartment osteoarthritis [6].

Muscle Forces May Explain Paradoxical Knee Loads During Different Gait Patterns

2010 ◽  
Author(s):  
Jonathan P. Walter ◽  
Darryl D. D’Lima ◽  
Benjamin J. Fregly
Keyword(s):  
Disease Progression ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Gait Patterns ◽  
Common Assumption ◽  
Clinical Disorder ◽  
Surrogate Measure ◽  
Gait Modification ◽  
External Knee Adduction Moment

Medial compartment knee osteoarthritis is a common clinical disorder [1] in which the articular cartilage in the medial compartment progressively deteriorates. To slow disease progression without surgical intervention, researchers have proposed gait modifications to offload the medial compartment. Since knee medial contact force (MCF) cannot be measured non-invasively in vivo, researchers have identified the external knee adduction moment (KAM) as a surrogate measure that is easy to calculate [2]. A common assumption has been that reducing the peak KAM will result in a corresponding reduction in peak MCF. While the magnitude of the peak KAM has been correlated with disease severity and rate of disease progression [3,4], it is not clear that reduction of this external load via gait modification will always result in a decrease in internal MCF.

scholarly journals Effect of a Home Program of Hip Abductor Exercises on Knee Joint Loading, Strength, Function, and Pain in People With Knee Osteoarthritis: A Clinical Trial

2010 ◽  
Vol 90 (6) ◽  
pp. 895-904 ◽  
Author(s):  
Elizabeth A. Sled ◽  
Latif Khoja ◽  
Kevin J. Deluzio ◽  
Sandra J. Olney ◽  
Elsie G. Culham
Keyword(s):  
Knee Joint ◽  
Functional Performance ◽  
Knee Adduction Moment ◽  
Control Group ◽  
Joint Loading ◽  
Medial Knee ◽  
Knee Oa ◽  
Sit To Stand ◽  
Hip Abductor ◽  
Knee Joint Loading

BackgroundHip abductor muscle weakness may result in impaired frontal-plane pelvic control during gait, leading to greater medial compartment loading in people with knee osteoarthritis (OA).ObjectiveThis study investigated the effect of an 8-week home strengthening program for the hip abductor muscles on knee joint loading (measured by the external knee adduction moment during gait), strength (force-generating capacity), and function and pain in individuals with medial knee OA.DesignThe study design was a nonequivalent, pretest-posttest, control group design.SettingTesting was conducted in a motor performance laboratory.PatientsAn a priori sample size calculation was performed. Forty participants with knee OA were matched for age and sex with a control group of participants without knee OA.InterventionParticipants with knee OA completed a home hip abductor strengthening program.MeasurementsThree-dimensional gait analysis was performed to obtain peak knee adduction moments in the first 50% of the stance phase. Isokinetic concentric strength of the hip abductor muscles was measured using an isokinetic dynamometer. The Five-Times-Sit-to-Stand Test was used to evaluate functional performance. Knee pain was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire.ResultsFollowing the intervention, the OA group demonstrated significant improvement in hip abductor strength, but not in the knee adduction moment. Functional performance on the sit-to-stand test improved in the OA group compared with the control group. The OA group reported decreased knee pain after the intervention.LimitationsGait strategies that may have affected the knee adduction moment, including lateral trunk lean, were not evaluated in this study.ConclusionsHip abductor strengthening did not reduce knee joint loading but did improve function and reduce pain in a group with medial knee OA.

Dynamic Versus Radiographic Alignment in Relation to Medial Knee Loading in Symptomatic Osteoarthritis

2012 ◽  
Vol 28 (5) ◽  
pp. 551-559 ◽  
Author(s):  
Joaquin A. Barrios ◽  
Todd D. Royer ◽  
Irene S. Davis
Keyword(s):  
Frontal Plane ◽  
Epidemiological Studies ◽  
Knee Adduction Moment ◽  
Knee Alignment ◽  
Radiographic Findings ◽  
Medial Knee ◽  
Knee Oa ◽  
Peak Knee ◽  
Knee Loading ◽  
Radiographic Alignment

Dynamic knee alignment is speculated to have a stronger relationship to medial knee loading than radiographic alignment. Therefore, we aimed to determine what frontal plane knee kinematic variable correlated most strongly to the knee adduction moment. That variable was then compared with radiographic alignment as a predictor of the knee adduction moment. Therefore, 55 subjects with medial knee OA underwent three-dimensional gait analysis. A subset of 21 subjects also underwent full-limb radiographic assessment for knee alignment. Correlations and regression analyses were performed to assess the relationships between the kinematic, kinetic and radiographic findings. Peak knee adduction angle most strongly correlated to the knee adduction moment of the kinematic variables. In comparison with radiographic alignment, peak knee adduction angle was the stronger predictor. Given that most epidemiological studies on knee OA use radiographic alignment in an attempt to understand progression, these results are meaningful.

Prediction of Internal Contact Forces at the Knee From External Measurements

2008 ◽  
Author(s):  
Jonathan P. Walter ◽  
Scott A. Banks ◽  
Darryl D. D’Lima ◽  
Benjamin J. Fregly
Keyword(s):  
Stance Phase ◽  
Cartilage Damage ◽  
Contact Forces ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Baby Boomer Generation ◽  
Risk Of Disease ◽  
Surrogate Measure ◽  
External Knee Adduction Moment

As the baby boomer generation ages, knee osteoarthritis (OA) will become increasingly prevalent in our society. Articular cartilage damage in the knee is highly dependent upon subject-specific kinematics and load distribution inside the joint. In particular, researchers have hypothesized that overloading of the medial compartment is a primary contributing factor to the development of the disease [1]. However, since medial compartment load cannot be measured non-invasively in vivo, researchers typically use the external knee adduction moment during stance phase as a surrogate measure. This quantity has been correlated with the medial tibial contact force measured from an instrumented knee implant [2] and with the risk of disease progression over time [3].

An Efficient One-Step Moment Balancing Algorithm for Computing Medial and Lateral Knee Compartment Contact Forces

2021 ◽  
Author(s):  
Kurt Manal ◽  
Thomas S. Buchanan
Keyword(s):  
Compressive Force ◽  
Frontal Plane ◽  
Lateral Force ◽  
Lateral Compartment ◽  
Contact Forces ◽  
Knee Adduction Moment ◽  
Muscle Forces ◽  
Bone Contact ◽  
Knee Oa ◽  
One Step

Abstract The knee adduction moment is associated with the progression of knee osteoarthritis (OA). The adduction moment reflects the net effect of muscles, passive tissues and bone-on-bone contact forces. Medial compartment OA is more common than lateral and therefore our ability to correctly partition bone-on-bones forces across the medial and lateral compartments is key to understanding mechanical factors associated with the onset and progression of knee OA. We have used frontal plane moment balancing to resolve medial and lateral compartment forces. In this technical brief we present an alternate and more efficient methodology, the 1-step approach, linking the sagittal and frontal planes in the determination of muscle forces. Muscle forces are the dominant contributors to knee joint loading and therefore our ability to predict compartmental contact is dependent on our ability to predict muscle forces. The 1-step approach introduces a penalty function limiting total compressive force from acting in the lateral compartment whenever the internal moment is net abduction (i.e., external knee adduction). Total compressive force in the lateral compartment implies greater lateral loading compared to medial, and this is inconsistent with what we know about the knee adduction moment and medial-to-lateral force distribution during gait. An EMG-driven musculoskeletal model with modified hamstrings EMG was implemented to demonstrate the 1-step methodology and compare results with frontal plane moment balancing. The 1-step approach is a more efficient methodology that can be used in place of frontal plane moment balancing.

Sign in / Sign up

Export Citation Format

Share Document