Gait biomechanics are not normal after anterior cruciate ligament reconstruction and accelerated rehabilitation
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Abstract:
Accelerated rehabilitation for anterior cruciate ligament (ACL) injury and reconstruction surgery is designed to return injured people to athletic activities in approximately 6 months. The small amount of empirical data on this population suggests, however, that the torque at the knee joint may not return until 22 months after surgery during walking and even longer during running. Although the rehabilitation has ended and individuals have returned to preinjury activities, gait mechanics appear to be abnormal at the end of accelerated programs. The purpose of this study was to compare lower extremity joint kinematics, kinetics, and energetics between individuals having undergone ACL reconstruction and accelerated rehabilitation and healthy individuals.Eight ACL-injured and 22 healthy subjects were tested. Injured subjects were tested 3 wk and 6 months (the end of rehabilitation) after surgery. Ground reaction force and kinematic data were combined with inverse dynamics to predict sagittal plane joint torques and powers from which angular impulse and work were derived.The difference in all kinematic variables between the two tests for the ACL group averaged 38% (all P < 0.05). The kinematics were not different between the ACL group after rehabilitation and healthy subjects. Angular impulses and work averaged 100% difference for all joints (all P < 0.05) between tests for the ACL group. After rehabilitation, the differences between injured and healthy groups in angular impulse and work at both the hip and knee remained large and averaged 52% (all P < 0.05).Results indicated that after reconstruction surgery and accelerated rehabilitation for ACL injury, humans walk with normal kinematic patterns but continue to use altered joint torque and power patterns.Keywords:
Biomechanics
ACL injury
Angular acceleration
Ground reaction force
Abstract Women are more prone to anterior cruciate ligament (ACL) injury during cutting sports than men. The purpose of this study was to examine knee kinematic and ground reaction forces (GRF) differences between genders during cutting. Male and female athletes performed cutting trials while force platform and video data were recorded (180 Hz). Differences (p ≤ .05) were observed between groups for knee flexion at contact and GRF at maximum knee flexion. Women averaged 5.8° less flexion at contact and 1.0 N·(kg·m·s1)−1 greater GRF at maximum flexion. Knee range of motion and peak GRF variables were not significantly different, but women had greater values. Women exhibited technique characteristics believed to increase ACL injury risk, but men exhibiting similar characteristics were also observed and could also be at risk.
Ground reaction force
ACL injury
Knee flexion
Sprint
Force platform
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An insole system was constructed with 32 sensors inside a size 10 men's shoe. This system allows evaluation of the contributions of individual sensors spread throughout the surface area of the insole. The kinetic variables of interest in this initial study are ground reaction force and anterior-posterior ankle moment. Use of all 32 sensors are able to replicate the shape of the ground reaction force and ankle moment in a stroke patient who has regained a more normal gait, but less so in a stroke patient with impaired gait. Subsets of sensors can now be evaluated in order to ultimately identify an optimum set of sensors for determining kinetic variables necessary to classify presence or absence of a particular gait abnormality or other pathology.
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Stroke
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Objective— To determine the combination of ground reaction forces (GRFs) that best discriminates between lame and non‐lame dogs. To compare the sensitivity of force platform gait analysis and visual observation at detecting gait abnormalities in Labradors after surgery for rupture of the cranial cruciate ligament (CCL). Animals— All dogs were adult Labrador Retrievers: 17 free of orthopedic and neurologic abnormalities, 100 with unilateral CCL rupture, and 131 studied 6 months after surgery for unilateral CCL injury, 15 with observable lameness. Procedure— Dogs were walked over a force platform with GRF recorded during the stance phase. Analytic properties of force platform gait analysis were calculated for several combinations of forces. The probability of visual observation detecting a gait abnormality was compared with that of force platform gait analysis. Results— We determined that a combination of peak vertical force (PVF) and falling slope were optimal for discriminating sound and lame Labradors. After surgery, many dogs (75%) with no observable lameness failed to achieve GRFs consistent with sound Labradors. Conclusion— A force platform is an accurate method of assessing lameness in Labradors with CCL rupture and is more sensitive than visual observation. Assessing lameness with a combination of GRFs is better than using univariate GRFs. Clinical Relevance— Therapies for stifle lameness can be accurately and objectively evaluated using 2 vertical ground reaction forces obtained from a force platform.
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Gait cycle
ACL injury
Biomechanics
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I report the results from gait analysis for coxarthrotic patients using a ground reaction force plate and a three-dimensional motion analysis system. Twenty-seven coxarthrotic patients, and 9 healthy females as controls, participated in this study. The waveform of the ground reaction force and the joint moment during the stance phase were evaluated. The waveform of the hip joint moment changed and flattened in both pre-coxarthrosis and early-coxarthrotic patients, compared to those in controls, indicating that coxarthrotic patients adopted a particular gait pattern to reduce the load on the affected hip joint. Beyond X-ray observations and physical examinations, joint moment analysis could achieve a more objective evaluation of the clinical stage of coxarthrosis.
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This study aims at testing the application of principal component analysis (PCA) in the ground reaction force (GRF) in discriminating the gait pattern between normal and abnormal subjects, and assessing the rehabilitation treatment. The sample was composed by 31 subjects, organized into two groups: a control group (CG) of 25 normal and a group (FG) of six patients with lower limb fractures, which was considered before (FGB) and after (FGA) a treadmill physiotherapeutic treatment. The vertical component of GRF data was collected with an instrumentized treadmill. PCA method was applied and the first two coefficients (PCC) were obtained for the three groups. The region of CG values was separated in the PCC plane with the elliptical area of displacement and with a linear threshold between CG and FGB obtained by stepwise logistic regression. Results show that all values of FGA moved towards CG region from the corresponding FGB position, indicating the potential power of PCA in discriminating between normal and abnormal gait and objectively evaluating the effects of rehabilitation treatment.
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The purpose of this paper is to perform a biomechanical analysis of a human normal cycle gait of some subjects with a body weight between 55 and 90 kg. The biomechanical analysis is presented to determining ground reaction forces (Fx, Fy, Fz) and moments (Mx, My, Mz) during normal human walking based only on anthropometrical data and a force plate. The pressures sensed by the transducers during a movement are captured on computer, and a graphical display is typically used to provide an indication of the time-history of the reaction forces over the contact surface.
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The locomotion biomechanics study provides very extensive and interesting material for investigating the physiological process involved and the neural mechanisms controlling the systems. Gait analysis - the systematic analysis of locomotion - is used today for pretretment assessment, surgical decision making, postoperative follow-up, and management of both adult and young patients. Over the past few decades, multiple advances in bioengineering technology have permited precise analysis of many specific gait characteristics, such as joint angles, angular velocities and angular accelerations (kinematic analysis), as well as ground reaction forces, joint forces, moments and powers (kinetic analysis); electromyographic activity and energy consumption. Sophisticated gait analysis equipment can generate a visible force vector on an oscilloscope screen and superimpose it simultaneously on a photograph of a gait subject. Visualizing ground reaction forces helps us understand the effect they are having on the body in walking. If we have a full kinematic description, accurate anthropometric measures, and the external forces, we can calculate the joint reaction forces and musle moments. This predicition, called the inverse solution, is a very powerful tool in gaining insight into the net summation of all muscle activity at each joint. In this paper, we present and discuss the results of a ground reaction force analysis, conducted using the data samples of 40 voluntary subjects from our faculty student and employee population, differing in age, sex, height and weight, measured by the AMTI force platform.
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Biomechanics
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The purpose of this study was to clarify relationship between foot arch deformation characteristics and balance maintenance mechanism during support phase in running. The functional roles of support leg joints were analyzed by quantifying dynamic contributions of the joint torques to the generation of ground reaction force (GRF) and ankle angular acceleration vectors normal to the frontal plane using the equation of whole-body motion. Seven male runners participated in this research and ran at the speed of 5.5m/s. The trajectories of 47 markers attached to the body and the ground reaction force of the support leg were measured with VICON-MX system with a force plate. In addition, the stiffness of the arch was identified during a support phase of a gait for one step. From the magnitude of the arch stiffness, the participants were divided into two groups such as Type L (low arch stiffness) and Type H (high arch stiffness). The results of analyses indicate that 1) the contributions of individual joint axial torques to the horizontal medial-lateral components of the GRF were canceled so as to reduce the component regardless of the type of groups, 2) the contributions of individual joint axial torques to the ankle angular acceleration, whose axis is normal to the frontal plane, were canceled so as to reduce the angular acceleration, 3) the GRF and the angular acceleration were induced by joint torques whose axes are not only normal to frontal plane but also along other directions, and 4) the difference of balance maintenance mechanisms between the groups in the frontal plane maybe due to differences in arch stiffness as well as running forms and COP locations.
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