Die Therapie der vorderen Kreuzbandruptur im Wachstumsalter wird nach wie vor kontrovers diskutiert. Es sollte mit der vorliegenden Studie untersucht werden, ob die operative oder konservative Therapie der vorderen Kreuzbandruptur im Wachstumsalter favorisiert werden sollte. Hierzu erfolgte eine Literaturrecherche in den Datenbanken Medline, dem Cochrane controlled trial register, Embase und Medpilot. Zehn Studien mit insgesamt 154 Patienten konnten zur Auswertung der konservativen Therapie, 55 Studien mit 935 Patienten zur operativen Therapie verwendet werden. Das Durchschnittsalter der konservativ behandelten Gruppe lag bei 12,3 (10-14,4) Jahren, das der operativen Gruppe bei 13,3 (10,0-15,8) Jahren. Zusammenfassend ergaben sich signifikant bessere Ergebnisse bezüglich Lysholm Score (95,5 vs. 73,2; p<0,05), der Instabilität gemessen am Giving Way Phänomen (2,8% vs. 89,5%; p<0,05) und der Wiedererlangung des Sportniveaus (91,2% vs. 30,9%; p<0,05) in der operativ versorgten Gruppe. Das relative Risiko für Beinlängendifferenzen von mehr als 1 cm bzw. Achsabweichungen von mehr als 3° nach operativer Behandlung ist mit 2,1% gering. Rerupturen treten in 3,8% der Fälle auf. Kein wesentlicher Einfluss auf das klinische Ergebnis konnte hinsichtlich Nachuntersuchungszeitraum und Publikationsjahr gefunden werden. Aufgrund der vorliegenden Ergebnisse ist die operative Therapie bei der vorderen Kreuzbandruptur im Wachstumsalter der konservativen Therapie überlegen und somit in den meisten Fällen vorzuziehen.

Bakgrund: Personer som drabbas av knäledsartros där inte medicinsk behandling fungerat blir aktuella för total knäartroplastik (TKA). Under en persons livstid är risken att få knäledsartros 40-45%. TKA förknippas med måttlig till svår smärta efter det kirurgiska ingreppet. Smärtlindringsmetoder har utvecklats och blivit effektivare för att patienten ska få bättre smärtlindring postoperativt. Tidigare studier har visat att god postoperativ smärtlindring förbättrar återhämtningen och minskar postoperativa komplikationer för patienten. Syftet: Syftet med vår kvantitativa enkätstudie var att undersöka patientens skattning av smärta postoperativt efter TKA. Metod: I studien deltog 29 kvinnor och män mellan 53-84 år. Deltagarna fick skatta sin smärta vid två tillfällen, 0-1 timme och mellan 2-4 timmar postoperativt med visuell analog skala (VAS). Data analyserades i SPSS version 24.0. Resultatet: Resultatet visade att efter 0-1 timme postoperativt hade 89.7% VAS ≤ 3 och vid 2-4 timmar postoperativt hade 75.8% VAS ≤ 3. Majoriteten av deltagarna 72.4% skattade sin smärta VAS ≤ 3 vid båda tillfällena. Det fanns en skillnad mellan de deltagare som erhållit spinalanestesi och generell anestesi. Vid första skattningen postoperativt var det ingen som erhållit spinalanestesi som skattade smärta, de som skattade VAS &gt; 3 hade erhållit generell anestesi. Konklusion: Slutsatsen är att patienter som genomgår TKA är väl smärtlindrade men att en större studie med fler antal deltagare skulle behövas göras för att utveckla bättre omvårdnadsrutiner för att möta personers behov av smärtlindringen när spinalanestesins effekter avtagit.

Osteoarthritis (OA) is the leading cause of disability in North American and has major economic consequences for society. People with knee OA experience the worst quality of life, among musculoskeletal conditions, with function and mobility being influenced by symptoms such as pain and stiffness. However, the impact of OA symptoms varies due to intrinsic and extrinsic factors, leading many researchers to employ biopsychosocial and other population health frameworks to study the disease. These population health approaches have not been adopted when studying knee OA outcomes in bioarchaeology, where a limited biological lens prevails due to the sole reliance on skeletal remains. The purpose of this research was to explore methods for identifying the impairment potential of knee OA in archaeological populations using a clinical sample and population health approaches. Clinical studies have the advantage of assessing not only the biological implications of knee OA but also the functional outcomes. By creating a knee OA grading system applicable for both MRI and dry bone femora samples (Clinical Archaeological Osteoarthritis Score) a link between clinical and archaeological populations was proposed. Using this link to infer functional deficits onto archaeological populations using population health frameworks, a theoretical analysis was performed with two populations; the 17th century Huron and the 19th century Inuit from the Igloolik region of Nunavut. The results demonstrated the increased impairment potential of knee OA in the Inuit population versus the Huron population, produced by contrasting factors captured by the determinants of health, including social and physical environments.

Background: Joint stability has been experimentally and clinically linked to mechanisms of knee injury and joint degeneration. The only dynamic, and perhaps most important, regulators of knee joint stability are contributions from muscular contractions. In participants with unstable knees, such as anterior cruciate ligament (ACL) injured, a range of neuromuscular adaptations has been observed including quadriceps weakness and increased co-activation of adjacent musculature. This co-activation is seen as a compensation strategy to increase joint stability. In fact, despite increased co-activation, instability persists and it remains unknown whether observed adaptations are the result of injury induced quadriceps weakness or the mechanical instability itself. Furthermore, there exists conflicting evidence on how and which of the neuromuscular adaptations actually improve and/or reduce knee joint stability. Purpose: The overall aim of this thesis is therefore to elucidate the role of injury and muscle weakness on muscular contributions to knee joint stability by addressing two main objectives: (1) to further our understanding of individual muscle contribution to internal knee joint moments; and (2) to investigate neuromuscular adaptations, and their effects on knee joint moments, caused by either ACL injury and experimental voluntary quadriceps inhibition (induced by pain). Methods: The relationship between individual muscle activation and internal net joint moments was quantified using partial least squares regression models. To limit the biomechanical contributions to force production, surface electromyography (EMG) and kinetic data was elicited during a weight-bearing isometric force matching task. A cross-sectional study design determined differences in individual EMG-moment relationships between ACL deficient and healthy controls (CON) groups. A crossover placebo controlled study design determined these differences in healthy participants with and without induced quadriceps muscle pain. Injections of hypertonic saline (5.8%) to the vastus medialis induced muscle pain. Isotonic saline (0.9%) acted as control. Effect of muscle pain on muscle synergies recruited for the force matching task, lunging and squatting tasks was also evaluated. Synergies were extracted using a concatenated non-negative matrix factorization framework. Results/Discussion: In CON, significant relationships of the rectus femoris and tensor fascia latae to knee extension and hip flexion; hamstrings to hip extension and knee flexion; and gastrocnemius and hamstrings to knee rotation were identified. Vastii activation was independent of moment generation, suggesting mono-articular vastii activate to produce compressive forces, essentially bracing the knee, so that bi-articular muscles crossing the hip can generate moments for the purpose of sagittal plane movement. Hip ab/adductor muscles modulate frontal plane moments, while hamstrings and gastrocnemius support the knee against externally applied rotational moments. Compared to CON, ACL had 1) stronger relationships between rectus femoris and knee extension, semitendinosus and knee flexion, and gastrocnemius and knee flexion moments; and 2) weaker relationships between biceps femoris and knee flexion, gastrocnemius and external knee rotation, and gluteus medius and hip abduction moments. Since the knee injury mechanism, is associated with shallow knee flexion angles, valgus alignment and rotation, adaptations after ACL injury are suggested to improve sagittal plane stability, but reduce frontal and rotational plane stability. During muscle pain, EMG-moment relationships of 1) semitendinosus and knee flexor moments were stronger compared to no pain, while 2) rectus femoris and tensor fascia latae to knee extension moments and 3) semitendinosus and lateral gastrocnemius to knee internal rotation moments were reduced. Results support the theory that adaptations to quadriceps pain reduces knee extensor demand to protect the joint and prevent further pain; however, changes in non-painful muscles reduce rotational plane stability. Individual muscle synergies were identified for each moment type: flexion and extension moments were respectively accompanied by dominant hamstring and quadriceps muscle synergies while co-activation was observed in muscle synergies associated with abduction and rotational moments. Effect of muscle pain was not evident on muscle synergies recruited for the force matching task. This may be due to low loading demands and/or a subject-specific redistribution of muscle activation. Similarly, muscle pain did not affect synergy composition in lunging and squatting tasks. Rather, activation of the extensor dominant muscle synergy and knee joint dynamics were reduced, supporting the notion that adaptive response to pain is to reduce the load and risk of further pain and/or injury. Conclusion: This thesis evaluated the interrelationship between muscle activation and internal joint moments and the effect of ACL injury and muscle pain on this relationship. Findings indicate muscle activation is not always dependent on its anatomical orientation as previous works suggest, but rather on its role in maintaining knee joint stability especially in the frontal and transverse loading planes. In tasks that are dominated by sagittal plane loads, hamstring and quadriceps will differentially activate. However, when the knee is required to resist externally applied rotational and abduction loads, strategies of global co-activation were identified. Contributions from muscles crossing the knee for supporting against knee adduction loads were not apparent. Alternatively hip abductors were deemed more important regulators of knee abduction loads. Both muscle pain and ACL groups demonstrated changes in muscle activation that reduced rotational stability. Since frontal plane EMG-moment changes were not present during muscle pain, reduced relationships between hip muscles and abduction moments may be chronic adaptions by ACL that facilitate instability. Findings provide valuable insight into the roles muscles play in maintaining knee joint stability. Rehabilitative/ preventative exercise interventions should focus on neuromuscular training during tasks that elicit rotational and frontal loads (i.e. side cuts, pivoting maneuvers) as well as maintaining hamstring balance, hip abductor and plantarflexor muscle strength in populations with knee pathologies and quadriceps muscle weakness.

Introduction. The pain is an important symptom that could be related to alteration of body balance in patients who has osteoarthritis and total knee arthroplasty (TKA). Objective. To analyze the intensity of pain, functionality, muscle strength, static and dynamic balance in patients submitted to TKA and to compare with healthy control. Methods. There were 40 subjects, 20 of them were evaluated in three phases: (1) pre-operatory, (2) 6 months after TKA and (3) 12 months after TKA and 20 others healthy people evaluated in one only moment. The evaluation of pain and functionality were done with Numeric Pain Scale and Western Ontario and McMaster Universities Arthritis Index, respectively. The static body balance was evaluated by stabilometry measuring the oscillating area of the center of pressure oscillating, and average speed of the center of pressure oscillating (AS of CPO). The dynamic balance was assessed through the Star Excursion Balance Test (SEBT). And the strength of the muscles of lower members was measured by a manual dynamometer. Results. The intensity of knee pain of those one submitted to TKA was significantly major in preoperative phase (4,05 ±0,84) when related to six (1,95 ± 0,62; p < 0,0001) and twelve months (1,9 ± 0,64; p < 0,007) after surgery. It was observed significant increase of WOMAC score in operated member at six (26,43 ± 5,508) and twelve months (31,48 ± 3,920) after surgery when compared to preoperative period (52,33 ± 3,98) (p<0,01). In intragroup comparisons in AP direction, the AS of CPO increased significantly, in TKA group, after six months (2,90 mm/s ± 0,36) and after twelve months (2,30 mm/s ± 0,31) when compared to preoperative (1,98 mm/s ± 0,16) (p< 0,05). There was no significant difference in area of CPO in intragroup (p=0,3280) and intergroups (p=0,2236) comparisons. The dynamic balance in intragroup comparisons increased significantly in six months (p=0,001) and twelve months (p<0,01) when compared to preoperative. There was significantly increased of hip and knee muscles in operated patients six and twelve months after surgery comparing to preoperative (p<0,05). When comparing healthy control group to TKA group it was observed a lower pain intensity, better functionality, major muscle strength and static and dynamic balance in control group than preoperative, six and twelve months after surgery (p<0,001). Conclusion. The intensity of pain influence in a negative way the functionality, muscle strength, static and dynamic balance in patients with severe osteoarthritis and TKA related to healthy control. / Introdução. A dor é um sintoma pertinente que pode estar relacionado à alteração do equilíbrio corporal em pacientes portadores de osteoartrose e Artroplastia Total do Joelho (ATJ). Objetivo. Analisar a intensidade da dor, funcionalidade, força muscular, equilíbrio corporal em pacientes submetidos à artroplastia total do joelho (ATJ) e comparar com controles saudáveis. Casuística e Métodos.Participaram do estudo 40 sujeitos, sendo 20 avaliados em três fases: (1) pré-operatório, (2) 6 meses após ATJ e (3) 12 meses após ATJ e 20 sujeitos saudáveis avaliados em um único momento. A avaliação da dor e funcionalidade foi realizada através da Escala Numérica de Dor (NRS) e do Western Ontario and McMaster Universities Arthritis Index (WOMAC), respectivamente. O equilíbrio corporal estático foi avaliado por meio de estabilometria, mensurando-se área de oscilação do centro de oscilação de pressão (área do COP) e velocidade média do centro de oscilação de pressão (VM do COP).O equilíbrio dinâmico foi avaliado através do Star Excursion Balance Test (SEBT). E a força dos músculos dos membros inferiores foi mensurada através de um dinamômetro manual. Resultados.A intensidade da dor no joelho dos sujeitos submetidos a ATJ foi significativamente maior na fase pré-operatória (4,05 ± 0,84) em relação às medidas realizadas seis (1,95 ± 0,62 ; p < 0,0001) e 12 meses (1,9 ± 0,64; p<0,007) após a cirurgia. Observou-se aumento significativo do escore do WOMAC do membro operado aos 6 (26,43 ± 5,508) e 12 meses (31,48 ± 3,920) após a cirurgia quando comparado ao período pré-operatório (52,33 ± 3,89) (p<0,01). Nas comparações intragrupos na direção AP, a VM do COP aumentou significativamente, no grupo ATJ, no momento de 6M (2,90 mm/s ± 0,36) e 12M (2,30 mm/s ± 0,31) quando comparada ao pré-operatório (1,98 mm/s ± 0,16) (p < 0,05). Não houve diferença significativa em relação à área do COP nas comparações intra (p=0,3280) e intergrupos (p=0,2236). O equilíbrio dinâmico nas comparações intragrupos aumentou de forma significativa em 6M (p= 0,001) e 12M (p < 0,01) quando comparado ao pré-operatório.Houve aumento significativo da força dos músculos do quadril e joelho nos pacientes operados seis e 12 meses após a cirurgia em comparação ao período pré-operatório (P< 0,05). Ao comparar os controles saudáveis com o grupo ATJ observou uma menor intensidade dolorosa,melhor funcionalidade, maior força muscular, equilíbrio estático e dinâmico do grupo controle em relação aos períodos pré-operatório, 6M e 12M do grupo ATJ (p < 0,001). Conclusão.A intensidade da dor influência de forma negativa na funcionalidade, força muscular, no equilíbrio estático e dinâmico em pacientes portadores de osteoartrose severa e ATJ em relação a controles saudáveis.

Introdução: A síndrome da dor patelofemoral (SDP) é definida como queixa dolorosa na região anterior do joelho, mais comumente na face medial da patela. Teoriza-se que o déficit de força dos músculos estabilizadores do quadril e do controle dinâmico do membro inferior esteja relacionado com o desenvolvimento da SDP. Objetivos: O objetivo primário foi comparar o ângulo de projeção no plano frontal (APPF) do joelho e a força isométrica dos músculos do quadril e tronco em indivíduos com e sem SDP. O objetivo secundário foi analisar a correlação do APPF com a força dos músculos do quadril e tronco. Métodos: A amostra foi composta por 43 mulheres, divididas em dois grupos: Dor Patelofemoral (GDP, n = 22) e Controle (GC, n = 21). A força dos músculos abdutores, rotadores laterais e extensores do quadril e flexão lateral de tronco (Core lateral) foram avaliados com um dinamômetro isométrico. A avaliação da força foi bilateral para calcular o Índice de Simetria entre os Membros (ISM). O complexo póstero-lateral do quadril foi calculado pela soma dos três grupos musculares do quadril divido por três. O APPF foi avaliado com uma câmera digital durante step down em três desfechos: a) Inicial: antes de iniciar o movimento; b) Final: ao final do movimento de step down; e c) Final-Inicial: diferença entre os ângulos inicial e final. Para análise do APPF foi utilizado o Software de Avaliação Postural (SAPo). Resultados: O GDP apresentou APPF Final e Final-Inicial 5,2º maior que o GC. Em relação à força dos músculos do quadril, foi constatado um déficit no GDP em comparação ao controle para os abdutores (10,4 ± 3,3 vs 12,7 ± 2,7, P = 0,02), extensores (14,2 ± 7,1 vs 18,9 ± 5,9, P = 0,02), rotadores laterais (11,6 ± 3,1 vs 13,5 ± 2,4, P = 0,03) e complexo póstero-lateral (12,1 ± 3,8 vs 15,1 ± 2,8, P = 0,01) do quadril. O GDP apresentou maior assimetria entre os membros em relação à força dos músculos do quadril e tronco. A assimetria entre os membros variou entre 13,1 a 22,6% no GDP e 1,8 a 3,3% no GC (P < 0,05). No GDP, a força dos músculos rotadores laterais e do complexo póstero-lateral do quadril apresentou boa correlação negativa com o APPF Final-Inicial (r = -0,4). No GC, o APPF Final e Final-Inicial apresentaram boa correlação negativa com o índice de simetria dos músculos abdutores, força dos rotadores laterais e do complexo póstero-lateral do quadril (r > -0,4). Além disso, no APPF Final-Inicial foi encontrada correlação negativa com a força dos músculos abdutores (r = -0,42). Conclusão: Os dados indicam que mulheres com dor patelofemoral apresentam maior APPF do joelho, déficit de força dos abdutores, rotadores laterais, extensores e do complexo póstero-lateral do quadril e assimetria dos músculos do quadril e tronco. O déficit de força, principalmente dos rotadores laterais e do complexo póstero-lateral do quadril, está associado com o aumento do APPF do joelho / Introduction: The Patellofemoral Pain Syndrome (PFPS) is characterized by anterior knee pain, most commonly in the medial patellar facet. Reduced hip-stabilizers strength and dynamic control of lower limb might be related to the development of the PFPS. Objectives: The primary objective was to compare the Frontal Plane Projection Angle (FPPA) of the knee and hip and trunk strength in women with and without PFPS. The secondary objective was to analyze the relationship between FPPA with hip and trunk strength. Methods: The sample consisted of 43 women divided into two groups: Patellofemoral Group (PFG, n = 22) e Control Group (CG, n = 21). Muscle strength for hip-abduction, hip- extension, hip external- rotation extensors and lateral trunk-flexion (Core lateral) were measured bilaterally using a handheld dynamometer. The limb symmetry index (LSI) was calculated for all subjects. Hip posterolateral complex was calculated as the sum of the three hip muscles assessed divided by three. The FPPA was recorded by a digital camera during step down in three outcomes: a) Initial: before starting the movement; b) Final: in the end of the step down; and c) Final-Initial: difference between the final and initial angles. For FPPA analysis was used the Postural Assessment Software (PAS/SAPo). Results: FPPA Final and Final-Initial for the PFG reveal 5.2º greater than the CG (P < .05). Regarding the hip muscle strength, women with PFPS demonstrated deficit compared to the control group for hip abduction (10.4 ± 3.3 vs 12.7 ± 2.7, P = .02), hip extension (14.2 ± 7.1 vs 18.9 ± 5.9, P = .02), hip external rotation (11.6 ± 3.1 vs 13.5 ± 2.4, P = .03) and hip posterolateral complex (12.1 ± 3.8 vs 15.1 ± 2.8, P = .01). LSI values in women with PFPS were significantly worse than the control group. The hip and trunk asymmetry ranged from 13.1 to 22.6% in the PFG and 1.8 to 3.3% in the CG (P < .05). In the PFG, the hip-abduction and hip posterolateral complex strength showed moderate negative correlation with FPPA Final-Initial (r = -.4). In the CG, the LSI hip-abduction, hip-abduction and hip posterolateral complex strength showed moderate negative correlation with FPPA Final e Final-Initial (r > -.4). In addition, the hip-abduction strength deficit was associated with increased FPPA Final-Initial (r = -.42). Conclusion: The results indicate that women with patellofemoral pain demonstrate increased FPPA of the knee, weakness in hip-abduction, hip- extension, hip external- rotation, extensors and hip posterolateral complex. Women with patellofemoral showed most asymmetry of the hip and trunk muscle strength. The hip weakness, mainly hip external- rotation and posterolateral complex, is associated with increased FPPA of the knee

Objetivo: Investigar o efeito da laserterapia de baixa intensidade (LBI) e do alongamento estático, combinados ou não, em pessoas com osteoartrite de joelho (OAJ). Método: Foram randomizados 145 sujeitos de 50 a 75 anos com OAJ em cinco grupos de intervenção (n=29 cada): Laserativo+Along; Laserplacebo+Along; Along; Laserativo e controle. A laserterapia (GaAs; 904nm; 40mW; 3J/ponto; 27J/joelho) consistiu de nove sessões nos grupos de terapia combinada e 24 quando monoterapia. O alongamento foi composto por sete exercícios repetidos por 24 sessões. O controle recebeu uma cartilha educacional. A frequência de tratamento foi de 3x/sem. A variável primária foi a intensidade da dor medida pela Escala Visual Analógica e as variáveis secundárias incluídas foram domínios dor, função, rigidez e escore total do questionário Western Ontario and McMaster Universities Arthritis Index (WOMAC), funcionalidade avaliado pelo Lequesne, mobilidade pelo Timed Up and Go, amplitude de movimento do joelho (ADMJ) pela goniometria e encurtamento de isquiotibiais (IQT) pelo ângulo poplíteo. O nível de significância foi de ?=0,05. Resultados: Nos grupos de terapia combinada, não foi observada diferença entre o laser ativo e placebo (p>0,05). Ao final do estudo, os grupos demonstraram, em média, ganho relativo significativo na dor durante AVDs (50%), WOMAC total (39%), funcionalidade (30%) e mobilidade (20%) em comparação ao controle (p < 0,001). Houve melhora de 43% no encurtamento de IQT e de 9% no ganho de ADMJ nos grupos de terapia combinada em relação ao controle (p < 0,001 e p=0,02, respectivamente). Conclusão: LBI e alongamento estático, quando isolados, foram efetivos na melhora da dor, funcionalidade, mobilidade e nos domínios dor, função e escore total do WOMAC. A LBI nos grupos de terapia combinada não foi superior à aplicação placebo. Portanto, não devemos desconsiderar a contribuição do efeito placebo no resultado do tratamento isolado. A LBI combinada ao alongamento não promoveu benefícios adicionais em relação ao alongamento de forma isolada / Objective: To investigate the effect of low-level laser therapy (LLLT) and static stretching, in combination and as monotherapy, in people with knee osteoarthritis (KOA). Methods: 145 people aged 50-75 years with KOA were randomly allocated to five groups (each n=29): Laseractive+Stretch, Laserplacebo+Stretch, Stretch, Laseractive and control. The laser therapy (GaAs; 904nm; 40mW; 3J/point; 27J/knee) consisted of nine sessions in the combined treatment groups and 24 when used as monotherapy. Stretching consisted of seven exercises repeated for 24 sessions. The control group received an educational booklet. Treatment frequency was 3 times/week. The primary outcome was pain intensity measured by Visual Analogue Scale and the secondary outcomes included pain, function and stiffness\' domains and total score of Western Ontario and McMaster Universities Arthritis Index (WOMAC), function assessed by Lequesne, mobility by Timed Up and Go, knee range of motion (KROM) by goniometry and hamstring shortening by popliteal angle. Results: In the combined treatment groups, there was no difference between the laser active and placebo (p > 0.05). At the end of the study, the treatment groups demonstrated, on average, a significant relative gain in pain (50%), total WOMAC (39%), function (30%) and mobility (20%) when compared to control (p < .001). For the combined treatment groups there was a 43% improvement in hamstring shortening (p <.001) and 9% improvement in KROM (p=0.02) when compared to control group. Conclusion: LLLT and stretching exercises, as monotherapy, were effective in reducing pain and improving function, mobility and the domains pain and function as well as the total score of WOMAC. The LLLT in the combined groups was not superior to the placebo application. Thus, we should not discard the contribution of the placebo effect in the result of the LLLT as monotherapy. The LLLT combined with stretching did not promote additional benefits compared to stretching alone

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22346号 / 医博第4587号 / 新制||医||1042(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 安達 泰治, 教授 森本 尚樹, 教授 福原 俊一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: Symptomatic knee osteoarthritis (OA) is an incurable condition that affects nearly 50% of adults, and women are twice as likely as men to develop OA. Throughout pregnancy, women experience large changes in morphology and gait mechanics, as well as changes in joint loading. It is possible these adaptations could cause lasting changes postpartum, which may potentially contribute to initiation of OA, thereby increasing the overall risk of OA for women. Purpose: This exploratory study looked to identify differences between lower limb gait mechanics of healthy nulliparous women and healthy parous women. Methods: 28 healthy female participants (14 parous, 14 nulliparous) were recruited for the study. Nulliparous participants had never given birth to a child, and were self-reported not pregnant. Parous participants had given birth to at least one full term infant (37 – 42 weeks) without complications between one to five years before data collection. Kinematic and kinetic data was collected for the lower body, using motion capture and in-ground force plates. Participants completed one quiet standing trial, and walked over-ground through the motion capture space at their preferred, fast, and set walking speeds (1.4 m/s). An ANOVA was performed to test if there were significant differences in between groups. Results: Q angle did not differ between groups. There was a significant main effect of group indicating a larger knee flexion angle at toe off (p = 0.060), smaller knee extension moment at heel strike (p = 0.0006), smaller first peak knee flexion moment (p = 0.040), and smaller peak hip adduction moment for the parous group compared to the nulliparous group (p = 0.003). Conclusions: Our data revealed a decrease in the moments experienced, which could possibly lead to degradation of cartilage due to under loading of the joint. We think this may be an indication that pregnancy could increase risk of OA, and therefore more research into this possibility is warranted.

My thesis is engaged in description of ineligibility original version of the elbow draft tube new constructed small hydro power plant Doudlevce. Other main purpose was construction of better hydraulic thus more efficient this draft tube. First chapter meets project small hydro power plant Doudlevce and it specifies this interesting contstruction of the power plant (for example position of the turbine in vacuum fontain) and many others information about it. Second chapter and its particular parts there deal with functions of this draft tube, for example out-flow of water from turbine and a principle of water-energy utilization placing behind turbine runner. There is also described energy profit and how to get it throught draft tube. There is an analysis of important quantities, which are used during the scoring of flow in the draft tube in third chapter. This part of my thesis is aimed to meeting their principles. There is one of the main purposes of this thesis, where is a description of ineligibility original version of the elbow draft tube in fourth chapter. It results sizable from Kaplan´s attemps and analysis of flowing based on computations in computer programme CFD Fluent. Fifth chapter is about general principles, which should be looked out during the construction of the draft tube. There is also project of new hydraulic better draft tube and its another parts. Last chapter compares original version with new better project based on computations in computer programme CFD Fluent. Comparison is made of specific criterion flowing of water, where are described quantites in third chapter, and efficiency of this draft tube.