The anterior cruciate ligament (ACL) plays an important role in knee joint stability, and unfortunately is one of the most commonly injured knee joint structures. The muscles surrounding the knee are also critical for stabilising the knee joint and their activations are altered following ACL injury. Despite the fact that ACL injuries are up to 8 times more likely to occur in females compared to males, there is limited research evaluating the effects of sex on how ACL-deficient individuals adjust neuromuscular control strategies during varying loading conditions. In order to have clinicians implement optimal rehabilitation strategies for ACL-deficient males and females, it is crucial to understand the adaptive functional strategies that are taking place once an ACL injury has occurred. The purpose of this thesis was therefore to provide objective and quantitative measurements describing the functional roles of muscles surrounding the knee. This was accomplished and outlined in this thesis through two chapters in manuscript format and summarised below. i) Sex and ACL-deficiency influence functional muscle roles during an isometric, weight-bearing, force-generation task First, the functional roles of muscles were quantified through the assessment of muscle activations during a series of multi-directional force-production tasks in ACL-deficient males and females while weight bearing. A highly controlled, isometric, force-matching task, whereby participants modulated ground reaction forces in various combinations of sagittal and frontal plane loads was used to quantify force-generation strategies (muscle activations and functional role) of the knee joint. Mean activation magnitudes and profile patterns from 10 muscles in the lower extremity (rectus femoris, vastus lateralis, vastus medialis, biceps femoris, semitendinosus, lateral gastrocnemius, medial gastrocnemius, tensor fascia latae, adductor muscle group, and gluteus medius) were recorded using wireless electromyography (EMG) sensors. Their activations were quantified with an orientation analysis to determine if differences in functional muscle roles existed between four groups; healthy female controls, healthy male controls, ACL-deficient females, and ACL-deficient males. Overall, different functional muscle roles were found between groups. Healthy male controls activated their muscles the most specifically; females with ACL-deficiency activated their muscles the least specifically, while healthy female controls and males with ACL-deficiency shared similar functional muscle roles. This suggests that there was a specificity hierarchy in the ability, or efficiency, to modulate the activation of muscles about the knee joint when exposed to various directional loading conditions. ii) Associations between subjective measures of knee dysfunction and measures of ground reaction forces in ACL-deficient males and females Correlational relationships were evaluated between perceived knee joint function and functional capacity of the knee joint. These relationships were calculated between patient reported outcome measures (PROM) from commonly used knee assessment scoring scales maximal generated forces in the sagittal and frontal planes. Both ACL-deficient groups had significantly lower perceived knee joint function compared to healthy controls. A trend towards significance was observed in the ability to generate maximum forces in the sagittal and frontal planes, with ACL-deficient females generating smaller maximal posterior GRFs compared to healthy females. Only two statistically significant correlations (both for ACL-deficient females) were found between maximal medial GRFs and patient reported outcome measures from the Lysholm and Tegner scoring scales. This indicates that there may be a discrepancy in the sensitivity of subjective outcome measures between sexes and their corresponding ability to generate maximum GRFs. In conclusion, sex differences exist in subjective outcome measures and the functional strategy of neuromuscular control of the knee joint both before and after ACL-injury. The results of this thesis indicate the need for sex-specific tailoring of rehabilitation programs, thus providing an opportunity to improve the success rate of rehabilitation following ACL-injury. Moreover, sensitivity of subjective outcome measures and their relation to simple, practical, functional tasks between sexes warrants further investigations.

O resultado clínico a longo prazo das osteotomias valgizantes da tíbia depende da obtenção do adequado alinhamento do eixo mecânico pelo procedimento cirúrgico. Essa correção do eixo mecânico é obtida pela adição ou subtração de cunhas ósseas. O tamanho das cunhas pode ser planejado pré-operatoriamente ou determinado durante a cirurgia utilizando controle intraoperatório do alinhamento do membro. Modernamente, o controle intraoperatório pode ser realizado com auxílio de equipamentos de navegação cirúrgica computadorizados. Neste estudo, comparamos os valores dos eixos mecânicos e dos tamanhos das cunhas obtidos pelo método de planejamento pré-operatório das osteotomias com cálculo trigonométrico e pelas cirurgias auxiliadas por sistema de navegação intraoperatória. A medida dos eixos mecânicos em imagens radiográficas panorâmicas dos membros inferiores foi realizada por catorze cirurgiões de joelho em treze pacientes. A cirurgia de osteotomia valgizante auxilada por navegação cirúrgica foi realizada pelo mesmo cirurgião nos mesmos treze pacientes, documentando-se o tamanho da cunha de adição medial e os eixos mecânicos do membro inferior. Após as cirurgias, planejamos os tamanhos das cunhas de adição medial, por cálculo trigonométrico, utilizando os dados dos eixos mecânicos medidos nas radiografias. Nós realizamos comparação entre os valores dos eixos mecânicos obtidos nas cirurgias e os valores medidos nas imagens radiográficas e entre os tamanhos das cunhas de adição medial medidos intraoperatoriamente e planejadas nos cálculos trigonométricos. A análise dos dados foi realizada por análise descritiva dos resultados e por gráficos de Bland e Altman. Como resultados, observamos alta correlação entre os valores dos eixos mecânicos medidos nos exames radiográficos e pelo navegador cirúrgico e observamos que os valores planejados para as cunhas de adição são diferentes dos valores medidos durante as cirurgias / The long-term clinical outcome of tibial osteotomy depends on achieving the proper mechanical axis alignment for the surgery. Adding or subtracting bone wedges obtains the mechanical axis correction. The correction size may be planned preoperatively or defined during surgery under limb alignment control. Nowadays, the limb alignment control may be accomplished with the aid of computerized surgical navigation equipment. In this study, we compared the values of the mechanical axes and the wedges sizes obtained by the osteotomies preoperative planning method with trigonometric calculation and those values measured on navigated surgeries. Fourteen knee surgeons performed the measurement of the mechanical axes in panoramic radiographs of the lower limbs of thirteen patients. The same surgeon performed all thirteen surgeries. The wedges sizes and the mechanical axes of the lower limb were measured during surgeries. After surgery, the sizes of the planned addition of medial wedges, for trigonometric calculation, using data from the mechanical axis measured on the radiographs. We carry out comparison between the values of the mechanical axes obtained in the surgeries and the values measured in the radiographs and between the sizes of the wedges and wedge sizes planned in trigonometric calculations. We performed data analyses by descriptive analysis and Bland and Altman. We have observed a high correlation between the values of the mechanical axes measured on radiographs and in navigated surgeries and noticed that the planned values for wedges are different from values measured during surgery

Musculoskeletal complaints account for 15-30% of all patient visits to primary care physicians, yet many providers express a lack of confidence in their ability to perform a satisfactory musculoskeletal exam (Day and Yeh, 2008). Deficiencies in knowledge often stem from inadequate training during medical school or residency and continue as physicians become immersed in practice. Numerous researchers have called for improvement in the musculoskeletal education of medical students and residents. We suggest a novel curriculum-based upon the family medicine milestones that will assist educators and clinicians in developing competence and confidence in their knee and shoulder examinations and enhance the training of students and residents. Upon completion of this session, participants should be able to: Perform a complete examination of the knee and shoulder joints Implement the knee and shoulder exam musculoskeletal milestones in their practices or programs Present the knee and shoulder exams using visual, auditory, read/write, and kinesthetic modes.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21705号 / 人健博第71号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 黒木 裕士, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22831号 / 医博第4670号 / 新制||医||1047(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 別所 和久, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Introducción: Determinar la asociación entre el ángulo de inclinación del tendón patelar (AITP) y la presencia de dolor anterior de rodilla (DAR), así como conocer la prevalencia de DAR en deportistas universitarios. Material y métodos: Estudio de corte transversal en 143 deportistas universitarios. La presencia de DAR se detectó usando la Anterior Knee Pain Scale de Kujala y se calculó el AITP analizando una fotografía de ambas piernas con el programa Kinovea ®. Cada rodilla se consideró como una muestra. La razón de prevalencia entre el DAR y el AITP se calculó usando regresión de Poisson robusta. Resultados: Se evaluaron 143 sujetos, por tanto, 286 rodillas, donde 176 (61.5%) presentaban DAR. El AITP se clasificó en cuartiles. Para el análisis se unió el segundo y tercer cuartil, por lo que se obtuvo un cuartil medio (9°y 14°).Se encontró que un AITP menor a 9° tiene 1,34 (IC95%; 1,09-1,65) más probabilidad de tener DAR, y un AITP mayor a 14° tiene 1,35 (IC95%; 1,09-1,69) más probabilidades. Conclusiones: Los deportistas con un AIPT menor a 9° o mayor a 14° tienen mayor probabilidad de presentar DAR. Se recomienda que el profesional considere el ángulo de inclinación del tendón patelar en su evaluación. / Introduction: To determine the association between patellar tendon angle (AITP) and the presence of anterior knee pain (DAR) and the prevalence of DAR in college athletes. Materials and methods: Cross-sectional study of college athletes. The presence of DAR was detected using the Anterior Knee Pain Scale by Kujala and AITP was calculated by analyzing a photograph of both legs with Kinovea program ®. Each knee was considered as a sample. The prevalence ratio between the DAR and the AITP was calculated using Poisson regression robust Results: 143 subjects were evaluated, therefore, 286 knees, where 176 (61.5%) had anterior knee pain (DAR). The AITP was ranked in quartiles. To analyze was joined second and third quartile so was obtained a midquartile (9° and 14°). It was found that AITP fewer than 9° is 1.34 (95% CI, 1.09 - 1.65) more likely to have DAR, and AITP greater than 14° is 1.35 (95% CI; 1,09- 1.69) more likely. Conclusions: Athletes with AITP fewer than 9 ° or greater than 14 ° are more likely to have DAR. It is recommended that the professional considers the inclination patellar tendon angle in the evaluation / Tesis

No description available.

abstract: As the world population continues to age, the demand for treatment and rehabilitation of long-term age-related ailments will rise. Healthcare technology must keep up with this demand, and existing solutions must become more readily available to the populace. Conditions such as impairment due to stroke currently take months or years of physical therapy to overcome, but rehabilitative exoskeletons can be used to greatly extend a physical therapist’s capabilities. In this thesis, a rehabilitative knee exoskeleton was designed which is significantly lighter, more portable and less costly to manufacture than existing designs. It accomplishes this performance by making use of high-powered and weight-optimized brushless DC (BLDC) electric motors designed for drones, open-source hardware and software solutions for robotic motion control, and rapid prototyping technologies such as 3D printing and laser cutting. The exoskeleton is made from a series of laser cut aluminum plates spaced apart with off-the-shelf standoffs. A drone motor with a torque of 1.32 Nm powers an 18.5:1 reduction two-stage belt drive, giving a maximum torque of 24.4 Nm at the output. The bearings for the belt drive are installed into 3D printed bearing mounts, which act as a snug intermediary between the bearing and the aluminum plate. The system is powered off a 24 volt, 1,500 MAh lithium battery, which can provide power for around an hour of walking activity. The exoskeleton is controlled with an ODrive motor controller connected to a Raspberry Pi. Hip angle data is provided by an IMU, and the knee angle is provided by an encoder on the output shaft. A compact Rotary Series Elastic Actuator (cRSEA) device is mounted on the output shaft as well, to accurately measure the output torque going to the wearer. A Proportional-Derivative (PD) controller with feedforward relates the input current with the output torque. The device was tested on a treadmill and found to have an average backdrive torque of 0.39 Nm, significantly lower than the current state of the art. A gravity compensation controller and impedance controller were implemented to assist during swing and stance phases respectively. The results were compared to the muscular exertion of the knee measured via Electromyography (EMG). / Dissertation/Thesis / Masters Thesis Engineering 2020

No description available.

Bakgrund: Excentrisk träning (ECC) har varit det dominerande träningssättet vid patellar tendinopati (PT) under de senaste 15 åren. Det skulle vara av värde för kliniker att veta vilken effekt ECC har på kort sikt efter en träningsperiod. Syfte: Systematiskt granska enskilda artiklar och bedöma tillförlitligheten i det sammanvägda resultatet gällande effekten på funktion och smärta samt förmåga att delta i sport eller fysiska aktiviteter som excentrisk träning har efter en träningsperiod på 12 veckor hos idrottande personer med PT. Design: Systematisk granskning av randomiserade kontrollerade studier. Metod: Sökningar utfördes i PubMed, CINAHL, PEDro och Cochrane library. Sju studier inkluderades och granskades med PEDro Scale. GRADEstud användes för att bedöma tillförlitligheten i resultatet. Resultat: Inkluderade studiers kvalitet varierade mellan acceptabel och hög kvalitet, enligt PEDro Scale. Det var inga skillnader mellan ECC och kontrollbehandlingar. Vid sammanvägningen av studiernas respektive resultat ansågs tillförlitligheten enligt GRADEstud vara måttligt hög (+++) p.g.a. hög samstämmighet, men bristande precision. Slutsats: ECC är inte mer effektivt än andra undersökta kontrollbehandlingar, därav kan denna studie inte säkerställa att förbättringar som sker efter 12 veckor beror på ECC. / Background: Eccentric exercise (ECC) has been the dominant treatment option for patellar tendinopathy (PT) in the last 15 years. It would be of value to clinicians to know about the short-term effect ECC has after a training period. Objective: Systematically review individual articles and assess the certainty in the weighted result regarding the effect on function, pain, and the ability to participate in sport and physical activities that eccentric training has after a 12week period of training on athletes with PT. Design: Systematic review of randomized controlled trials.                                           Method: Searches were conducted in PubMed, CINAHL, PEDro and Cochrane Library. Seven studies were included and reviewed with the PEDro Scale. GRADE-stud was used to assess the certainty in the result.  Results: Included studies quality varied between acceptable and high quality, according to the PEDro Scale. There were no differences between ECC and control treatments. When weighing the respective results of the studies, the certainty was considered moderately high (+++) according to GRADEstud, due to high coherence in all included studies, but a lack of precision. Conclusion: ECC is not more effective than other control therapies studied. Therefore, this study cannot ensure that improvements that occur after 12 weeks are due to ECC.