A generally accepted goal in orthopaedic surgery today is to maximize conservation of tissue and reduce tissue damage. Bone-conserving implants have bone-mating surfaces that reproduce the natural curvature of bone structures, requiring less bone removal. No small, reliable, inexpensive and universal bone sculpting technique currently exists, however, that can both create and accurately align such complex surfaces. The goal of this thesis was to develop a haptic hard surface emulation mechanism that could be applied to curvilinear bone sculpting using a surgical robot. A novel dynamic physical constraint concept was developed that is able to emulate realistic hard constraints, smooth surface following, and realistic surface rigidity, while allowing complete freedom of motion away from the constraints. The concept was verified through the construction of a two-link manipulator prototype. Tests were run on nine users that involved each user tracing out five different virtual surfaces on a drawing surface using the prototype. The primary purposes of prototype testing were to obtain subjective data on how effectively the dynamic physical constraint concept simulates simple surfaces, to assess how it reacts to typical user interactions and to identify any unexpected behaviour. Users were 100% satisfied with the prototype’s ability to emulate realistic and stiff hard surfaces and with its ease of manipulation. The amount of incursion into each of the virtual surfaces by all the users was measured to assess the precision of the system with the goal of deciding whether this new haptic concept should be further developed specifically for precision applications such as surgery. For curvilinear surfaces, 90% of the cumulative distribution of the measured data was less than 2mm, while for linear surfaces it was less than 6mm. Four behavioural effects were noticed: lateral deflection, reverse ‘stickiness’, hysteresis and instability in certain areas. These effects were studied in detail to determine how to either eliminate them or to minimize them through system design optimization. A computer simulation was also used to model the behaviour of the prototype and to gain further understanding of these effects. These analyses showed that the concept can be successfully used in curvilinear bone sculpting. / Applied Science, Faculty of / Mechanical Engineering, Department of / Graduate

Study Design: Methodological study. Objectives: To examine the agreement and validity of using observational risk screening guidelines to evaluate ACL injury risk factors. Background: Post-pubescent females have an increased risk of anterior cruciate ligament (ACL) injury compared with their male counterparts partly due to their high-risk landing and cutting strategies. There are currently no scientifically-tested methods to screen for these high risk strategies in the clinic or on the field. Methods and Measures: Three physiotherapists used observational risk screening guidelines to rate the neuromuscular characteristics of 40 adolescent female soccer players. Drop jumps were rated as high risk or low risk based on the degree of knee abduction. Side hops and side cuts were rated on the degree of lower limb 'reaching'. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. 3D motion analysis was used as a gold standard for determining the validity of ratings. Results: Acceptable intrarater and interrater agreement (k≥0.61) were attained for the drop jump and the side hop, with kappa coefficients ranging from 0.64 to 0.94. Acceptable sensitivity (≥0.80) was attained for the side hop and the side cut, with values ranging from 0.88 to 1.00. Acceptable specificity (≥0.50) was attained for the drop jump, with values ranging from 0.64 to 0.72. Conclusion: Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Based on levels of agreement and sensitivity, the side hop appears to be a suitable screening task. Agreement was acceptable for the drop jump but its validity needs further investigation. / Medicine, Faculty of / Graduate

Neuromuscular control is believed to play an essential role during dynamic knee joint stabilisation. Evaluation of voluntary muscle action can be delineated as support strategies against external loading moments (Lloyd & Buchanan, 2001). The aim of this study was to determine if males and females exhibit differences in knee muscle action and cocontraction during voluntary isometric closed kinetic chain force generation in various directions in the horizontal plane representative of applied loads transverse to the long axis of the shank. Twenty-six healthy young adults (13 male, 13 female) stood with their dominant leg in a boot fixed to a force platform. A force target matching protocol required subjects to position a cursor (projected on a video screen) over a target and maintain the position for one second. To control the cursor, loads were applied against the force platform with their dominant leg to produce various combinations of anterior-posterior, medial-lateral loads while maintaining constant inferior-superior loads. A successful target match required a normalised force magnitude of equal effort for each subject and target location which triggered the recording of electromyography (EMG) for eight muscles crossing the knee joint. EMG was normalised to percent maximum voluntary isometric contraction. A mean magnitude of muscle activation, mean direction of muscle activation and a muscle specificity index was determined using EMG vectors. In addition, cocontraction indices were also computed for antagonist muscle pairs. Based on similar previous research, it was hypothesised that females would have greater quadriceps and hamstrings coactivation, greater muscle activation magnitudes, lower specificity for the quadriceps than males and no difference in hamstring characteristics. In our study, females significantly cocontracted their vastus lateralis and lateral gastrocnemius muscles to a greater degree than males (p=0.001). No significant differences were observed across sexes for the cocontraction of quadriceps and hamstrings or the lateral quadriceps and gastrocnemius muscles. Females displayed significantly lower specificity than males in their semitendinosus (p=0.025) and tensor fascia lata (p=0.012) activity patterns, greater magnitude of muscle activation in their lateral gastrocnemius (p=0.002) and tensor fascia lata (p<0.003) and no statistical difference in the other muscles. Furthermore, the activation patterns in our study grossly differed from previous open kinetic chain force target matching. These findings indicate that healthy young males and females have differences in their knee muscle control strategies and that knee muscle recruitment patterns differ during weight bearing and non-weight bearing tasks.

The Ottawalk-Speed (OWS) orthosis prevents knee collapse in stumble situations. The purpose of this study was to develop a virtual stumble perturbation to measure OWS response to a knee collapse when walking. A new split speed perturbation was developed for the CAREN virtual reality system. This perturbation induced a stumble with increased knee flexion for five able-bodied participants, with either a hopping or stopping recovery strategy. Three knee-ankle-foot orthosis users were subjected to five stumble trials while wearing the OWS. OWS participants used a straight-legged recovery strategy, and extended the knee through recovery weight acceptance. Therefore, the split speed perturbation was not appropriate to measure OWS response to a stumble since knee collapse did not occur. The OWS allowed free knee motion during gait. Further study is required to measure OWS response during a stumble with a knee collapse event.

Modeling and simulations are useful tools to help understand knee function and injuries. As there are more muscles in the human knee joint than equations of motion, optimization protocols are required to solve a problem. The purpose of this thesis was to improve the biofidelity of these simulations by adding in vivo constraints derived from experimental intra-cortical pin data and stability-inspired objective functions within an OpenSim-Matlab forward-inverse dynamics simulation framework on lower limb muscle activation predictions. Results of this project suggest that constraining the model knee joint’s ranges of motion with pin data had a significant impact on lower limb kinematics, especially in rotational degrees of freedom. This affected muscle activation predictions and knee joint loading when compared to unconstrained kinematics. Furthermore, changing the objective will change muscle activation predictions although minimization of muscle activation as an objective remains more accurate than the stability inspired functions, at least for gait. /// La modélisation et les simulations in-silico sont des outils importants pour approfondir notre compréhension de la fonction du genou et ses blessures. Puisqu’il y a plus de muscles autour du genou humain que d’équations de mouvement, des procédures d’optimisation sont requises pour résoudre le système. Le but de cette thèse était d’explorer l’effet de changer l’objectif de cette optimisation à des fonctions inspirées par la stabilité du genou par l’entremise d’un cadre de simulation de dynamique directe et inverse utilisant MatLab et OpenSim ainsi qu'un model musculo-squelétaire contraint cinématiquement par des données expérimentales dérivées de vis intra-corticales, sur les prédictions d’activation musculaire de la jambe. Les résultats de ce projet suggèrent que les contraintes de mouvement imposées sur le genou modélisé ont démontré des effets importants sur la cinématique de la jambe et conséquemment sur les prédictions d'activation musculaire et le chargement du genou. La fonction objective de l'optimisation change aussi les prédictions d’activations musculaires, bien que la fonction minimisant la consommation énergétique soit la plus juste, du moins pour la marche.

While stepping in place without vision, individuals displace linearly and rotate, without perceiving these displacements. The aims of this study were to evaluate the effect of a concomitant cognitive task and the influence of knee height on these displacements in stepping in place for 50 steps. Sixteen adults (mean age = 22 years) performed four conditions of stepping: normal knee height and high knee height with and without a cognitive task. Antero-posterior (AP) displacement was significantly smaller in dual task than in single task at normal knee height, and AP and medio-lateral displacements were significantly larger at high than at normal knee height for single and dual task. No changes in body rotation were found. These findings suggest that automaticity is involved in the control of stepping in place with a concurrent cognitive task and that one’s attentional capacity is exceeded when stepping in place with high knees and a cognitive task.

This thesis investigates if support vector machine classification is a suitable approach when performing automatic segmentation of knee cartilage using quantitative magnetic resonance imaging data. The data sets used are part of a clinical project that investigates if patients that have suffered recent knee damage will develop cartilage damage. Therefore the thesis also investigates if the segmentation results can be used to predict the clinical outcome of the patients. Two methods that perform the segmentation using support vector machine classification are implemented and evaluated. The evaluation indicates that it is a good approach for the task, but the implemented methods needs to be further improved and tested on more data sets before clinical use. It was not possible to relate the cartilage properties to clinical outcome using the segmentation results. However, the investigation demonstrated good promise of how the segmentation results, if they are improved, can be used in combination with quantitative magnetic resonance imaging data to analyze how the cartilage properties change over time or vary between knees.

M.Tech. (Homoeopathy) / Osteoarthritis (OA) is a chronic and debilitating condition, characterized by irreversible damage to the joint space, most commonly affecting the knees, hips, hands and spine (Colledge et al., 2010). OA is the leading cause of joint pain and disability in middle-aged and elderly persons (Long et al., 2001). The prevalence of OA of the knee in adults living in the United Sates has grown from a reported 21 million in 1990 to a total estimate of 26.9 million in 2005 (CDC, 2011). By the age of 65 years, 80% of the total population has been reported as showing radiographic evidence of OA; while a 20-30% of the total population is symptomatic with radiographic evidence of OA (Doherty et al., 2006). Conventional treatment for OA of the knee is aimed at pain management by use of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). Some negative effects of these drugs include drug dependency, liver and kidney damage, cardiovascular pathologies, gastric upset and depression. Corticosteroid injections are also used to alleviate chronic inflammation and joint pain, but may lead to further joint destruction (Shamoon and Hochberg, 2000; Mayo Foundation for Medical Education and Research, 2011). OsteoEze Gold™ is a nutraceutical product that contains chondroitin sulphate, glucosamine sulphate, vitamin C and manganese. In combination, the constituents of OsteoEze Gold™ have been shown to be useful in the treatment for OA of the knee (Clegg et al., 2006). In addition, studies have shown that these ingredients prove effective in reducing moderate to severe pain in sufferers of OA of the knee (Vidyasagar et al., 2004). The aim of this study was to determine the effect of OsteoEze Gold™ on the inflammatory marker C-reactive protein (CRP) and quality of life in OA of the knee using blood tests and the Arthritic Impact Measurement Scales (AIMS2SF) respectively. This was a 16-week, double blind, placebo-controlled study using matched pairs according to age, gender and severity of symptoms, and formed part of a group study, with another researcher, who utilized the Intermittent and Constant Osteoarthritis Pain scale (ICOAP) Short Physical Performance Battery (SPPB) and the same sample...

Orientador: João Batista de Miranda / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T13:37:30Z (GMT). No. of bitstreams: 1 Ferreira_DanielBecharaJacob_M.pdf: 1620645 bytes, checksum: 6452df17927d464b10dd8a697e2a2126 (MD5) Previous issue date: 2011 / Resumo: Introdução: A osteotomia valgizante no terço proximal da tíbia é considerada um método confiável para o tratamento de pacientes jovens com osteoartrite medial do joelho, associado a alinhamento em varo. Entretanto, procedimentos realizados para a correção de desalinhamentos no plano frontal podem alterar o alinhamento do plano sagital. Vários fatores estão relacionados ao aumento da inclinação posterior do planalto tibial pós-osteotomia valgizante no terço proximal da tíbia. Hipótese: O posicionamento posterior da placa-calço está relacionado com menor alteração da inclinação posterior do planalto tibial. Modelo do estudo: Estudo clínico retrospectivo. Métodos: Foram realizadas 42 osteotomias entre abril de 2007 e agosto de 2008. Imagens radiográficas em perfil do joelho foram obtidas no pré-operatório e no pós-operatório recente. Determinou-se o ângulo formado entre a tangente do planalto tibial medial e uma linha perpendicular ao eixo da cortical posterior da tíbia por medidas goniométricas manuais, antes e após cirurgia. Determinou-se também a posição relativa da placa-calço em relação à cortical posterior da tíbia. Resultados: Houve aumento de aproximadamente 34% no valor da inclinação posterior do planalto tibial após a cirurgia, com a média subindo de 7,6° para 10,2° (p = 0,0006). Existe correlação entre o ângulo de inclinação do planalto tibial pré-operatório e o seu valor pós-cirúrgico (r = 0,4131 e p = 0,0065). A posição relativa e o tamanho do implante não influenciaram as alterações do alinhamento sagital. Conclusão: Nesta população amostral houve aumento estatisticamente significativo da angulação da superfície articular tibial proximal, no plano sagital, após osteotomia valgizante no terço proximal da tíbia. O posicionamento posterior da placa-calço não foi relacionado a um menor aumento desta angulação / Abstract: Background: The high tibial osteotomy is considered a reliable method for the treatment of young patients with medial knee osteoarthritis associated with varus alignment. However, procedures performed to correct misalignments in the frontal plane can change the alignment of the sagittal plane. Several factors are related to the increase in the posterior inclination of the tibial plateau after high tibial osteotomy. Hypothesis: The posterior positioning of the Puddu plate causes less alteration of the posterior inclination of the tibial plateau. Study design: Retrospective clinical trial. Methods: Forty-two opening-wedge high tibial osteotomies were carried out. Lateral radiographic images of the knee were obtained preoperatively and right after surgery. The angle between the tangent of the medial tibial plateau and a line perpendicular to the axis of the posterior tibial cortex was determined by manual goniometric measurements before and after surgery. We also determined the relative position of the Puddu plate in relation to the posterior tibial cortex. Results: There was an increase of approximately 34% in the tibial slope after surgery, with the mean value rising from 7.6° to 10.2°. This difference was statistically significant (p = 0.0006). There is a correlation between the preoperative and postoperative inclination angles of the tibial plateau (r = 0.4131, p = 0.0065). The relative position and the size of the implant did not influence the changes in sagittal alignment. Conclusion: There was a statistically significant increase in the angulation of the proximal tibial articular surface in the sagittal plane after high tibial osteotomy. The posterior positioning of the Puddu plate was not related to a smaller increase of this angle / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Existe um conceito difundido entre professores de educação física, fisioterapeutas e ortopedistas que o joelho não deve ser demasiadamente anteriorizado em relação à ponta do pé na direção ântero-posterior durante qualquer tipo de agachamento de modo a diminuir a carga mecânica imposta ao joelho. No entanto, são escassas as evidências quantitativas que corroboram este conceito. Este trabalho tem como objetivo estimar forças e torque na articulação do joelho em indivíduos saudáveis durante o exercício de agachamento livre com peso em dois modos diferentes de execução: a) joelho não ultrapassando a linha vertical que passa pelos dedos do pé; b) joelho ultrapassando essa linha vertical. Os sujeitos realizaram o agachamento com o pé direito sobre uma plataforma de força que mensurou os torques e forças de reação do solo. O membro inferior direito dos indivíduos (pé, perna e coxa) foram filmados com cinco câmeras digitais. Visando reconstruir o movimento dos segmentos, nós utilizamos a técnica de calibração do sistema anatômico (CAST), aumentando assim, a acurácia na reconstrução da posição tridimensional dos segmentos. O centro articular do quadril foi determinado pelo método rotacional e as forças e torques articulares internos líquidos foram determinados por dinâmica inversa. Os resultados obtidos mostram que o pico da carga mecânica no joelho, quando esse passa em média 11cm da linha do pé, é cerca de 31% maior na condição em que o joelho ultrapassa a linha do pé. Esses resultados implicam que não passar o joelho da linha do pé diminui a força de compressão patelofemoral, levando assim a uma menor solicitação mecânica nesta articulação. / There is a wide spread notion among health professionals that during a squat exercise the knee should not pass forward the forefoot region in order to not overload the knee joint. However, it seems there isn’t scientific literature to support or negate this concept. The goal of this paper is to investigate the effect of different foot-knee positions on the knee joint moment and on the patelofemoral force during squat, which was performed into two different ways: a) knee do not passing the forefoot region; b) knee passing the forefoot region. The subjects performed the squat exercise with the right foot on a force plate that measured the ground reaction force and moment components. The subject’s right leg (foot, shank, and thigh) and pelvis were filmed with five digital cameras. In order to reconstruct the segments’ movement, we used the Calibrated Anatomical System Technique (CAST), improving the accuracy on three-dimensional reconstruction of segment’s position. The hip center was determined by the rotational method and the internal net forces and torques were estimated by inverse dynamics. The results showed that during the condition were knee passed the forefoot region, the knee passed 11 cm on average, what resulted in a peak of mechanical load on the knee 30% higher in relation to the do not pass condition. Based on these results it is suggested that the knee should not pass the forefoot region during squatting in order to decrease the patelofemoral force.