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.

Knee replacement surgery is often performed in cases where the pain due to knee osteoarthritis can no longer be effectively controlled by conservative measures. The surgery—which replaces the articular surfaces of the tibia, femur and sometimes the patella with a mix of metal and polyethylene—is one of the most commonly performed lower limb surgeries. Despite patient reports of reduced pain and increased participation in activities of daily living, knee function following total knee arthroplasty (TKA) does not return to normal. Reductions in both passive and active knee range of motion, alterations in magnitude and timing of muscle activity, and changes in knee joint kinetics have all been reported. Comparatively little is known about why knee function is altered following TKA. In an attempt to address this gap in the literature, this thesis was designed to examine the biomechanical factors thought to contribute to reduced knee extensor moments following TKA. In particular, the contribution of alterations in passive knee moments, muscle moment arm lengths, and muscle activation magnitude and timing were examined in detail to determine which factors contributed to reduced knee extensor moment following TKA. To accomplish this goal, two groups--6 healthy controls and 6 individuals who were at least one year post-TKA—were examined in four different studies. The initial study of this thesis, a comprehensive examination of patients and controls during gait and stepping onto a raised surface, had two purposes. This moment data was needed to clearly define the knee moment deficits that existed in the patient – the remainder of the thesis focused on determining why these specific deficits existed. A secondary aim of this first study was to allow for the assessment of muscle activation patterns in this population during weight bearing tasks. Results of study one confirmed the existence of knee extensor moment deficits in the TKA group and also demonstrated that patients exhibited increased gastrocnemius EMG, prolonged stance phase activation of biceps femoris and reduced knee flexion during the loading phase of stance. Analysis of results across the two tasks suggested that reduced knee moments in members of the TKA group may be related to changes in gastrocnemi activation, however, differences in knee joint kinematics between patients and controls made it difficult to draw this conclusion. Study number two was designed to further probe the muscle activation strategies adopted by members of the TKA group. In order to avoid complications involved when comparing muscle activation patterns between groups using different kinematic strategies, seated knee extension was examined. This task was chosen as it challenged the knee musculature while at the same time restricting both groups of participants to use the same knee joint kinematics. The results of this analysis revealed that, while EMG magnitude for quadriceps and hamstrings were similar for both groups, patients exhibited increased amplitude of EMG in both the medial and lateral gastrocnemi. While the first two studies of this thesis focused on the active knee joint moment, in the third study the force required to passively move the knee from a flexed to an extended position was measured and used to estimate the passive moment of the knee joint. This study was based on the rational that if the passive knee moment was altered following TKA it could potentially affect the net knee joint moment. The comparison of patient and control results showed that, while small changes in passive moment were evident in patients, these differences were not large enough to account for changes in the knee extensor moment. The goal of the final thesis study was to examine moment arms of the knee musculature in an attempt to determine if TKA resulted in changes to this variable. However, various methodological issues arose in the course of completing this study. As a result, limited data were produced that sufficiently addressed the question posed. Despite the problems that arose, important issues regarding in vivo moment arm determination were realized and are included for discussion in this thesis. Together, the four studies provided a unique opportunity to observe knee function over a range of activities. The following conclusions were reached. • Changes in passive knee moment did not seem to contribute to reductions in knee extensor moment observed following TKA. • Quadriceps and hamstring muscle function, as evidenced by EMG recording during the seated knee extension task, appeared intact following TKA, suggesting that alteration in the function of these muscles were not directly responsible for reductions in knee extensor moments. • Changes in medial and lateral gastrocnemi activation were observed during knee extension and weight-bearing tasks. These changes may account for reduced knee extensor moment, particularly during the step-up task. • Knee extensor moment reductions during gait appear to be related to the reduced knee flexion exhibited by patients during the stance phase of gait . It was hypothesized that these changes in knee kinematics were directly linked to the increased activation of the gastrocnemi during gait. Although low subject numbers limited the generalizability of the results these conclusions will serve to guide future research in this area and ultimately help improve function and quality of life in this patient population.

Knee replacement surgery is often performed in cases where the pain due to knee osteoarthritis can no longer be effectively controlled by conservative measures. The surgery—which replaces the articular surfaces of the tibia, femur and sometimes the patella with a mix of metal and polyethylene—is one of the most commonly performed lower limb surgeries. Despite patient reports of reduced pain and increased participation in activities of daily living, knee function following total knee arthroplasty (TKA) does not return to normal. Reductions in both passive and active knee range of motion, alterations in magnitude and timing of muscle activity, and changes in knee joint kinetics have all been reported. Comparatively little is known about why knee function is altered following TKA. In an attempt to address this gap in the literature, this thesis was designed to examine the biomechanical factors thought to contribute to reduced knee extensor moments following TKA. In particular, the contribution of alterations in passive knee moments, muscle moment arm lengths, and muscle activation magnitude and timing were examined in detail to determine which factors contributed to reduced knee extensor moment following TKA. To accomplish this goal, two groups--6 healthy controls and 6 individuals who were at least one year post-TKA—were examined in four different studies. The initial study of this thesis, a comprehensive examination of patients and controls during gait and stepping onto a raised surface, had two purposes. This moment data was needed to clearly define the knee moment deficits that existed in the patient – the remainder of the thesis focused on determining why these specific deficits existed. A secondary aim of this first study was to allow for the assessment of muscle activation patterns in this population during weight bearing tasks. Results of study one confirmed the existence of knee extensor moment deficits in the TKA group and also demonstrated that patients exhibited increased gastrocnemius EMG, prolonged stance phase activation of biceps femoris and reduced knee flexion during the loading phase of stance. Analysis of results across the two tasks suggested that reduced knee moments in members of the TKA group may be related to changes in gastrocnemi activation, however, differences in knee joint kinematics between patients and controls made it difficult to draw this conclusion. Study number two was designed to further probe the muscle activation strategies adopted by members of the TKA group. In order to avoid complications involved when comparing muscle activation patterns between groups using different kinematic strategies, seated knee extension was examined. This task was chosen as it challenged the knee musculature while at the same time restricting both groups of participants to use the same knee joint kinematics. The results of this analysis revealed that, while EMG magnitude for quadriceps and hamstrings were similar for both groups, patients exhibited increased amplitude of EMG in both the medial and lateral gastrocnemi. While the first two studies of this thesis focused on the active knee joint moment, in the third study the force required to passively move the knee from a flexed to an extended position was measured and used to estimate the passive moment of the knee joint. This study was based on the rational that if the passive knee moment was altered following TKA it could potentially affect the net knee joint moment. The comparison of patient and control results showed that, while small changes in passive moment were evident in patients, these differences were not large enough to account for changes in the knee extensor moment. The goal of the final thesis study was to examine moment arms of the knee musculature in an attempt to determine if TKA resulted in changes to this variable. However, various methodological issues arose in the course of completing this study. As a result, limited data were produced that sufficiently addressed the question posed. Despite the problems that arose, important issues regarding in vivo moment arm determination were realized and are included for discussion in this thesis. Together, the four studies provided a unique opportunity to observe knee function over a range of activities. The following conclusions were reached. • Changes in passive knee moment did not seem to contribute to reductions in knee extensor moment observed following TKA. • Quadriceps and hamstring muscle function, as evidenced by EMG recording during the seated knee extension task, appeared intact following TKA, suggesting that alteration in the function of these muscles were not directly responsible for reductions in knee extensor moments. • Changes in medial and lateral gastrocnemi activation were observed during knee extension and weight-bearing tasks. These changes may account for reduced knee extensor moment, particularly during the step-up task. • Knee extensor moment reductions during gait appear to be related to the reduced knee flexion exhibited by patients during the stance phase of gait . It was hypothesized that these changes in knee kinematics were directly linked to the increased activation of the gastrocnemi during gait. Although low subject numbers limited the generalizability of the results these conclusions will serve to guide future research in this area and ultimately help improve function and quality of life in this patient population.

Thesis (Ph.D.)--University of Delaware, 2009. / Principal faculty advisor: Lynn Snyder-Mackler, Dept. of Physical Therapy. Includes bibliographical references.

Thesis (Ph. D.)--University of Queensland, 2001. / Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 37-41).

Trunk lean over the stance limb during gait has been linked to a reduction in the knee adduction moment, which is associated with joint loading. Differences were examined in knee adduction moments and frontal plane trunk lean during gait between subjects with knee osteoarthritis and a control group of healthy adults. Additionally, subject variability in human motion data presents a challenge to researchers when trying to detect differences between subject groups. The individual differences in neutral posture between subjects is a source of variation in joint angles. A method was developed using principal component analysis (PCA) to objectively reduce this inter subject variability. Gait analysis was performed on 80 subjects (40 osteoarthritis). Models were developed to define lateral thoracic tilt, as well as pelvic tilt. The trunk and pelvis frontal plane angles were used to describe trunk lean and pelvic tilt. Angles were calculated across the stance phase of gait. We analyzed the data, (i) by extracting discrete parameters (mean and peak) waveform values, and (ii) using principal component analysis (PCA) to extract shape and magnitude differences between the waveforms. Osteoarthritis (OA) subjects had a higher knee adduction moment than the control group (α=0.05). Although the discrete parameters for trunk lean did not show differences between groups, PCA did detect characteristic waveform differences between the control and osteoarthritis groups. The data show that subjects display similar waveform shapes, however waveforms vary in magnitude, suggesting a variation in posture between subjects. The results from the PCA reveal that the first PC, which captures the most variation in the data, represents this variation in magnitude. The second PC describes a significant difference in range of motion between the subject groups. Subjects with knee OA were found to have a different range of motion of their pelvis and trunk than control subjects. These changes are consistent with a strategy to lower the knee adduction moment. As an alternative to conventional subjective methods, PCA should be employed to reduce inter subject variability in order to ensure objective analysis in human motion waveform data. / Thesis (Master, Mechanical and Materials Engineering) -- Queen's University, 2009-08-14 14:43:53.127

No description available.

No description available.

The purpose of this research was twofold: 1) Develop a controlled-release ergometer for the measurement of musculo-tendinous stiffness of the knee flexors and 2) Compare results of the measurement of musculo-tendinous stiffness obtained via controlled-release method and oscillation method. Each purpose was addressed in a separate research paper. Research paper one describes the successful modification of a Cybex NORM isokinetic ergometer for use in controlled-release experiments. The modifications include not only the ones to the Cybex, but also the design of an instrumented leg cuff and software to collect and analyze the data from the experiment. The stiffness values obtained from this technique compared favorably, when considering morphological differences, to those obtained from controlled-release experiments of the ankle joint. The main difficulty encountered in this experiment was the lack of information obtained from low end of the stiffness-moment curve. In research paper two, both techniques were successfully used to measure stiffness of the knee-flexors and no significant difference was found between the two methods, (p = 0.157). However, it was clear that each technique has its advantages and disadvantages in regard to what part of the stiffness-moment curve they are able to measure. Due to the inability of participants to perform the oscillation technique with high loads, this technique is best suited to measure stiffness of lightly loaded systems.On the other hand, the controlled-release technique provided a good representation of the high, linear end of the stiffness-moment curve, but was unable to provide good information about the toe-region of the stiffness-moment curve. / School of Physical Education