Medial tibiofemoral joint contact forces can be estimated using musculoskeletal models. To assess change in these forces that accompany load-modifying interventions, minimum detectable change (MDC) thresholds must be established. The primary study purpose was to derive MDCs for medial tibiofemoral peak force and force impulse during walking. The secondary purpose was to identify the proportions of individuals exhibiting reductions greater than these MDCs when walking with lateral foot wedging. Eight healthy individuals provided 3-dimensional gait data over 3 test sessions to serve as inputs for an inverse dynamics-driven medial tibiofemoral contact force model, from which MDCs for peak force and impulse were derived. The MDC was 0.246 BW (8.7%) for peak force and 0.0385 BW∙s (3.7%) for impulse. Then, 25 healthy individuals provided gait data by walking with and without 6° laterally wedged foot orthoses, and the proportion of individuals exhibiting changes in medial tibiofemoral contact peak force and impulse values exceeding the MDC threshold was determined. For impulse and peak force, 52% and 4% of participants exhibited a decrease exceeding the MDC, respectively. In summary, medial tibiofemoral contact force MDCs were derived, with impulse showing greater sensitivity than peak force to the effects of a biomechanical intervention.
David M. Werner and Joaquin A. Barrios
Context: Core stability is considered critical for the successful execution of rehabilitative and athletic tasks. Although no consensus definition exists, different components related to core stability have been identified. An important component is the domain of motor control. There are few clinical tests assessing the motor control component of core stability (MCCS). Objective: To evaluate the interrater reliability and known-groups validity of a novel test of MCCS, the in-line half-kneeling test. The test is aimed at assessing MCCS by challenging the ability to maintain a static position with minimized contributions from the distal extremities over a minimized base of support. Design: Cross-sectional group comparison study. Setting: Laboratory. Patients or Other Participants: A total of 75 participants (25 individuals with a history of anterior cruciate ligament reconstruction, 25 uninjured Division 1 collegiate athletes, and 25 uninjured controls) were recruited from a university community. Intervention: Participants were video recorded while performing the in-line half-kneeling test for 120 seconds bilaterally. Three observers independently viewed each video to determine if individuals broke form during each test using 2 dichotomous criteria. Main Outcome Measures: Cohen’s kappa was used to assess interrater reliability, and chi-square tests of independence were used to compare break rates between groups. Results: Good-to-excellent interrater reliability (.732–.973) was seen between the 3 observers. Chi-square tests of independence revealed different break rates between all 3 groups. Compared to break rate for the reference control group (11/25—44%), those with a history of anterior cruciate ligament reconstruction broke at a higher rate (18/25—72%), whereas the uninjured collegiate athletes broke at a lower rate (4/25—16%). Conclusions: The in-line half-kneeling test is a reliable test between raters that can differentiate between groups expected to differ in MCCS.
Joaquin A. Barrios and Danielle E. Strotman
The prevalence of medial knee osteoarthritis is greater in females and is associated with varus knee alignment. During gait, medial knee osteoarthritis has been linked to numerous alterations. Interestingly, there has been no research exploring sex differences during walking in healthy individuals with and without varus alignment. Therefore, the gait mechanics of 30 asymptomatic individuals with varus knees (15 females) and 30 normally-aligned controls (15 females) were recorded. Gait parameters associated with medial knee osteoarthritis were analyzed with two-factor analyses of variance. In result, varus males exhibited the greatest peak knee adduction moments, while normal females showed the greatest peak hip adduction angles and pelvic drop excursions. By sex, females exhibited greater peak hip adduction angles and moments and greater pelvic drop excursion, but lesser peak knee adduction angles. By alignment type, varus subjects exhibited greater peak knee adduction angles and moments, midstance knee flexion angles and excursion, and eversion angles and lateral ground reaction forces, but lesser peak hip adduction angles. In conclusion, females generally presented with proximal mechanics related to greater hip adduction, whereas males presented with more knee adduction. Varus subjects demonstrated a number of alterations associated with medial knee osteoarthritis. The differential sex effects were far less conclusive.
Joaquin A. Barrios, Todd D. Royer and Irene S. Davis
Dynamic knee alignment is speculated to have a stronger relationship to medial knee loading than radiographic alignment. Therefore, we aimed to determine what frontal plane knee kinematic variable correlated most strongly to the knee adduction moment. That variable was then compared with radiographic alignment as a predictor of the knee adduction moment. Therefore, 55 subjects with medial knee OA underwent three-dimensional gait analysis. A subset of 21 subjects also underwent full-limb radiographic assessment for knee alignment. Correlations and regression analyses were performed to assess the relationships between the kinematic, kinetic and radiographic findings. Peak knee adduction angle most strongly correlated to the knee adduction moment of the kinematic variables. In comparison with radiographic alignment, peak knee adduction angle was the stronger predictor. Given that most epidemiological studies on knee OA use radiographic alignment in an attempt to understand progression, these results are meaningful.
David Werner, John Willson, Richard Willy and Joaquin Barrios
Frontal plane knee alignment can influence the development and management of various knee pathologies. Valid and reliable clinical methods for assessment are needed. The primary purposes of this study were to assess the validity and reliability of inclinometer-based frontal plane tibial orientation as a limb alignment measure, and secondarily to establish normal values in healthy individuals. Frontal tibial orientation was validated per moderately strong correlation to radiographic knee alignment. Intra- and interrater reliability were excellent. The normative mean was approximately 7°. In summary, inclinometer-based frontal tibial orientation is a valid and reliable clinical measure of frontal plane knee alignment.
Daniel J. Petit, John D. Willson and Joaquin A. Barrios
Efforts to compare different surface marker configurations in 3-dimensional motion analysis are warranted as more complex and custom marker sets become more common. At the knee, different markers can been used to represent the proximal shank. Often, two anatomical markers are placed over the femoral condyles, with their midpoint defining both the distal thigh and proximal shank segment ends. However, two additional markers placed over the tibial plateaus have been used to define the proximal shank end. For this experiment, simultaneous data for both proximal shank configurations were independently collected at two separate laboratories by different investigators, with one laboratory capturing a walking population and the other a running population. Common discrete knee joint variables were then compared between marker sets in each population. Using the augmented marker set, peak knee flexion after weight acceptance was less (1.2−1.7°, P < .02) and peak knee adduction was greater (0.7−1.4°, P < .001) in both data sets. Similarly, the calculated peak knee flexion moment was less by 15–20% and internal rotation moment was greater by 11–18% (P < .001). These results suggest that the calculation of knee joint mechanics are influenced by the proximal shank’s segment endpoint definition, independent of dynamic task, investigator, laboratory environment, and population in this study.
Andrew R. Boldt, John D. Willson, Joaquin A. Barrios and Thomas W. Kernozek
We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.
Allison L. Kinney, Matthew Giel, Brady Harre, Kyle Heffner, Timothy McCullough, Maria Savino, Alexi Scott and Joaquin A. Barrios
Context: Tasks that activate the lateral trunk muscles are clinically relevant in athletic and rehabilitation programs. However, no electromyography studies have compared tasks aimed at lateral trunk muscle activation. Objective: To compare the activation magnitudes of the internal and external obliques between 4 tasks targeting recruitment of the lateral trunk muscles, including the proposal of a novel assessment. Design: Comparative laboratory study. Setting: University-based biomechanics laboratory. Participants: Sixty-three participants (35 females, age = 23.6 [2.0] y, height = 1.72 [0.10] m, mass = 70.7 [14.4] kg, body mass index = 23.6 [2.86] kg/m2). Intervention(s): Surface electromyography data were recorded bilaterally from the internal and external obliques while the participants performed 2 maximum voluntary contraction tasks followed by 4 isometric tasks. The isometric tasks included feet-elevated side-supported, trunk-elevated side-unsupported, lateral plank, and side-lying hip abduction. Main Outcome Measures: Maximum voluntary contraction-normalized and integrated muscle activities were calculated for targeted and nontargeted muscles in each task. A side-by-task analysis of variance with Bonferroni correction was conducted. Results: The trunk-elevated side-unsupported task strongly activated the internal (199% maximum voluntary contraction) and external (103%) oblique muscles. The feet-elevated side-supported task strongly activated the internal obliques (205%) but not the external obliques (55%). The lateral plank task successfully activated the internal (107%) and external (72%) obliques, but not at the highest levels of the tested tasks. The side-lying hip abduction task was the least effective at activating either the internal (48%) or external (20%) obliques. Conclusions: We recommend the novel trunk-elevated side-unsupported task for assessing lateral trunk muscle performance. For independent exercise, we recommend the lateral plank task, unless arm or shoulder pathologies are present, whereby the feet-elevated side-supported task may be favorable.