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Megan P. Brady and Windee Weiss

the knee joint was done before admission and in some cases before the clinical diagnostic tests ACL injury was diagnosed based on a Lachman test and an anterior drawer test All physical exams were performed by a physician specialized in knee surgery and included examinations of ACL, anterior drawer

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J. Craig Garrison, Joe M. Hart, Riann M. Palmieri, D. Casey Kerrigan and Christopher D. Ingersoll

Context:

Although kinematic analyses are helpful in describing movement differences between genders, kinetic data might further explain the predisposing factors contributing to potential injury during athletic landing maneuvers.

Objective:

To determine whether there are differences in knee moments between male and female varsity college soccer players during a single-leg landing.

Design:

Preexperimental with static group comparison.

Setting:

Motion-analysis laboratory.

Participants:

16 varsity college soccer players (8 men, 8 women).

Intervention:

Subjects performed 5 single-leg landings from a height of 60 cm.

Main Outcome Measures:

Peak internal rotation, valgus, varus, and extension knee moments calculated from raw ground-reaction forces and kinematic data.

Results:

Significant gender differences were present (P = .020), with men exhibiting 31% greater mean peak knee-varus moments than women when landing on a single leg from 60 cm (P = .020).

Conclusions:

Male soccer players demonstrate greater knee-varus moments than female soccer players during single-leg landing. This might be valuable in designing clinical treatment and prevention programs for ACL injuries.

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Rhodri S. Lloyd, Jon L. Oliver, Gregory D. Myer, Mark B. De Ste Croix, Josh Wass and Paul J. Read

Context: Despite the popularity of jump-landing tasks being used to identify injury risk factors, minimal data currently exist examining differences in knee kinematics during commonly used bilateral jumping tasks. This is especially the case for rebounding-based protocols involving young athletes. Objective: To compare the frontal plane projection angles (FPPAs) during the drop vertical jump (DVJ) and tuck jump assessment (TJA) in a cohort of elite male youth soccer players of varying maturity status. Methods: A total of 57 male youth soccer players from an English championship soccer club participated in this study. Participants performed 3 trials of the DVJ and TJA, during which movement was recorded with 2-dimensional video cameras. FPPA for both right (FPPA-r) and left (FPPA-l) legs, with values <180° indicative of medial knee displacement. Results: On a whole-group level, FPPA-r (172.7° [7.4°] vs 177.2° [11.7°]; P < .05; effect size [ES] = 0.46) and FPPA-l (173.4° [7.3°] vs 179.2° [11.0°]; P < .05; ES = 0.62) were significantly greater for both limbs in the TJA compared with the DVJ; however, these differences were less consistent when grouped by maturity status. FPPA-r during the TJA was significantly and moderately greater in the circa-peak height velocity (PHV) group compared with the post-PHV cohorts (169.4° [6.4°] vs 175.3° [7.8°]; P < .05; ES = 0.49). Whole-group data showed moderate relationships for FPPA-r and FPPA-l between the TJA and DVJ; however, stronger relationships were shown in circa- and post-PHV players compared with the pre-PHV cohort. Conclusions: Considering that the TJA exposed players to a larger FPPA and was sensitive to between-group differences in FPPA-r, the TJA could be viewed as a more suitable screen for identifying FPPA in young male soccer players.

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Aaron Nelson, Nathan Koslakiewicz and Thomas Gus Almonroeder

second injury involves the previously uninjured knee. It appears that there is an urgent need to improve rehabilitation following ACL reconstruction. Athletes who have undergone an ACL reconstruction often demonstrate greater interlimb knee joint kinetic (ie, joint moments and power) asymmetry during

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Masao Tomioka, Tammy M. Owings and Mark D. Grabiner

We previously reported that lower extremity muscular strength of older adults did not predict success of a balance recovery task. We propose that lower extremity coordination may limit performance independently of lower extremity strength. The present study was conducted to determine the extent to which knee extension strength and hip–knee coordination independently contribute to maximum vertical jump height. Maximum vertical jump height and isometric and isokinetic knee extension strength and power were determined in 13 young adults. Hip–knee coordination during the vertical jump was quantified using relative phase angles. Stepwise nonlinear multiple regression determined the variable set that best modeled the relationship between the dependent variable, maximum vertical jump height, and the independent variables of strength, power, and coordination. The quadratic terms of the normalized knee extension strength at 60 deg·s–1, and the average relative phase during the propulsion phase of the vertical jump, collectively accounted for more than 80% of the shared variance (p = .001). The standardized regression coefficients of the two terms, .59 and .52, respectively (p = .004 and .008), indicated the independence and significance of the contributions of knee extension strength and hip–knee coordination to maximum vertical jump height. Despite the pitfalls of extrapolating these results to older adults performing a balance recovery task, the results are interpreted as supporting the contention that while muscle strength confers a number of functional benefits, the ability to avoid falling as a result of a trip is not necessarily ensured. Increased muscle strength per se can occur in the absence of improved kinematic coordination.

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David Parsons and Wendy Gilleard

Patellofemoral taping is a technique used in the management of patellofemoral pain that has been shown to alter the pattern of muscle activation onset in symptomatic subjects. It is unknown, however, if this taping technique directly influences the patterns of muscle activity that controls patella position or if its benefits are more related to the effect of pain reduction. The purpose of this study was to investigate the effect of a taping technique on the muscle activation onset of selected quadriceps muscles where pain was not a confounding factor. Thirteen asymptomatic subjects completed a stair ascent and descent task with the right patella untaped and taped for a medial patella glide. Muscle activation onset was determined by computer algorithm from surface EMG of vastus lateralis (VL) and vastus medialis obliquus (VMO). Taping significantly delayed the muscle activation onset of VMO and VL during stair ascent. There was no significant change for stair descent. This effect may be an attempt by the motor control system to counter the mechanical effect of patella perturbation or may be due to cutaneous stimulation affecting threshold or recruitment of motor units.

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Ashley Stern, Chris Kuenze, Daniel Herman, Lindsay D. Sauer and Joseph M. Hart

Context:

Central and peripheral muscle fatigue during exercise may exacerbate neuromuscular factors that increase risk for noncontact anterior cruciate ligament injury.

Objective:

To compare lower extremity motor-evoked potentials (MEPs), muscle strength, and electromyography (EMG) activation after an exercise protocol.

Design:

Pretest, posttest group comparison.

Setting:

University laboratory.

Participants:

34 healthy volunteers (17 female, age = 21.9 ± 2.3 years, weight = 77.8 ± 3.0 kg, height = 171.1 ± 6.6 cm, and 17 male, age = 23.4 ± 6.5 years, weight = 81.6 ± 3.3 kg, height = 179.6 ± 7.3 cm).

Intervention:

A standardized 30-min exercise protocol that involved 5 repeated cycles of uphill walking, body-weight squatting, and step-ups.

Main Outcome Measures:

Quadriceps and hamstring MEP amplitude (mV) and transmission velocity normalized to subject height (m/s) were elicited via transcranial magnetic stimulation and measured via surface EMG. Quadriceps and hamstring peak EMG activation (% MVIC) and peak torque (Nm/kg) were measured during MVICs. Separate ANCOVAs were used to compare groups after exercise while controlling for baseline measurement.

Results:

At baseline, males exhibited significantly greater knee-extension torques (males = 2.47 ± 0.68 Nm/kg, females = 1.95 ± 0.53 Nm/kg; P = .036) and significantly higher hamstring MEP amplitudes (males = 223.5 ± 134.0 mV, females = 89.3 ± 77.6 mV; P = .007). Males exhibited greater quadriceps MEP amplitude after exercise than females (males = 127.2 ± 112.7 mV, females = 32.3 ± 34.9 mV; P = .016).

Conclusions:

Males experienced greater peripheral neuromuscular changes manifested as more pronounced reductions in quadriceps torque after exercise. Females experienced greater central neuromuscular changes manifested as more pronounced reduction in quadriceps MEP amplitude. Reduced central neural drive of the quadriceps coupled with knee-extension torque preservation after exercise may increase risk of knee injury in females.

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Jenny Toonstra and Carl G. Mattacola

Context: Physicians and clinicians need portable, efficient, and cost-effective assessment tools to determine the effectiveness of rehabilitation programs after knee injury. Progress in rehabilitation should be evaluated using valid and reliable measurement methods. Objective: To examine the test-retest reliability of portable fixed dynamometry (PFD), handheld dynamometry (HHD), and isokinetic dynamometry (IKD). In addition, the authors sought to examine the validity of PFD and HHD by comparing differences in peak torque of the knee flexors and extensors to that of the "gold standard" IKD. Design: Repeated measures. Participants: 16 healthy subjects (age 29.3 ± 7.2 y, height 167.4 ± 8.04 cm, mass 73.7 ± 20.0 kg). Main Outcome Measures: The dependent variables were trial (trial 1, trial 2) and instrument (IKD, PFD, and HHD). Results: Test-retest reliability was high for both PFD and IKD. However, fair to poor reliability was found for HHD. There were no differences in peak torque (Nm) between IKD and PFD. However, significant differences in peak torque were observed between IKD and HHD and between PFD and HHD. Conclusions: PFD provides reliable measures of strength and also demonstrates similar output measures as IKD. Its portability, ease of use, and cost provide clinicians an effective means of measuring strength.

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John H. Hollman, Jeffrey M. Hohl, Jordan L. Kraft, Jeffrey D. Strauss and Katie J. Traver

Context:

Abnormal lower extremity kinematics during dynamic activities may be influenced by impaired gluteus maximus function.

Objective:

To examine whether hip-extensor strength and gluteus maximus recruitment are associated with dynamic frontal-plane knee motion during a jump-landing task.

Design:

Exploratory study.

Setting:

Biomechanics laboratory.

Participants:

40 healthy female volunteers.

Main Outcome Measures:

Isometric hip-extension strength was measured bilaterally with a handheld dynamometer. Three-dimensional hip and knee kinematics and gluteus maximus electromyography data were collected bilaterally during a jumplanding test. Data were analyzed with hierarchical linear regression and partial correlation coefficients (α = .05).

Results:

Hip motion in the transverse plane was highly correlated with knee motion in the frontal plane (partial r = .724). After controlling for hip motion, reduced magnitudes of isometric hip-extensor strength (partial r = .470) and peak gluteus maximus recruitment (partial r = .277) were correlated with increased magnitudes of knee valgus during the jump-landing task.

Conclusion:

Hip-extensor strength and gluteus maximus recruitment, which represents a measure of the muscle’s neuromuscular control, are both associated with frontal-plane knee motions during a dynamic weight-bearing task.

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Johanna M. Hoch, Cori W. Sinnott, Kendall P. Robinson, William O. Perkins and Jonathan W. Hartman

Context: There is a lack of literature to support the diagnostic accuracy and cut-off scores of commonly used patient-reported outcome measures (PROMs) and clinician-oriented outcomes such as postural-control assessments (PCAs) when treating post-ACL reconstruction (ACLR) patients. These scores could help tailor treatments, enhance patient-centered care and may identify individuals in need of additional rehabilitation. Objective: To determine if differences in 4-PROMs and 3-PCAs exist between post-ACLR and healthy participants, and to determine the diagnostic accuracy and cut-off scores of these outcomes. Design: Case control. Setting: Laboratory. Participants: A total of 20 post-ACLR and 40 healthy control participants. Main Outcome Measures: The participants completed 4-PROMs (the Disablement in the Physically Active Scale [DPA], The Fear-Avoidance Belief Questionnaire [FABQ], the Knee Osteoarthritis Outcomes Score [KOOS] subscales, and the Tampa Scale of Kinesiophobia [TSK-11]) and 3-PCAs (the Balance Error Scoring System [BESS], the modified Star Excursion Balance Test [SEBT], and static balance on an instrumented force plate). Mann-Whitney U tests examined differences between groups. Receiver operating characteristic (ROC) curves were employed to determine sensitivity and specificity. The Area Under the Curve (AUC) was calculated to determine the diagnostic accuracy of each instrument. The Youdin Index was used to determine cut-off scores. Alpha was set a priori at P < 0.05. Results: There were significant differences between groups for all PROMs (P < 0.05). There were no differences in PCAs between groups. The cut-off scores should be interpreted with caution for some instruments, as the scores may not be clinically applicable. Conclusions: Post-ACLR participants have decreased self-reported function and health-related quality of life. The PROMs are capable of discriminating between groups. Clinicians should consider using the cut-off scores in clinical practice. Further use of the instruments to examine detriments after completion of standard rehabilitation may be warranted.