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Charlie A. Hicks-Little, Richard D. Peindl, Tricia J. Hubbard-Turner and Mitchell L. Cordova

Context:

Knee osteoarthritis (OA) is a debilitating disease that affects an estimated 27 million Americans. Changes in lowerextremity alignment and joint laxity have been found to redistribute the medial and/or lateral loads at the joint. However, the effect that changes in anteroposterior knee-joint laxity have on lower-extremity alignment and function in individuals with knee OA remains unclear.

Objective:

To examine anteroposterior knee-joint laxity, lower-extremity alignment, and subjective pain, stiffness, and function scores in individuals with early-stage knee OA and matched controls and to determine if a relationship exists among these measures.

Design:

Case control.

Setting:

Sports-medicine research laboratory.

Participants:

18 participants with knee OA and 18 healthy matched controls.

Intervention:

Participants completed the Western Ontario McMaster (WOMAC) osteoarthritis questionnaire and were tested for total anteroposterior knee-joint laxity (A-P) and knee-joint alignment (ALIGN).

Main Outcome Measures:

WOMAC scores, A-P (mm), and ALIGN (°).

Results:

A significant multivariate main effect for group (Wilks’ Λ = 0.30, F 7,26 = 8.58, P < .0001) was found. Knee-OA participants differed in WOMAC scores (P < .0001) but did not differ from healthy controls on ALIGN (P = .49) or total A-P (P = .66). No significant relationships were identified among main outcome measures.

Conclusion:

These data demonstrate that participants with early-stage knee OA had worse pain, stiffness, and functional outcome scores than the matched controls; however, ALIGN and A-P were no different. There was no association identified among participants’ subjective scores, ALIGN, or A-P measures in this study.

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Jennifer M. Medina McKeon, Craig R. Denegar and Jay Hertel

The purpose of this study was to formulate a predictive equation to discriminate males from females using static and dynamic lower extremity (LE) alignments. Twenty-four healthy adults volunteered to participate. Three-dimensional motion analysis was used to assess the kinematics of the right hip and knee during two functional tasks. Six measures of static LE alignment were also performed. Statistical comparisons were made between males and females for all variables. Static and dynamic variables that were significantly different by sex were entered into separate discriminant analyses for each task. The resulting equations were each able to correctly predict 87% of the subjects by sex. Fifty-eight percent and 55% of the variance was explained by sex for the vertical jump and plant & jump, respectively. The frontal plane hip angle was the best predictor of sex for both tasks. While there were statistically significant differences between the sexes for static measures of LE alignment, kinematic measures were better at discriminating between sexes.

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Deborah L. King and Barbara C. Belyea

Context: Landing kinematics have been identified as a risk factor for knee injury. Detecting atypical kinematics in clinical settings is important for identifying individuals at risk for these injuries. Objective: To determine the reliability of a handheld tablet and application (app) for measuring lower-extremity kinematics during drop vertical-jump landings. Design: Measurement reliability. Setting: Laboratory. Participants: 23 healthy young adults with no lower-extremity injuries and no contraindications for jumping and landing. Intervention: Subjects performed 6 drop vertical jumps that were captured with an iPad2 and analyzed with a KinesioCapture app by 2 novice and 2 experienced raters. Three trials each were captured in the frontal and sagittal planes. Main Outcome Measures: Frontal-plane projection angles, knee flexion, and hip flexion at initial contact and maximum knee flexion were measured. ICC and SEM were calculated to determine intertrial and interrater reliability. One-way ANOVAs were used to examine differences between the measured angles of the raters. Results: Average intertrial reliability ranged from .71 to .98 for novice raters and .77 to .99 for experienced raters. SEMs were 2.3-4.3° for novice raters and 1.6-3.9° for experienced raters. Interrater ICC2,1 was .39-.98 for the novice raters and .69-.93 for the experienced raters. SEMs were smallest with the experienced raters, all less than 1.5°. Conclusion: A handheld tablet and app is promising for evaluating landing kinematics and identifying individuals at risk for knee injury in a clinical setting. Intertrial reliability is good to excellent when using average trial measures. Interrater reliability is fair to excellent depending on experience level. Multiple trials should be assessed by a single rater when assessing lower-extremity mechanics with a handheld tablet and app, and results may vary with experience level or training.

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Figen Govsa, Gkionoul Nteli Chatzioglou, Simin Hepguler, Yelda Pinar and Ozden Bedre

assessment of lower-extremity alignment . Osteoarthritis Cartilage . 2015 ; 23 ( 3 ): 379 – 382 . PubMed ID: 25528105 doi: 10.1016/j.joca.2014.12.009 25528105 11. Sritharan P , Lin YC , Richardson SE , Crossley KM , Birmingham TB , Pandy MG . Lower-limb muscle function during gait in

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Shogo Uota, Anh-Dung Nguyen, Naoko Aminaka and Yohei Shimokochi

Context:

Excessive knee valgus and tibial external rotation relative to the femur during weight bearing motions, such as jump-landing, reportedly increases the risk of developing chronic knee pain, such as patellofemoral pain. Excessive deviations from normal ranges of several static lower extremity alignment measures and dynamic hip motions may also increase the risks for patellofemoral pain.

Objective:

To determine the relationship between lower extremity alignments and hip motions to frontal and transverse plane knee motions during double-leg landings.

Design:

Correlational study.

Setting:

Laboratory.

Patients or Other Participants:

69 healthy, competitive athletes (27 men, 42 women; height, 166.5 ± 9.5 cm; weight, 61.3 ± 9.9 kg; age, 20.7 ± 1.0 y) participated in this study.

Interventions:

Prone and supine hip version, quadriceps angle, and tibiofemoral angle were measured. Frontal and transverse knee and hip angles at peak knee extensor moment during landing were calculated.

Main Outcome Measures:

2 separate stepwise multiple regression analyses were conducted to predict frontal and transverse plane knee motions using 4 static lower extremity alignment measures and hip motions.

Results:

Greater hip adduction and prone hip anteversion, and lesser hip internal rotation and supine hip anteversion, were related to greater knee valgus motions (R 2 = .475, P < .01). Greater hip adduction was related to greater knee external rotation (R 2 = .205, P < .01).

Conclusions:

Some targeted static lower extremity alignments and hip motions are associated with frontal and transverse knee motions. However, stronger relationships of hip motions with knee motions than static lower extremity alignments provided evidence that improving hip movements may help improve patellofemoral pain in those with lower extremity malalignments.

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Barbara C. Belyea, Ethan Lewis, Zachary Gabor, Jill Jackson and Deborah L. King

Context: Lower-extremity landing mechanics have been implicated as a contributing factor in knee pain and injury, yet cost-effective and clinically accessible methods for evaluating movement mechanics are limited. The identification of valid, reliable, and readily accessible technology to assess lower-extremity alignment could be an important tool for clinicians, coaches, and strength and conditioning specialists. Objective: To examine the validity and reliability of using a handheld tablet and movement-analysis application (app) for assessing lower-extremity alignment during a drop vertical-jump task. Design: Concurrent validation. Setting: Laboratory. Participants: 22 healthy college-age subjects (11 women and 11 men, mean age 21 ± 1.4 y, mean height 1.73 ± 0.12 m, mean mass 71 ± 13 kg) with no lower-extremity pathology that prevented safe landing from a drop jump. Intervention: Subjects performed 6 drop vertical jumps that were recorded simultaneously using a 3-dimensional (3D) motion-capture system and a handheld tablet. Main Outcomes Measures: Angles on the tablet were calculated using a motion-analysis app and from the 3D motion-capture system using Visual 3D. Hip and knee angles were measured and compared between both systems. Results: Significant correlations between the tablet and 3D measures for select frontal- and sagittal-plane ranges of motion and angles at maximum knee flexion (MKF) ranged from r = .48 (P = .036) for frontal-plane knee angle at MKF to r = .77 (P < .001) for knee flexion at MKF. Conclusion: Results of this study suggest that a handheld tablet and app may be a reliable method for assessing select lower-extremity joint alignments during drop vertical jumps, but this technology should not be used to measure absolute joint angles. However, sports medicine specialists could use a handheld tablet to reliably record and evaluate lower-extremity movement patterns on the field or in the clinic.

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* Zachary Gabor * Jill Jackson * Deborah L. King * 1 11 2015 24 4 10.1123/jsr.2014-0194 Reliability of Using a Handheld Tablet and Application to Measure Lower-Extremity Alignment Angles Deborah L. King * Barbara C. Belyea * 1 11 2015 24 4 10.1123/jsr.2014-0195 Effect of a High

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.3.281 Pelvifemoral Kinematics while Ascending Single Steps of Different Heights Richard W. Bohannon * Jason Smutnick * 8 2010 26 3 290 294 10.1123/jab.26.3.290 Sex Differences and Discriminative Value of Lower Extremity Alignments and Kinematics during Two Functional Tasks Jennifer M. Medina McKeon * Craig R

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Original Research Report The Relationship Between Early-Stage Knee Osteoarthritis and Lower-Extremity Alignment, Joint Laxity, and Subjective Scores of Pain, Stiffness, and Function Charlie A. Hicks-Little * Richard D. Peindl * Tricia J. Hubbard-Turner * Mitchell L. Cordova * 8 2016 25 3

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Mohammad H. Izadi Farhadi, Foad Seidi, Hooman Minoonejad and Abbey C. Thomas

increase in lumbar lordosis angle may result in a change in lower-extremity alignment. In support of this view, lumbar hyperlordosis causes a change in the whole of lower-extremity alignment 3 beginning with an increase in anterior pelvic tilt. 4 Anterior pelvic tilt is associated with increased femoral