Knee Biomechanics

Currently, a suitable and reliable noninvasive method to evaluate rotational stability in vivo in anterior cruciate ligament-deficient knees, particularly during sports movements, does not exist. We speculated that if there is a rotational instability, the patient would avoid reaching a high pivoting moment during pivoting activities as a defense mechanism, and that the ground reaction moment, as registered by dynamometric platforms, would be reduced. On the basis of this hypothesis, we developed a study using kinetic analysis to evaluate rotational stability under dynamic loading. Thirty recreationally active athletes, including fifteen healthy subjects and fifteen with an anterior cruciate ligament-deficient knee, were recruited for this study. Patients performed jumping with pivoting with internal tibial rotation and external tibial rotation on the dynamometric platform with both the healthy and the injured limb. The quantitative results were graphically plotted, and the followin...

Objectives Osteoarthritis is the most common musculoskeletal disease in old age, which has a negative effect on psychological health and reduces the quality of life and life expectancy. This study aimed to evaluate the effect of two aquatic exercise programs (with Theraband or based on the National Academy of Sports Medicine [NASM] approach) on pain, kinesiophobia, and mood in older women with knee osteoarthritis (KO). Methods & Materials In this quasi-experimental study with a pre-test/post-test design, 45 older women with KO were selected by a purposive sampling method and were divided into three groups: Aquatic exercise with Theraband (n=15), aquatic exercise with the NASM approach (n=15), and control (n=15). The exercise programs were performed for eight weeks, three sessions per week, each for 60 minutes. The visual analog scale (VAS), Tampa scale of kinesiophobia (TSK), and the Brunel mood scale (BRUMS) were used to measure the study variables. To analyze the data, MANCOVA and Bonferroni's post hoc test were conducted in SPSS software, version 26, considering a significance level of P≤0.05. Results The mean age, height, weight, and BMI were 66.2±4.11 years, 160.6±4.64 cm, 74.3±8.39 kg, and 29.04±13.56 kg/m 2 , respectively. The results showed that pain (F=313.71, P=0.002), kinesiophobia (F=271.84, P=0.001), and mood (F=49.66, P=0.001) improved significantly in both exercise groups compared to the control group. No significant difference was observed between the two exercise groups in these variables (P≥0.05). Conclusion Aquatic exercises with Theraband or based on the NASM approach have positive effects on pain, kinesiophobia, and mood of older women with KO. Therefore, these exercise methods are recommended as a suitable prevention and treatment method for these women.

Floating knee is a clinical entity characterized by the simultaneous existence of fractures of the femur and tibia on the same side. The aim of our study was to describe the epidemiological and clinical aspects and evaluate the functional results of patients treated for floating knee in our department at the CHUR. Material and methods: This was a prospective and descriptive study from January 2017 to December 2022, including all patients treated and followed up for floating knee in the Orthopedic and trauma-surgery at the Department of the CHUR. The fractures were classified according to the Fraser classification. The functional and anatomical results were evaluated according to the Karlstrom and Olerud criteria. Results: There were 29 cases of floating knee out of 1427 cases of pelvic fractures (2.03%), with 27 cases in men (93.1%) and a sex ratio of 13.5:1. The mean age was 33.3 ± 15.7 years (range: 9-70 years). The etiology was dominated by road accidents (93%), involving motorcycles and cars (55.6%). The right pelvic limb was most often affected (55.2%). There were 75.9% open fractures, mostly at the leg (68.2%). The type I fracture according to the Gustilo-Anderson classification was most common at the femur and tibia. The type I fracture according to the Fraser classification was most represented (72.4%), followed by type IIc (13.8%). Surgical treatment (93.1%) was performed using plate fixation at the femur (62.1%) and tibia (48.3%). Complications were dominated by stiffness (60%). With a mean follow-up of 32 months, the anatomical and functional results were satisfactory (excellent: 31% and good: 44.8%). Conclusion: Floating knee is a rare and serious clinical entity. Treatment should be surgical and early.

The shear stress relaxation of cylindrical, osteochondra1 plugs was measured by means of ramp displacements at strain rates ranging approximately from 0.06 s-1 to 13 S-1. The plugs were prepared from patellar grooves of fresh bovine femora. For each specimen separately, the data was fitted t o a five-parameter quasi- linear viscoelastic model. The different loading rates were pooled together to obtain a solution that would conform as well as possible to all time-dependent force functions measured with a particular specimen. This method makes it possible to analyze stress functions caused by arbitrary strain histories. From strain rate 10 3-1 to rate 0.1 s-1 the shear modulus dropped in average by a factor of 1 . 5 2 and the relaxation was roughly logarithmic. At rate 10 s-1, the average ,shear modulus was 4 . 8 5 MPa. All the moduli were assessed a t a fixed, 4% strain to avoid errors due to nonlinearity of the material. The measured stresses were well within human physiological lim...

Prophylactic taping is commonly used to prevent ankle injuries during sports. However, unnatural constraint of the ankle joint may increase the risk of injury to proximal joints such as the knee. The association between ankle taping and knee joint loading during open sporting tasks has not been quantified. This research aimed to measure changes in knee and ankle kinetics and kinematics during dynamic athletic activities undertaken with and without ankle taping.

Introduction and Objectives: Higher levels of movement or coordination variability have been reported to provide flexibility and allow adaptations to complex dynamic sport environments [1]. Decreased movement and coordination variability has been previously been reported in females [2] and proposed as a risk factor for injury. The aim of this study was to compare the variability of hip and knee joint kinematics (movement) variability and lower extremity joint and segment coupling (coordination) variability in healthy males and females during a dynamic landing task. There is a scarcity of information on gender differences in coordination and movement variability during dynamic landing and cutting tasks. This information may provide valuable insight to further explain the gender bias of ACL injury, where lower levels of movement and/or coordination variability may increase injury risk. Methods: Ten healthy males and ten healthy females were recruited for this investigation. Participan...

This study compared the lower limb coordination of the previously injured leg of ACL injured participants (ACLr, n=18), against their non-injured leg and a control (nACL, n=18) leg. The lower limb joint and segment couplings were calculated during maximal drop-jump land and unanticipated cutting task. Differences between the previously injured and nACL control leg were present in all but one of the lower limb joint and segment couplings. Differences between the previously injured and nACL control leg were present in the hip rotation - knee abduction adduction, and knee rotation knee abduction adduction couplings. The hip and thigh were the main areas where differences were reported. Altered proximal neuromuscular function may be the origin of these altered coordination patterns.

The purpose of the present study was to compare lower limb alignment at initial ground contact between groups with normal and abnormal hip rotation range of motion. Male (n=8) and female (n=8) subjects performed an maximal drop jump diagonal side cut task ten to the left and ten to the right. Lower limb alignment was assessed through knee angle, hip angle, ankle angle, thigh rotation and shank rotation at initial foot contact. One significant difference was reported between groups for the knee angle variable on the non dominant side. This indicates that the only the knee angle variable is affected by unbalanced hip rotation range of motion and on the non-dominant side.

Purpose: Deep freezing and storing in formalin are some of the common techniques of human tissue preservation. However, the preservation modes affect the biomechanical properties of the tissues. In this work, the effects of the above-stated preservation techniques are compared with that of fresh cadaveric samples. Methods: FATC samples from male cadavers of age between 60 and 70 years were tested under tensile loading at a strain rate of 0.8 s -1 . Fourteen FATC samples from soft embalmed cadavers were preserved for 3 weeks by two methods: (a) 10% formalin and (b) deep freezing at -20 C followed by thawing. Seven FATC samples from fresh cadavers were experimented as control samples. The results were evaluated by a two-stage statistical process of Kruskal-Wallis H test and Mann-Whitney U-test. Results: It was observed that the failure force of fresh cadavers was the highest while that of preserved samples were approximately half the value. Failure elongation of frozen samples exceeded fresh samples while formalin samples failed at lesser elongations. Higher incidence of tibial insertion point or mid-section failures were observed in fresh samples while the higher incidence of ruptures at femoral insertion point was observed in the two preservation methods. Conclusion: Tensile properties of fresh tissues vary significantly from that of formalin preserved or frozen preserved samples.

The aim of this study was to perform an electromyography comparison of three commonly used lower limb injury prevention exercises: a single-leg squat on a bench (SLSB), a double-leg squat (DLS) and a double-leg squat on a BOSU® balance trainer (DLSB). After determining the maximum isometric voluntary contraction of the hamstring and quadriceps, eight female athletes performed 3 repetitions of each exercise, while electromyography activity of the biceps femoris (BF), semitendinosus (ST), vastus lateralis (VL) and vastus medialis (VM) was monitored. Comparisons between exercises revealed higher activation in BF (descending phase: p = 0.016, d = 1.36; ascending phase: p = 0.046, d = 1.11), ST (descending phase: p = 0.04, d = 1.87; ascending phase: p = 0.04, d = 1.87), VL (ascending phase: p = 0.04, d = 1.17) and VM (descending phase: p = 0.05, d = 1.11; ascending phase: p = 0.021, d = 1.133) muscles for the SLSB compared to the DLSQ. Furthermore, higher muscular activation of the ST (a...

Strengthening exercises have been routinely used in persons with orthopaedic problems and athletes to increase force production or minimize muscle imbalance and joint injuries.Many studies have reported that isometric contractions can rapidly increases strength in quadriceps muscle. Objective: Objective of the study was to find out the effect of isometric strengthening exercise on strength of quadriceps at 45 and 90 degree of knee joint and also to compare the effect of strengthening exercise on strength of quadriceps at multiple angles of knee joint among control and experimental group. This was a ccomparative experimental study with forty female healthy subjects from physiotherapy department of KPJ Healthcare University College, Malaysia. Convenient sampling method used to select the samples. The subjects were selected by inclusion criteria and randomly divided equally in to two with 20 subjects in each group. Isometric strengthening exercise and squatting exercise were given as intervention program for eight weeks respectively for experimental and control group. Pre and post data of quadriceps muscle strength measured were collected separately at 45 and 90 degree of knee joint using goniometry during resisted extension of knee in multi gym. In experimental group Pre -Post statistical analysis found significant effect in increase of quadriceps strength at 45 and 90 degree with P<0.0001.****In control group quadriceps pre-post statistical analysis found no significant effect in increase of quadriceps strength at 45 and 90 degree with P<0.083NS and P<0.055 NS respectively. Comparative study between experimental and control groups for quadriceps strength at 90 degree of knee joint found significant effect in increase of quadriceps strength with P< 0.001.*** Comparative study between experimental and control groups for quadriceps strength at 45 degree of knee joint found significant effect in increase of quadriceps strength with P<0.01* Conclusion: This study concluded that isometric strengthening exercise can improve quadriceps strength at 45 and 90 degree of knee joint. And also found that the strength at 90 degree has improved more compared to the strength at 45 degree.

Introducción: Se han descripto múltiples técnicas quirúrgicas para estabilizar la patela. Se realizó un estudio retroprospectivo analizando los resultados al año del tratamiento de la luxación recidivante de rótula mediante reconstrucción del ligamento patelofemoral medial (LPFM) con injerto de semitendinoso autólogo. Material y Métodos: Entre enero de 2010 y abril de 2012 se operaron 37 pacientes (24 hombres y 13 mujeres con edad promedio de 21 años) por inestabilidad patelofemoral recurrente. Se incluyeron los que se les realizó reconstruccion del ligamento patelofemoral medial con injerto autólogo de semitendinoso. Se excluyeron 4 pacientes a los que se les realizó una ostetomía de TAT. Mediante un riguroso exámen fisico y estudios de imágenes (Rx, TAC y RNM), se evaluó estabilidad articular, ángulo Q, versión femoral y rotación tibial, daño osteocondral. Los pacientes fueron evaluados a las 6 semanas, 3 meses y al año. En el preoperatorio y el último seguimiento se realizó una evaluación con score de Lysholm y de Kujala. Resultados: Ninguno presentó recidivas hasta el año postoperatorio. 31 pacientes comenzaron la actividad deportiva 6 meses después de la cirugía. Como complicaciones se registraron: dos infecciones de herida quirúrgica y un caso con hipotrofia muscular cuadricipital. No se registraron fracturas ni trombosis venosa profunda. Ninguno necesitó reintervenciones. El score Kujala promedio mejoró de 48 en el preoperatorio a 90, 32 al año de seguimiento y el score de Lysholm de 53 el preoperatorio a 87,5 al año. Discusión: El LPFM actua como una rienda restringiendo la traslación externa de la patela desde la extensión hasta los 30 grados de flexión para luego relajarse en el resto de la flexión. En nuestra serie, la reconstrucción de LPFM con injerto autólogo de semitendinoso, mejoró los scores funcionales, presentando un bajo índice de complicaciones y sin recidivas al año de seguimiento.

Presentamos el caso de un paciente deportista de rugby profesional de 22 años de edad, que sufrió lesión multiligamentaria de rodilla izquierda. Presentaba lesión de LCA, LCP, LCM, y Complejo postero lateral. Se realizó la reconstrucción multiligamentaria en agudo, a los 10 días del trauma, con aloinjerto de banco, congelado, y no irradiado. A los 15 meses de operado, el paciente retornó al deporte profesional de alto rendimiento, al mismo nivel pre-lesión, demostrando la importancia de una reconstrucción multiligamentaria temprana, en un solo tiempo, y destacando que el uso de aloinjerto benefició el retorno deportivo profesional.

To compare the effects of spatting, taping and spatting, taping, and not taping on the amount and rate of inversion of the ankle before and after exercise. We filmed subjects at 60 Hz while they stood on a platform that suddenly inverted the right ankle. Five trials were measured before and after a 30-minute period of drills. We tested 15 male rugby players with no history of lower-leg injury within the previous 6 months limiting activity for more than 2 days. The amount and rate of inversion in the four conditions were digitized and analyzed. The combination of spatting and taping was the most effective in reducing inversion rate and range of motion before and after exercise. All three taping treatments were effective in reducing the amount and rate of inversion. Exercise loosened the tape, but there may be a functional restriction of the amount and rate of inversion after exercise.

Objective To provide the off -loading knee brace was designed relief for the pain associated with osteoarthritis by reduce loads on the degenerative compartment of the knee. Th is study examined the eff ects of the off -loading knee brace on activation of femoral muscles during squatting, slow and fast walking exercise in healthy young individuals. Method Ten healthy male subjects without a history of knee pain were recruited. Each subject was asked to do squatting, slow and fast walking exercises with a brace secured to the dominant leg. The same exercises were repeated without the brace. Surface electromyographic (sEMG) data was collected from the vastus medialis oblique (VMO), vastus lateralis (VL) and biceps femoris (BF) muscles from the dominant side of the leg. All dynamic root mean squre (RMS) values of sEMG were standardized to static RMS values of the maximal isometric contraction and expressed as a percentage of maximal activity. Results We found that VMO activity was signifi cantly decreased with application of the off -loading knee brace during squatting and fast walking exercise. However there were no signifi cant diff erences in VMO activity with application of the off -loading knee brace during slow walking exercise. Conclusion Th ese results suggest that the external moment of the brace which eff ectively stabilized the patella in the movement in which the knee joints become relatively unstable. Th e brace could be useful in the short term, but for long-term use, weakening of the VMO is predicted. Th erefore the program of selective muscular strength strengthening for the VMO should be emphasized.

Background: Little is known about the effects of verbal instructions on the technique and performance of sports-related tasks. The aim of this study was therefore to investigate the acute effects of knee alignment instructions on knee kinematics and the performance of a single-leg jump in female adolescent soccer players. Methods: Twenty-eight adolescent female soccer players completed three blocks of 15 single-leg jumps. The participants were randomised to an experimental group receiving verbal instructions focussing on proper knee alignment (the avoidance of knee valgus) or to a control group only receiving instructions on task execution. Outcomes were knee kinematics (flexion and valgus angles) and jump performance (number of incorrect trials and contact time). Results: The experimental group demonstrated 36% less knee valgus and 11-13% greater knee flexion compared to the control group. While jump performance remained unchanged in the experimental group over the course of the experiment, the control group demonstrated a 20% decrease in the number of incorrect trials and a 25% reduction in contact time over the course of the experiment. Conclusions: The present results indicate that verbal instructions accentuating proper knee alignment benefit knee kinematics but not jump performance in adolescent female soccer athletes.

Background: To determine whether a proximal tibiofibular joint dislocation (TFJD) increases lateral compartment gapping more than a fibular head osteotomy (FHO) during a closing-wedge high tibial osteotomy (CWHTO). The second objective was to determine whether lateral compartment gapping affects clinical outcomes. Methods: A prospective randomized clinical study was carried out that included 18 patients in Group 1 (FHO) and 18 in Group 2 (TFJD). Varus-stress radiographs of all the patients with both knees at full extension and at 30 • of flexion were studied pre-operatively and 12 months post-operatively. Lateral compartment gapping was measured in millimeters. The Knee Society Score (KSS) was used to assess clinical stability. Results: The difference between the preand post-operative measurements relative to gapping in the lateral knee compartment at 0 • of knee flexion was 1.3 mm (SD 1.8) in Group 1 and 4.5 mm (SD 2.4) in Group 2 (p = 0.006). At 30 • of knee flexion, this difference was 1.9 mm (SD 1.2) in Group 1 and 5.2 mm (SD 3.1) in Group 2 (p = 0.01). No differences were observed in the pre-and post-operative period relative to gapping in healthy knees. Pre-operatively, both groups presented similar KSS knee values: Group 1 with 54.7 (SD 11.7), Group 2 with 54.8 (SD 11.1) (n.s.). Post-operatively, these values were also similar: Group 1 with 93.2 (SD 7.4), Group 2 with 93.5 (SD 5.5) (n.s.). Conclusions: In patients who have undergone a CWHTO, TFJ dislocation increases knee lateral compartment gapping when compared to an FHO at 0 • and 30 • of knee flexion. However, this fact seems to have no repercussion on the functional status of the knees as measured with the KSS at the one-year follow-up.

This case report presents an implementation of dynamic balance and isokinetic (concentric) strength testing for a comprehensive assessment of the degree of strength and balance deficits during anterior cruciate ligament (ACL) reconstruction recovery. Tests were performed on the extensors and flexors of an injured and non-injured knee in a professional football player, six months after arthroscopic ACL intervention. The dynamic balance was tested with the Y balance test (YBT) and the results showed a good recovery based on proprioceptive targeted lower limb exercises with values of 100.1% for the non-injured leg and 98.5% for the injured leg with a norm >95% and indicate an appropriate physiotherapy program. According to the peak torque data obtained during isokinetic dynamometry the strength characteristics of the extensors of the injured knee were significantly lower compared to the healthy limb (1.91 Nm/kg vs. norm-2.67 Nm). The bilateral PT difference of the extensors was 35% and was higher than the recommended 10% difference for safe return to sport. Peak torque values in concentric contractions of the athlete showed deficiencies in strength and risk of re-injury in early return to sport. These results allow an improvement in the training and therapeutic program of the football player and are beneficial for restoring the strength of the knee muscle groups and the unilateral/bilateral balance of strength in both legs in order to avoid re-injury.

Anterior cruciate ligament injuries contribute to the major ligament injuries involving the knee. What we thought of isolated anterior cruciate ligament (ACL) injuries were not isolated injuries, there are associated posterolateral, posteromedial, anterolateral corner injuries and meniscal injuries. Identifying these injuries is of paramount importance to prevent the knee from developing arthritic changes in the future. Objectives-To know the spectrum of posterolateral corner injuries in ACL injured knee. Patients who came to Radiology Department of Government Medical College, Kozhikode with positive history and symptoms of ACL injury, of which there was MRI evidence of ACL injury, were taken for studying the prevalence of posterolateral corner injuries. The study period was from January 2015 to September 2016. Type of Study-Descriptive study. Inclusion Criteria-Positive history of ACL lesion. Positive one or two ACL lesion physical tests (the Lachman, anterior drawer test and pivot test). Exclusion Criteria-Patients <18 yrs. and >80 yrs. ACL injury with knee dislocation. Posterolateral (PL) corner injuries showed prevalence of 5.1% and all the cases were in grade 3 ACL injured knees. Isolated lateral collateral ligament showed prevalence of 10%. In cases of ACL injury undergoing MR imaging, posterolateral corner injuries have to be specifically looked and reported for better management of the patients.

Anterior cruciate ligament injuries contribute to the major ligament injuries involving the knee. What we thought of isolated anterior cruciate ligament (ACL) injuries were not isolated injuries, there are associated posterolateral, posteromedial, anterolateral corner injuries and meniscal injuries. Identifying these injuries is of paramount importance to prevent the knee from developing arthritic changes in the future. Objectives-To know the spectrum of posterolateral corner injuries in ACL injured knee. Patients who came to Radiology Department of Government Medical College, Kozhikode with positive history and symptoms of ACL injury, of which there was MRI evidence of ACL injury, were taken for studying the prevalence of posterolateral corner injuries. The study period was from January 2015 to September 2016. Type of Study-Descriptive study. Inclusion Criteria-Positive history of ACL lesion. Positive one or two ACL lesion physical tests (the Lachman, anterior drawer test and pivot test). Exclusion Criteria-Patients <18 yrs. and >80 yrs. ACL injury with knee dislocation. Posterolateral (PL) corner injuries showed prevalence of 5.1% and all the cases were in grade 3 ACL injured knees. Isolated lateral collateral ligament showed prevalence of 10%. In cases of ACL injury undergoing MR imaging, posterolateral corner injuries have to be specifically looked and reported for better management of the patients.

Complete access to the posterior medial compartment of the knee may represent a technical challenge during arthroscopy in patients with a tight tibiofemoral joint space. Medial collateral release reduces direct iatrogenic cartilage damage in the medial compartment of the knee through manipulation with instruments. We recommend performing medial collateral release in surgeries that access the posteromedial compartment (e.g. partial meniscectomy for ruptures of the posterior horn of medial meniscus or posterior root repairs) when the patient has a tight tibiofemoral joint space. There are two main techniques to perform medial collateral release: inside-out and outside-in. Regardless of the technique used, releasing medial ligament structures is a safe and effective method to be used in the diagnosis and treatment of injuries to the medial compartment. Cite this article: EFORT Open Rev 2021;6:669-675. DOI: 10.1302/2058-5241.6.200128

In today's market, customers need substitute goods for numerous reasons. There are several factors that influence the decision to choose a substitute product, including price sensitivity, convenience, regional availability, and individualization. Seller can improve consumer satisfaction, sales, and gain by offering substitute items. We highlighted the potential benefits of applying a cross-price selling strategy to maximize sales of high-deteriorating substitute goods. This study aim is to find the optimal selling price, order quantity, and cycle time that maximize the joint profit of two substitutable products subject to deterioration. The global optimality of total average profit is verified through the Hessian matrix method. The result shows that the profit can be increased by providing substitute products and which depend on degree of substitution. This framework is validated through numerical example. Conclusion that discusses potential future paths, constraints, and challenges.

Background: Patellofemoral pain (PFP) is a common affliction and complex clinical entity. Deficit in neuromotor control of the core may be a remote contributing factor to the development of PFPS. Comparative evaluation of core and extensor mechanism muscle activation patterns between healthy group and patients involved by patellofemoral pain syndrome(PFPS) in a stair stepping task is the aim of this study. Methods : In this non-randomized interventional study fifteen males with PFPS and fifteen asymptomatic controls participated. Electromyographic(EMG) activity of Vastusmedialisobliquus(VMO),Vastuslateralis(VL), Gluteus medius (GMED),Gluteus Maximus (GMAX),Internal oblique (IO) and Erector spinae (ES) were recorded and EMG onsets were assessed in both stepping up (SU) and  down (SD).The time of foot contact determined by a foot switch. Results: During SU:Onset times of all muscles except, VL and ES in the controls were significantly less than PFPS group (P &lt; 0.05). In PFPS group ...

Introduction: Various tools exist to analyse human locomotion, with optical systems being the most widely used due to their high accuracy and reliability. Marker-based motion capture (MBMC) systems, though considered a gold standard, require complex setups with multiple cameras. To overcome these limitations, researchers have explored single-camera, markerless approaches using Human Pose Estimation (HPE), which estimates joint coordinates and body segment orientations from 2D images. While HPE has advanced significantly, its application using single-camera systems for lower-limb analysis in healthcare remains limited.
Methods: One healthy male walked over a 7 (m) walkway at a self-selected speed. Institutional ethics approval was obtained (ID: ETH2425-0307). Full-body kinematics were captured using Theia3D with eight RGB Sony RX0 II cameras (120 Hz), arranged radially 3 (m) from the center at 1.5 (m) height. For 2D analysis, one of the Sony cameras was placed perpendicular to the walkway at 0.8 (m) height. Joint positions (hip, knee, ankle) were extracted per frame using OpenPose, PoseFormerV2, and manual digitization (Kinovea), then used to compute sagittal-plane knee angles for one gait cycle (left leg occluded, right leg visible). Mean Absolute Error (MAE) and Root Mean Square Error (RMSE) were calculated against Theia3D ground truth and compared with published benchmarks.
Results: For the occluded left leg, OpenPose yielded 7.97° RMSE and 6.75° MAE, improving to 5.09° RMSE and 4.47° MAE for the fully visible right leg. PoseFormerV2 performed better, with 6.14° RMSE and 4.79° MAE for the occluded left leg and 4.11° RMSE and 3.61° MAE for the visible right leg. In contrast, Kinovea manual digitization showed significantly higher errors (left/occluded: 25.58° RMSE, 18.80° MAE; right/visible: 26.38° RMSE, 20.05° MAE).
Discussion: RGB single-camera markerless analysis yields clinically valid occluded and visible knee-flexion angles during overground gait. Future work should examine the applicability of these methods in real-world settings across varied speeds and tasks.

The purpose of this study was to investigate the effect of fatigue in knee biomechanics in female handball athletes during the sidestep cutting and single-leg landing. Twenty female handball athletes participated in this study. The fatigue protocol was composed of specific handball movements/actions. The participants performed three trials of the sidestep cutting and single-leg drop landing before (baseline) and after the fatigue protocol. The effect of the fatigue was compared using a paired t-test compared using statistical parametric mapping. During sidestep cutting, the athletes performed the task with lower knee flexion and greater knee abduction during the fatigue state. During the single-leg landing, an increase in the knee valgus was found during the fatigue state. No difference was found on knee kinetics. The fatigue impacted the knee kinematics decreasing the knee flexion during the sidestep cutting and increasing the knee valgus during both, sidestep cutting and single-le...

Purpose. Single-leg landing is frequent in basketball and volleyball, two sports with high incidence of anterior cruciate ligament injuries. the similarity in the number of landings between these sports could be the culprit of the high incidence of injuries. However, the comparison of knee joint motion during landings in both sports has yet to be investigated. this study aimed to contrast the knee kinematics of basketball and volleyball athletes during a single-leg landing task. Methods. Overall, 10 male athletes, 5 in basketball (181.4 ± 6.7 cm; 93.21 ± 33.06 kg) and 5 in volleyball (178.4 ± 6.6 cm, 79.11 ± 6.46 kg) performed single-leg drop landings. Differences between the groups were verified with the superposition of 95% confidence intervals. Additionally, the probability approach was applied with magnitude-based inferential statistics calculated to compare individual instants (40 ms after the initial ground contact, maximum flexion, and abduction). Results. Different knee movement patterns were detected between the groups. While volleyball athletes showed greater knee flexion, basketball players exhibited greater knee abduction. the magnitude-based inference also demonstrated that volleyball athletes presented higher values in the sagittal plane. Conclusions. Basketball athletes exhibited greater valgus in the instants before and after ground contact. In addition, volleyball athletes showed greater knee flexion during the single-leg drop landing.

Introduction: Osteoarthritis (OA) is a significant public health burden in Asia, affecting millions of people. Effective management of OA requires the implementation of evidence-based interventions in real-world settings. Objective: This systematic review aims to synthesize the existing literature on implementation research for OA in Asian countries, identifying effective strategies, challenges and opportunities for improving patient outcomes. Materials and methods: Multiple databases, including PubMed, Scopus, Embase, EBSCO (CINAHL), ScienceDirect and grey literature sources (Google Scholar, ProQuest, Shodhganga), will be searched for relevant studies. The review will include studies published in English between 2003 and 2024 that investigate implementation research for osteoarthritis or have any implementation research component. The focus will be on studies that examine implementation effectiveness, influencing factors, strategies and outcomes. The quality appraisal will be done using the Standards for Reporting Implementation Studies (StaRI) checklist and the results will be summarized in accordance with Synthesis without Meta-analysis (SWiM) guidelines. Expected Outcome: An extensive overview of Osteoarthritis (OA) implementation research in Asian nations will be provided by this systematic review. The review will identify successful implementation strategies, barriers and prospects for enhancing OA management by synthesizing the current research. Policymakers and healthcare professionals will be more equipped to make evidence-based choices and put initiatives that improve patient outcomes and reduce the prevalence of OA.

Anterior cruciate ligament (ACL) rupture is one of the most common musculoskeletal injuries in young individuals,[1,2] with an eight times higher incidence observed among female athletes than male athletes.[3] Such an injury often leads to increased translational and rotational instability,[2] presenting orthopaedic surgeons with the dilemma of whether to reconstruct the anterolateral complex. Numerous studies have reported on the persistence of knee instability after isolated ACL reconstruction (ACLr) in up to 20% of cases,[4] with a positive pivot shift test considered an important indicator of failed reconstruction.[5]

Aim and background: Chronic back pain is a prevalent condition for which various management methods, including participation in sports rehabilitation programs, have been proposed to reduce pain. The aim of this study was to investigate the effectiveness of specialized yoga exercises on pain, functional capacity, and range of motion in women with non-specific chronic back pain. Material and Methods: The study included a sample of 50 women with non-specific chronic low back pain in Amol city, selected through convenience sampling and randomly assigned to two experimental groups (n=25) and a control group (n=25). The research tools used were the McGill Pain Questionnaire, the 6-minute fast walking functional test, and waist flexion range measurement using Kinovea software. These measurements were taken before and 48 hours after the final session of yoga exercises. The experimental group underwent 24 sessions of specialized yoga exercises, each lasting 60 minutes. The study design was a pre-test-post-test with a control group, and the data were analyzed using univariate covariance analysis (ANCOA). Results: The results showed that the specialized yoga training program significantly reduced the pain in women with chronic low back pain (p≤ 0.05), improved functional capacity (p ≤ 0.001), and increased back range of motion (p ≤ 0.001). Conclusion: Due to the integration of mental and strengthening exercises, specialized yoga exercises can positively impact psychological factors such as fear of movement and fear of pain, leading to improved back range of motion and functional capacity in patients.

Posterior cruciate ligament reconstruction is a demanding procedure with several techniques described so far. The all-inside technique offers the advantage of minimal invasiveness, whereas the remnant-preservation technique results in a stronger construct with superior biology. We present a combination of these 2 techniques with special attention to reproducing the normal anatomy of the posterior cruciate ligament and avoiding injury to the popliteus artery.

Objective Many articles have demonstrated the beneficial impact of core stability training (CST) in lowering the risk of injury while exercising. However, the specific reasons for this effect have not been thoroughly investigated. Based on studies, proprioceptive and dynamic balance improvement positively reduces the risk of sports injuries. So, it is important to explore further the impact of these exercises on the specific factors contributing to reducing the risk of injury during sports activities. Aims: This research aims to evaluate the impact of 6 weeks of CST and balance training (BT) programs on knee proprioception and dynamic balance in healthy female amateur athletes. Materials & Methods Twenty female soccer players (Mean±SD age: 25.85±3.18 years; Mean±SD body mass index: 22.14±1.11 kg/m 2) were divided randomly into the CST and BT groups. Knee proprioception was measured using the joint position sense test (JPST), and dynamic balance was measured using the modified star excursion balance test (mSEB) one week before and immediately after the 6-week intervention. Results This study found that both training protocols significantly affected knee proprioception and dynamic balance (P<0.05). CST had a significant difference from BT in the result of the posteromedial direction of the mSEBT and the absolute error of the JPST at 60 degrees. In contrast, BT had a significant difference from CST in improving the anterior direction of mSEBT Conclusion The research indicates that CST and BT can enhance dynamic balance and knee proprioception in female soccer players.

Background Multiligamentous knee injuries (MLKIs), defined as injuries involving at least two of the four primary knee ligaments, are rare but severe, with potentially limb‐ or life‐threatening complications. Despite numerous pub‐ lications, the low incidence and heterogeneity of injury patterns limit high‐level evidence for optimal surgical timing, technique, and management of complications. This systematic review aims to consolidate the available evidence
on MLKI surgery complications, with a particular focus on arthrofibrosis as the underlying cause of stiffness, infection, and graft failure.
Methods This systematic review was conducted following Preferred Reporting Items for Systematic Reviews
and Meta‐analyses (PRISMA) 2020 guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (no. CRD42024618025). A comprehensive search of PubMed, EMBASE, and MEDLINE from Janu‐ ary 2013 to November 2024 identified studies reporting complications in surgically treated MLKIs with at least
a 12‐month follow‐up. The studies were screened independently by two reviewers. Data on demographics, injury mechanisms, surgical techniques, and complication outcomes were extracted. Study quality was assessed using
the Methodological Index for Non‐Randomized Studies (MINORS).
Results A total of 33 studies with 2863 patients met the inclusion criteria. The mean age was 32.4 years (standard deviation, SD ± 5.37), with males constituting 69.4% of the sample. Arthrofibrosis was the most common complica‐ tion, requiring surgical management in 8.4% of cases. Graft failure was reported in 5%, while infection, the third most common complication, occurred in 2.86% of cases. Management of lack of range of motion varied, with manipulation under anesthesia and arthroscopic arthrolysis utilized. Surgical timing also influenced outcomes; 54.2% of patients underwent acute surgery (< 21 days), which seems to be associated with increased stiffness rates.
Conclusions This systematic review highlights the complexity of managing MLKIs, with a 19.2% overall complication rate. Stiffness demanding reoperation remains a rare but a significant challenge, underscoring the need for standard‐ ized treatment protocols. However, the included studies demonstrate heterogeneity and lack high methodological rigor, highlighting the need to account for these limitations.

The purpose of this study was to investigate the effect of fatigue in knee biomechanics in female handball athletes during the sidestep cutting and single-leg landing. Twenty female handball athletes participated in this study. The fatigue protocol was composed of specific handball movements/actions. The participants performed three trials of the sidestep cutting and single-leg drop landing before (baseline) and after the fatigue protocol. The effect of the fatigue was compared using a paired t-test compared using statistical parametric mapping. During sidestep cutting, the athletes performed the task with lower knee flexion and greater knee abduction during the fatigue state. During the single-leg landing, an increase in the knee valgus was found during the fatigue state. No difference was found on knee kinetics. The fatigue impacted the knee kinematics decreasing the knee flexion during the sidestep cutting and increasing the knee valgus during both, sidestep cutting and single-le...

Mid-level constraint designs for total knee arthroplasty (TKA) are intended to reduce coronal plane laxity. Our aims were to compare kinematics and ligament forces of the Zimmer Biomet Persona posterior-stabilized (PS) and mid-level designs in the coronal, sagittal, and axial planes under loads simulating clinical exams of the knee in a cadaver model. We performed TKA on eight cadaveric knees and loaded them using a robotic manipulator. We tested both PS and mid-level designs under loads simulating clinical exams via applied varus and valgus moments, internal-external (IE) rotation moments, and anteroposterior forces at 0°, 30°, and 90° of flexion. We measured the resulting tibiofemoral angulations and translations. We also quantified the forces carried by the medial and lateral collateral ligaments (MCL/LCL) via serial sectioning of these structures and use of the principle of superposition. Mid-level inserts reduced varus angulations compared to PS inserts by a median of 0.4°, 0.9°, and 1.5° at 0°, 30°, and 90° of flexion, respectively, and reduced valgus angulations by a median of 0.3°, 1.0°, and 1.2° (p ≤ 0.027 for all comparisons). Mid-level inserts reduced net IE rotations by a median of 5.6°, 14.7°, and 17.5° at 0°, 30°, and 90°, respectively (p = 0.012). Mid-level inserts reduced anterior tibial translation only at 90° of flexion by a median of 3.0 millimetres (p = 0.036). With an applied varus moment, the mid-level insert decreased LCL force compared to the PS insert at all three flexion angles that were tested (p ≤ 0.036). In contrast, with a valgus moment the mid-level insert did not reduce MCL force. With an applied internal rotation moment, the mid-level insert decreased LCL force at 30° and 90° by a median of 25.7 N and 31.7 N, respectively (p = 0.017 and p = 0.012). With an external rotation moment, the mid-level insert decreased MCL force at 30° and 90° by a median of 45.7 N and 20.0 N, respectively (p ≤ 0.017 for all comparisons). With an applied anterior load, MCL and LCL forces showed no differences between the two inserts at 30° and 90° of flexion. The mid-level insert used in this study decreased coronal and axial plane laxities compared to the PS insert, but its stabilizing benefit in the sagittal plane was limited. Both mid-level and PS inserts depended on the MCL to resist anterior loads during a simulated clinical exam of anterior laxity.

Knee osteoarthritis (OA) is associated with increased varus knee alignment, altered gait kinematics and kinetics, quadriceps weakness, and high muscle cocontraction indices (CCI), all of which negatively affect joint integrity [1-4]. Total knee arthroplasty (TKA) generally improves function and relieves pain associated with severe knee OA. However, even after TKA, more patients have difficulty with daily activities than age-matched controls (52% versus 22%) [5]. Studies have investigated changes in strength, muscle activity, knee alignment and gait before and after TKA, but they primarily studied sagittal plane kinematics or made comparisons to controls [4,6]. To assess potential contributing factors of suboptimal TKA outcomes, it is important to understand how kinematics and kinetics may be affected by CCI, strength, and knee alignment before and after TKA.

Purpose. Anterior knee pain (AKP) is one of the most common musculoskeletal problems among adolescents, with an annual prevalence rate of 22.7% to 28.9%. Excessively pronated foot posture is a biomechanical factor that contributes to the risk of AKP. Physiotherapy plays a vital role in treating AKP. The aim of this research is to investigate the efficacy of neuromuscular training and manual therapy with augmented low-Dye taping for pronated foot correction in the management of AKP. Materials and methods. A prospective, double-blind, randomised controlled trial involving 48 individuals suffering from anterior knee pain will be conducted for this study. Participants will be randomly assigned in a 1:1:1 ratio to groups and will receive 12 sessions of talonavicular joint mobilisation (TJM), manual therapy, and neuromuscular exercises with antipronation and augmented low-Dye taping interventions over 4 weeks at Mediclinic Al Noor Hospital. The outcome measures include pain, functional limitations, foot posture, and dynamic valgus index (DVI), assessed at baseline (pre-intervention) and follow-up (post-intervention). Discussion. Previous literature supports that manual therapy and neuromuscular training exercises with anti-pronation augmented low-Dye taping are effective treatments for patients with AKP. We strongly believe that the evidence-based interventions used in this research for treating anterior knee pain will provide significant improvements in pain, functional limitations, foot posture, and dynamic valgus index (DVI). manual therapy, neuromuscular training exercise, foot posture, anterior knee pain, randomized controlled trial Cel. Ból przedniego przedziału kolana (AKP) jest jednym z najczęstszych problemów układu mięsńiowo-szkieletowego wsŕód młodziezẏ, z rocznym wskazńikiem występowania wynoszącym od 22,7% do 28,9%. Nadmiernie pronacyjna postawa stopy stanowi czynnik biomechaniczny, który zwiększa ryzyko AKP. Fizjoterapia odgrywa kluczową rolę w leczeniu AKP. Celem niniejszego badania jest ocena skutecznosći treningu nerwowo-mięsńiowego i terapii manualnej w połączeniu z wzmocnionym plastrowaniem metodą Low-Dye w korekcji pronacji stopy przy leczeniu AKP. Materiał i metody. W prospektywnym, podwójnie zasĺepionym randomizowanym badaniu kontrolnym wezḿie udział 48 osób cierpiących na ból przedniego przedziału kolana. Uczestnicy zostaną losowo przypisani do grup w stosunku 1:1:1 i będą uczestniczyć w 12 sesjach mobilizacji stawu skokowo-łódkowego (TJM), terapii manualnej oraz cẃiczeń nerwowo-mięsńiowych z zastosowaniem antypronacyjnego i wzmocnionego plastrowania metodą Low-Dye przez okres 4 tygodni w Mediclinic Al Noor Hospital. Miary wynikowe obejmują ból, ograniczenia funkcjonalne, postawę stopy oraz dynamiczny indeks kosĺawosći (DVI), oceniane na początku badania (przed interwencją) oraz w trakcie kontroli (po interwencji). Dyskusja. Dotychczasowe badania wskazują, zė terapia manualna i cẃiczenia nerwowo-mięsńiowe z antypronacyjnym wzmocnionym plastrowaniem metodą Low-Dye są skutecznymi metodami leczenia AKP. Wierzymy, zė interwencje oparte na dowodach, zastosowane w tym badaniu, przyczynią się do znacznej poprawy w zakresie bólu, ograniczeń funkcjonalnych, postawy stopy oraz dynamicznego indeksu kosĺawosći (DVI). terapia manualna, cẃiczenia nerwowo-mięsńiowe, postawa stopy, ból przedniego przedziału kolana, randomizowane badanie kontrolne

Purpose. Back squat (BS) is a popular exercise owing to its capacity to develop lower limb strength. During BS, trunk incli nation and knee range of motion (roM) are relevant aspects of a proper technique, and these movement kinematics parameters can be positively altered with official weightlifting shoes lifting the heel 13 mm above the ground. Wedges are a lowcost alternative to lifting the heel to different heights, but movement kinematics adaptations with higher elevations, above 25 mm, are not well described in the literature. thus, we compared the effect of different heights of heel wedges on BS kinematics. Methods. Fifteen experienced recreational weightlifters (22 ± 5.4 years; 83 ± 11 kg; 179 ± 6 cm; 5 ± 2.1 years of BS experience) were conveniently selected. three randomized conditions were applied: barefoot (B), 25mm (W25), and 50mm wedges (W50). BS movement was assessed by kinematic analysis with an optoelectronic camera system. Results. After ANOVA, the posthoc indicated significant roM differences in reducing trunk (F = 27.27; p < 0.01) and increasing knee (F = 16.87; p < 0.01) flexions between conditions. Posthoc analysis verified decreasing trunk inclination (B > W25 > W50; p < 0.05) and increasing knee (B < W25 < W50; p < 0.05) roM with increasing wedge height. Conclusions. Higher wedges allowed positive adaptations by promoting a more upright trunk position and greater BS depth. Using a heel wedge can be a lowcost and viable strategy to optimize BS technique in a variety of training settings and contexts.

Biomechanics, the study of the mechanical principles of human movement, plays a pivotal role in skill development
across various domains, including sports, physical education, and rehabilitation. This paper helps to explore how
biomechanics enhances our understanding of motor learning and performance optimization, emphasizing its
applications in injury prevention, training, and the development of effective skill acquisition strategies

To have no side effects of medication is essential for the acceptance by the patient. Therefore the evaluation of possible side-effects of medication is an important part in drug development or after launch evaluations. But also on the primary effect, especially in pain killers, must be focused. Most of the methods are invasive or painful, like the CO2-Inflation into to nose to measure the cortex activity after pain killer application. A common side effect of drugs, especially pain killers, is the negative alteration of the gait in patients due to inconstancy or even falls due to side effects. Therefore the evaluation of the effects of drugs on gait parameters is of importance. Different drug application, e.g. neuropathic pain killers, opioids or Cox-2-inhibitors, may have different effects on the gait parameters. The new concept consists of noninvasive parameters which could be accomplished in different environments and with low side costs. The gait of the person to be evaluated is...

Paraphrasing the message “Save the meniscus”, the message “Save the patella” comes to tell us to be more critical on the decision regarding the patella management during total knee arthroplasty (TKA). Patella is not just a bone in the center of the knee joint but it is the largest sesamoid bone in the human skeleton, acting as a fulcrum that increases the lever arm of the extended knee and thereby facilitates the function of the quadriceps muscle [1]. Interestingly, the patella can be character- ized as the brain of the knee joint, based on the increased brain activity involved during movement of the knee [2]. Thus, preserving the patella during TKA it is critically important.

Objectives The impairment of balance is a significant complication that affects older people suffering from knee osteoarthritis, potentially leading to falls. This research was conducted to determine the effects of fall-proof exercises on the balance system of older women with knee osteoarthritis. Methods & Materials In 2023, a quasi-experimental intervention with a pre-test-pos-ttest design was conducted on 25 older women aged 60-75, all diagnosed with knee osteoarthritis. They were divided into experimental and control groups. Participants in the experimental group engaged in targeted fall-proof exercises for 8 weeks, three days a week. The control group did not participate in any exercise activities. The mini-balance evaluation systems test (Mini-BESTest) assessed balance indices. Data analysis was performed using repeated measures analysis in SPSS version 26, with the significance level set at 0.05. Results The results showed a significant increase in the total scores of the Mini-BESTest and its three subscales after implementing exercises in the experimental group (F=42.51, P<0.001, η=0.69). However, there was no significant difference in sensory orientation scores between the pretest and posttest assessments in the control groups (P=1.0, Z=0) and the experimental groups (P=0.150, Z=1.41). Additionally, significant differences were observed in the total scores of the Mini-BESTest and its two subscales between the control and experimental groups (F=23.8, P=0.009, η=0.26). However, no significant differences were found in the anticipatory and reactive postural control subscales scores among the experimental groups (P>0.05). Conclusion The fall-proof exercise program is recommended for coaches and therapists to enhance the balance of elderly individuals with knee osteoarthritis. This recommendation is based on its effectiveness and cost-efficiency in not requiring expensive equipment.

The aim of this study was to analyze the effectiveness of conservative treatment of patellofemoral pain syndrome with physical exercise. [Subjects and Methods] A computer-based review conducted of four databases (PubMed, the Cochrane Library, PEDro, and the University Library) was completed based on the inclusion criteria of patellofemoral pain syndrome patients treated with physical exercise methods and examination with self-reported pain and/or functional questionnaires. [Results] The findings of ten clinical trials of moderate to high quality were evaluated to determine the effectiveness of physical exercise as conservative management for patellofemoral pain syndrome. [Conclusion] The intervention programs that were most effective in relieving pain and improving function in patellofemoral pain syndrome included proprioceptive neuromuscular facilitation stretching and strengthening exercises for the hip external rotator and abductor muscles and knee extensor muscles.

The purpose of the current study was to investigate the effect of knee muscle fatigue on knee joint moment, knee joint force and knee angular velocity during saggital perturbations of single-leg stance. 15 healthy men (age = 26.2±2.1 yr) with no history of knee injury or trauma participated in this study. Fatigue induced to knee muscle using a standard Monark bicycle ergometer. Isokinetic Dynamometer (Chattanooga, TN) was used to measure maximal knee force and time to task failure before and after fatigue protocol. Reflex muscle activity measured during single-leg stance perturbation before and after fatigue protocol. Using a motion capture system and force plate, knee kinematics data and ground reaction force were also recorded before and after fatiguing. Maximal knee force, time to task failure and associated EMG activities were significantly reduced (for both flexion and extension directions) after fatigue (P< 0.05). Moreover reflex activity of the knee muscles was significantly lower during post exercise single leg stance perturbation with respect to pre exercise phase (P < 0.05). However knee angular velocity increased (P < 0.05), knee joint force decreased (P< 0.05) and knee joint moment increased in the frontal (P< 0.05) and horizontal plan (P< 0.05) after dynamic fatigue protocol. The result of the current study demonstrated, that fatigue induced changes in muscle activity patterns around knee joint. The altered muscle activity pattern around knee joint can contribute to an increased knee varus moment and an excessive internal rotation of the tibia, during destabilizing perturbation of single-leg stance. This may further increase the risk ACL injuries during single-leg stance cutting action.

Objective: To evaluate the effect of standardization of surgical prep on the deep infection rate for ORIF of closed fractures. Participants and Methods: As part of a quality improvement project, a total of 738 surgical cases were identified with discrete, new onset, closed fractures that were treated with surgery following standardization of practice for surgical prep from September of 2016 through November of 2017 at an ACS level I trauma center. A retrospective chart review included prep type, compliance with dry times of surgical preparation and the surgical procedure. Patients with multiple fractures were given separate entries for fractures that occurred at different anatomical sites. Adequate followup for patients to be included in the study group was 6 weeks minimum at our facility. The endpoint was return to the OR for deep infection prior to fracture healing. Data from 2 years prior to instituting the protocol served as the control group. Results: Out of 738 patients, 25 patients (3.38%) returned to the OR for deep infection. The historical control infection rate for the previous 2 years was 5.7% (105/1827). Therefore, the standardization project led to a decrease of 2.32%. A Z-test showed a statistically significant decrease in infection risk with a z-score of 2.466 (P=.0068 95% CI .007-.04). 542/738 (73.4%) followed standardization procedures as described. 702/738 (95.1%) used chlorhexidine containing solution as the final step and complied with dry times before incision. Conclusion: Standardization of surgical prep in the setting of ORIF of closed fractures significantly decreased the risk of post-operative infection requiring operative debridement. Standardizing the surgical prep minimizes confusion by staff who perform the prepping and increases consistency. These effects were seen in the setting of using an alcohol pre-prep followed by use of an alcoholbased chlorhexidine final prep.