Background Step-up exercise is one of the most commonly utilized exercises during rehabilitation of patients after both ACL injury and reconstruction. Currently, insurance providers increasingly required a trial of intensified rehabilitation before surgical reconstruction is attempted. The purpose of this study was to investigate whether this “safe” rehabilitation exercise in the setting of ACL deficiency can cause altered knee kinematics. Methods Thirty patients with unilateral ACL rupture were recruited for this study. The mean time from injury was 3.3 months. Tibiofemoral kinematics were determined during a step-up exercise using a combination of MRI, dual fluoroscopy and advanced computer modeling. Findings The ACL-injured knee displayed an average 5° greater external tibial rotation than the uninjured knee (p<0.05), during the last 30% of step-up. The ACL-injured knee also demonstrated on average 2.5 mm greater anterior tibial shift during the last 40% of stance phase (p<0.01). In addition, during the last 30% of stance the tibia of the ACL-deficient knee tended to shift more medially (~1 mm) as the knee approached full extension (p<0.01). Interpertation The data confirmed the initial hypothesis as it was found that ACL deficient knees demonstrated significantly increased anterior tibial translation, medial tibial translation and external tibial rotation towards the end of the step-up as the knee approached full extension. Intensive rehabilitation utilizing the step-up exercise in the setting of ACL deficiency can potentially introduce repetitive microtrauma by way of altered kinematics.
BACKGROUND: Obesity is a mechanical risk factor for osteoarthritis. In individuals with obesity, knee joint pain is prevalent. Weight loss reduces joint loads, and therefore potentially delays disease progression; however, how the knee joint responds to weight loss in individuals with obesity and knee pain is not clear. RESEARCH QUESTION: To assess the effect of weight loss on knee joint kinematics during gait in individuals with obesity and knee pain. METHODS: We recruited individuals with obesity (BMI ≥ 35) and knee pain who were participating in a weight loss program which included bariatric surgery or medical management. At baseline before and at 1 year after treatment, participants walked on a treadmill, and their knee joint kinematics were assessed using a dual-fluoroscopic imaging system and subject-specific magnetic resonance imaging knee joint models. Gait changes were represented by change in range of tibiofemoral motion, i.e., excursions in flexion-extension, adduction-abduction, internal
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