The anterior-posterior displacement and rotation of the tibia elicited by isolated loading of the quadriceps muscle was determined as a function of joint angle and muscle load using a computerized radiographic technique. Data collected from 12 fresh-frozen cadaveric knees demonstrated that quadriceps contraction can result in significant (less than 7 mm) anterior displacement of the tibia in the range of 0 degrees to 80 degrees of flexion, and a mild (less than 2 mm) posterior displacement in the range of 80 degrees to 120 degrees of flexion. Peak anterior displacement of 6.3 mm was observed at 30 degrees of flexion under a 12 kg load in the quadriceps, while a constant 1.5 mm posterior displacement was observed throughout flexion angles exceeding 80 degrees. It was further shown that the magnitude of the anterior displacement increased nonlinearly as the quadriceps force increased. Loading of the quadriceps also resulted in internal rotation of the tibia in the range of 0 degrees to 90 degrees of flexion, and in external rotation of the tibia in the range of 90 degrees to 120 degrees. Peak internal rotation of 7 degrees was observed at 15 degrees of flexion and a peak external rotation of 1 degrees was detected at 120 degrees of flexion. Larger quadriceps load resulted in larger rotation. We concluded that quadriceps contraction during knee extension has direct impact on anterior displacement and rotation of the tibia and therefore on anterior cruciate ligament stress, increasing it as the muscle's force is increased during knee extension.(ABSTRACT TRUNCATED AT 250 WORDS)

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To clarify the relationship between metabolic energy expenditure and fatiguability in paraplegic persons fitted with orthoses, we measured energy consumption in six thoracic paraplegic patients ambulating by means of reciprocating gait orthosis (RGO) used with and without functional electrical stimulation (FES). The data obtained from persons using both RGO and FES were adjusted to allow for the effects of fatiguability so as to obtain an approximate value for upper-body consumption. The data obtained from persons using RGO only were not adjusted, because no energy consumption occurred in the lower portion of the body. The data, expressed in kcal/kg-min and kcal/kg-m, were plotted against walking speed attained using RGO, and RGO with FES. The results were compared with those from persons fitted with long leg braces (LLB), hip guidance orthoses (HGO) and an FES walking aid (data obtained from available literature). We found that the lowest energy expenditure in kcal/kg-m across the full range of walking speeds occurred when both RGO and FES were used together, followed by RGO only, HGO, LLB, and FES only, respectively. The lowest energy expenditure in kcal/kg-min, for walking speeds, below 0-28 m/s, also occurred when both RGO and FES were used together, followed by RGO only, HGO, LLB, and FES only. The results suggest that, although the use of FES with RGO may increase oxygen uptake, it decreases energy expenditure in the upper extremities, thereby reducing patient fatigue. They also suggest that mechanical orthosis giving passive support to the hip, knee and ankle in combination with FES may provide the most efficient walking aid for paraplegic persons.

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