A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome

Harato, Kengo; Nagura, Takeo; Matsumoto, Hideo; Otani, Toshiro; Toyama, Yoshiaki; Suda, Yasunori

doi:10.1016/j.gaitpost.2008.05.008

Cited by 78 publications

(53 citation statements)

References 19 publications

(21 reference statements)

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“…Furthermore, considering that conformity of the joint surfaces and anterior translation of the femur on the tibia were not directly measured in our study during the tasks, we can only determine altered knee kinematics, ground reaction, and predicted joint forces as probable strategies demonstrated in the rotary tasks. Although some would argue that the increased loading or altered knee angle may be due to the lack of proprioception and quadriceps control, studies are inconsistent in their findings to support either of these as single factors of activity performance [12,13,32]. Both weight acceptance and knee flexion excursion during gait were not significantly different in TKR participants at an average of 28 months post-surgery [33].…”

Section: Discussionmentioning

confidence: 99%

Strategies Utilized to Transfer Weight During Knee Flexion and Extension With Rotation for Individuals With a Total Knee Replacement

Ferris

Denney

Maletsky

2013

Journal of Biomechanical Engineering

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Functional activities in daily life can require squatting and shifting body weight during transverse plane rotations. Stability of the knee can be challenging for people with a total knee replacement (TKR) due to reduced proprioception, nonconforming articular geometry, muscle strength, and soft tissue weakness. The objective of this study was to identify strategies utilized by individuals with TKR in double-stance transferring load during rotation and flexion. Twenty-three subjects were recruited for this study: 11 TKR subjects (age: 65 ± 6 years; BMI 27.4 ± 4.1) and 12 healthy subjects (age: 63 ± 7; BMI 24.6 ± 3.8). Each subject completed a novel crossover button push task where rotation, flexion, and extension of the knee were utilized. Each subject performed two crossover reaching tasks where the subject used the opposite hand to cross over their body and press a button next to either their shoulder (high) or knee (low), then switched hands and rotated to press the opposite button, either low or high. The two tasks related to the order they pressed the buttons while crossing over, either low-to-high (L2H) or high-to-low (H2L). Force platforms measured ground reaction forces under each foot, which were then converted to lead force ratios (LFRs) based on the total force. Knee flexion angles were also measured. No statistical differences were found in the LFRs during the H2L and L2H tasks for the different groups, although differences in the variation of the loading within subjects were noted. A significant difference was found between healthy and unaffected knee angles and a strong trend between healthy and affected subject's knee angles in both H2L and L2H tasks. Large variations in the LFR at mid-task in the TKR subjects suggested possible difficulties in maintaining positional stability during these tasks. The TKR subjects maintained more of an extended knee, which is a consistent quadriceps avoidance strategy seen by other researchers in different tasks. These outcomes suggest that individuals with a TKR utilize strategies, such as keeping an extended knee, to achieve rotary tasks during knee flexion and extension. Repeated compensatory movements could result in forces that may cause difficulty over time in the hip joints or low back. Early identification of these strategies could improve TKR success and the return to activities of daily living that involve flexion and rotation.

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Section: Discussionmentioning

confidence: 99%

Strategies Utilized to Transfer Weight During Knee Flexion and Extension With Rotation for Individuals With a Total Knee Replacement

Ferris

Denney

Maletsky

2013

Journal of Biomechanical Engineering

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“…Concerning the ankle joint, the triceps surae contracture has been evaluated in many studies [9,12,24,[33][34][35][36][37][38]. At the knee joint, the hamstring contracture has also been evaluated [11,14,15,[39][40][41].…”

Section: Discussionmentioning

confidence: 99%

“…They explained that in patients with hemiplegia, hip ROM limitations and knee extension in gait were not caused by hamstring and/or hip flexor contractures but were linked to ankle plantarflexor contractures only. Harato et al [14] studied the influence of knee contractures on trunk kinematics and determined the minimum degree of contracture required to obtain a significant difference in trunk movements in gait. Whitehead et al [15] emulated hamstring contracture with an exoskeleton at the hip and knee level.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and reliability of using an exoskeleton to emulate muscle contractures during walking

Attias

Bonnefoy‐Mazure²,

Coulon³

et al. 2016

Gait & Posture

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Contracture is a permanent shortening of the muscle-tendon-ligament complex that limits joint mobility. Contracture is involved in many diseases (cerebral palsy, stroke, etc.) and can impair walking and other activities of daily living. The purpose of this study was to quantify the reliability of an exoskeleton designed to emulate lower limb muscle contractures unilaterally and bilaterally during walking. An exoskeleton was built according to the following design criteria: adjustable to different morphologies; respect of the principal lines of muscular actions; placement of reflective markers on anatomical landmarks; and the ability to replicate the contractures of eight muscles of the lower limb unilaterally and bilaterally (psoas, rectus femoris, hamstring, hip adductors, gastrocnemius, soleus, tibialis posterior, and peroneus). Sixteen combinations of contractures were emulated on the unilateral and bilateral muscles of nine healthy participants. Two sessions of gait analysis were performed at weekly intervals to assess the reliability of the emulated contractures. Discrete variables were extracted from the kinematics to analyse the reliability. The exoskeleton did not affect normal walking when contractures were not emulated. Kinematic reliability varied from poor to excellent depending on the targeted muscle. Reliability was good for the bilateral and unilateral gastrocnemius, soleus, and tibialis posterior as well as the bilateral hamstring and unilateral hip adductors. The exoskeleton can be used to replicate contracture on healthy participants. The exoskeleton will allow us to differentiate primary and compensatory effects of muscle contractures on gait kinematics.

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“…Finally, for the foot progression angle, only the mean angle during the gait cycle was analysed. These parameters were considered as relevant in a clinical context and reliable according to literature [1,13,23,24]. Indeed, thorax and pelvis obliquity and rotation can influence the gait pattern in many pathologies so that it seems important to consider these specific parameters [25][26][27].…”

Section: Data Analysis and Statisticsmentioning

confidence: 99%

Kinematics can help to discriminate the implication of iliopsoas, hamstring and gastrocnemius contractures to a knee flexion gait pattern

Attias

Bonnefoy‐Mazure²,

Coulon³

et al. 2019

Gait & Posture

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Background: Excessive Knee Flexion Gait Pattern (KFGP) is a common gait deviation in many pathological conditions. The contractures of the muscles that have been identified as being responsible of KFGP are: iliopsoas, hamstring and gastrocnemius. Research question:How do isolated contractures of the iliopsoas, hamstrings and gastrocnemius impact knee flexion during gait?Methods: Three levels of contracture (mild, moderate and severe) were simulated bilaterally using an exoskeleton on 10 healthy participants for iliopsoas, hamstring and gastrocnemius muscles. A gait analysis session was performed to evaluate the joint kinematics according to the different simulated contractures. Thirty one parameters were chosen to analyze the kinematics of the thorax, pelvis, hip, knee and ankle. A principal component analysis (PCA) was used to determine the kinematic parameters influenced by contractures. Results:In addition to a permanent knee flexion observed for the three muscles with contracture: the contracture of the iliopsoas induces a large hip flexion with pronounced anterior pelvis tilt; the contracture of the hamstrings induces an ankle dorsiflexion during the support phase with a posterior pelvis tilt; the contracture of the gastrocnemius induces an absence of first and second rocker of the ankle with a slight flexion of hip and a slight anterior pelvis tilt.Significance: These results support the identification of the muscles responsible for a KFGP.A better knowledge of the interactions between contractures and associated joint kinematics of the same and adjacent joints will support the interpretation of gait analyses by more precisely and faster targeting the concerned muscle.

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A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome

Cited by 78 publications

References 19 publications

Strategies Utilized to Transfer Weight During Knee Flexion and Extension With Rotation for Individuals With a Total Knee Replacement

Strategies Utilized to Transfer Weight During Knee Flexion and Extension With Rotation for Individuals With a Total Knee Replacement

Feasibility and reliability of using an exoskeleton to emulate muscle contractures during walking

Kinematics can help to discriminate the implication of iliopsoas, hamstring and gastrocnemius contractures to a knee flexion gait pattern

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