Evaluation of a patient-specific cost function to predict the influence of foot path on the knee adduction torque during gait

Fregly, Benjamin J.; Reinbolt, Jeffrey A.; Chmielewski, Terese L.

doi:10.1080/10255840701552036

Cited by 34 publications

(28 citation statements)

References 28 publications

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“…Walking with an increased stance width may also have a minor positive effect. 39 Compared to the subject's normal gait pattern, these walking modifications did not produce clear adduction torque reductions. However, we only had access to a single subject, the patient had an artificial rather than natural knee, and the subject performed only three trials of each gait pattern.…”

Section: Discussionmentioning

confidence: 99%

Correlation between the knee adduction torque and medial contact force for a variety of gait patterns

Zhang

Banks

Mitchell³

et al. 2007

Journal Orthopaedic Research

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436

298

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ABSTRACT:The external knee adduction torque has been proposed as a surrogate measure for medial compartment load during gait. However, a direct link between these two quantities has not been demonstrated using in vivo measurement of medial compartment load. This study uses in vivo data collected from a single subject with an instrumented knee implant to evaluate this link. The subject performed five different overground gait motions (normal, fast, slow, wide, and toe-out) with simultaneous collection of instrumented implant, video motion, and ground reaction data. For each trial, the knee adduction torque was measured externally while the total axial force applied to the tibial insert was measured internally. Based on data collected from the same subject performing treadmill gait under fluoroscopic motion analysis, a regression equation was developed to calculate medial contact force from the implant load cell measurements. Correlation analyses were performed for the stance phase and entire gait cycle to quantify the relationship between the knee adduction torque and both the medial contact force and the medial to total contact force ratio. When the entire gait cycle was analyzed, R 2 for medial contact force was 0.77 when all gait trials were analyzed together and between 0.69 and 0.93 when each gait trial was analyzed separately (p < 0.001 in all cases). For medial to total force ratio, R 2 was 0.69 for all trials together and between 0.54 and 0.90 for each trial separately (p < 0.001 in all cases). When only the stance phase was analyzed, R 2 values were slightly lower. These results support the hypothesis that the knee adduction torque is highly correlated with medial compartment contact force and medial to total force ratio during gait. ß

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Section: Discussionmentioning

confidence: 99%

Correlation between the knee adduction torque and medial contact force for a variety of gait patterns

Zhang

Banks

Mitchell³

et al. 2007

Journal Orthopaedic Research

Self Cite

436

298

View full text Add to dashboard Cite

show abstract

“…A medial knee thrust gait pattern was implemented in 2 single-subject studies (27,35), with another study implementing elements of a medial knee thrust pattern (increased hip internal rotation and adduction) (26). Two single-subject studies evaluated the effect of increased step width, achieved by increasing the frontal plane distance between feet during consecutive steps (29,34). Other gait modifications included single studies evaluating increased weight transfer to the medial foot (46), increased knee flexion and reduced vertical acceleration at initial contact (47), reduced stride length (48), increased mediolateral trunk lean (49), and Tai Chi gait (50).…”

Section: Resultsmentioning

confidence: 99%

“…The KAM was chosen as the primary outcome, given it is the most commonly used measure of medial joint loading in knee OA and its important relationship to disease progression (7). However, alternate measures of knee load are available, including medial compartment compressive force measured via instrumented joint replacement (9,56,57) or by mathematical musculoskeletal modeling (29,34,58). Despite this, only limited research is available using these measures due to their invasive nature, potential expense, and complicated and/or time-consuming nature.…”

Section: Discussionmentioning

confidence: 99%

Gait modification strategies for altering medial knee joint load: A systematic review

Simić¹,

Hinman²,

Wrigley³

et al. 2011

Arthritis Care & Research

224

178

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Objective. To evaluate the effect of gait modification strategies on the external knee adduction moment (KAM), a marker of medial knee joint load; determine potentially adverse effects; assess the methodologic quality; and identify areas of future research. Methods. Five electronic databases were searched. Studies evaluating the effects of gait modifications on the KAM in either healthy individuals or those with knee osteoarthritis (OA) were included. Methodologic quality was evaluated by 2 reviewers using the Downs and Black checklist. Results. Twenty-four studies met the inclusion criteria, exploring 14 different gait modifications of varying sample sizes, age groups, and OA classifications. Contralateral cane use, increased step width, medial knee thrust, increased hip internal rotation, weight transfer to the medial foot, and increased lateral trunk lean demonstrated KAM reductions. Tai Chi gait, ipsilateral cane use, Nordic walking poles, and increased knee flexion exhibited increases in the KAM, demonstrating a potential detriment to their use. The effects of reduced stride length, as well as increases and reductions in either toe-out or gait speed, were inconsistent across the studies and gait cycle. Conclusion. This review demonstrates that some gait modifications have the ability to alter knee load. Future research is required to determine the magnitude of modification required to maximize beneficial effects, the best method of training, long-term patient adherence, and if these biomechanical changes can translate into clinically relevant changes in symptoms or disease progression risk.

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“…Optimization and inverse dynarnics have been used previously to predict optimal walking motions [17] or muscle coordination strategies [18] for offloading the knee joint, but to our knowledge forward dynamics modeling has not been used for this purpose. Forward dynamics has many advantages in the prediction and optimization of human movement [16,19] at the expense of increased model complexity and computational requirements.…”

Section: Introductionmentioning

confidence: 99%

Predicting Sagittal Plane Biomechanics That Minimize the Axial Knee Joint Contact Force During Walking

Miller¹,

Brandon²,

Deluzio

2012

Journal of Biomechanical Engineering

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Both development and progression of knee osteoarthritis have been associated with the loading of the knee joint during walking. We are, therefore, interested in developing strategies for changing walking biomechanics to offload the knee joint without resorting to surgery. In this study, simulations of human walking were performed using a 2D bipedal forward dynamics model. A simulation generated by minimizing the metabolic cost of transport (CoT) resembled data measured from normal human walking. Three simulations targeted at minimizing the peak axial knee joint contact force instead of the CoT reduced the peak force by 12-25% and increased the CoT by 11-14%. The strategies used by the simulations were (1) reduction in gastrocnemius muscle force, (2) avoidance of knee flexion during stance, and (3) reduced stride length. Reduced gastrocnemius force resulted from a combination of changes in activation and changes in the gastrocnemius contractile component kinematics. The simulations that reduced the peak contact force avoided flexing the knee during stance when knee motion was unrestricted and adopted a shorter stride length when the simulated knee motion was penalized if it deviated from the measured human knee motion. A higher metabolic cost in an offloading gait would be detrimental for covering a long distance without fatigue but beneficial for exercise and weight loss. The predicted changes in the peak axial knee joint contact force from the simulations were consistent with estimates of the joint contact force in a human subject who emulated the predicted kinematics. The results demonstrate the potential of using muscle-actuated forward dynamics simulations to predict novel joint offloading interventions.

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Evaluation of a patient-specific cost function to predict the influence of foot path on the knee adduction torque during gait

Cited by 34 publications

References 28 publications

Correlation between the knee adduction torque and medial contact force for a variety of gait patterns

Correlation between the knee adduction torque and medial contact force for a variety of gait patterns

Gait modification strategies for altering medial knee joint load: A systematic review

Predicting Sagittal Plane Biomechanics That Minimize the Axial Knee Joint Contact Force During Walking

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