Joint contact forces when minimizing the external knee adduction moment by gait modification: A computer simulation study

Miller, Ross H.; Esterson, Aryeh Y.; Shim, Jae Kun

doi:10.1016/j.knee.2015.06.014

Cited by 27 publications

(25 citation statements)

References 54 publications

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“…representing true MCF and LCFs. This is of great importance considering so many studies stray beyond simple linear scaling (Fregly 2007;Shull et al 2013a;Ogaya et al 2014;Miller et al 2015;van Den Noort et al 2015;Liu et al 2016;Richards et al 2017). Two of the main limitations of this study were the small sample size and not randomizing the order of gait alterations, although beyond the scope of this study, this restricted detection of meaningful clinical results.…”

Section: Discussionmentioning

confidence: 96%

Gait alteration strategies for knee osteoarthritis: a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques

Dzialo

Mannisi

Halonen

et al. 2019

International Biomechanics

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Gait modifications and laterally wedged insoles are non-invasive approaches used to treat medial compartment knee osteoarthritis. However, the outcome of these alterations is still a controversial topic. This study investigates how gait alteration techniques may have a unique effect on individual patients; and furthermore, the way we scale our musculoskeletal models to estimate the medial joint contact force may influence knee loading conditions. Five patients with clinical evidence of medial knee osteoarthritis were asked to walk at a normal walking speed over force plates and simultaneously 3D motion was captured during seven conditions (0°-, 5°-, 10°-insoles, shod, toe-in, toe-out, and wide stance). We developed patient-specific musculoskeletal models, using segmentations from magnetic resonance imaging to morph a generic model to patientspecific bone geometries and applied this morphing to estimate muscle insertion sites. Additionally, models were created of these patients using a simple linear scaling method. When examining the patients' medial compartment contact force (peak and impulse) during stance phase, a 'one-size-fits-all' gait alteration aimed to reduce medial knee loading did not exist. Moreover, the different scaling methods lead to differences in medial contact forces; highlighting the importance of further investigation of musculoskeletal modeling methods prior to use in the clinical setting. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 96%

Gait alteration strategies for knee osteoarthritis: a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques

Dzialo

Mannisi

Halonen

et al. 2019

International Biomechanics

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show abstract

“…Medial knee contact forces were then calculated by balancing internal and external moments of force about the lateral tibiofemoral contact point (Miller, Esterson & Shim, 2015). This approach produces estimates of knee contact forces and medial-lateral force distributions that compare reasonably well with measurements from instrumented joint replacements, with typical errors in the range of 0.3-0.9x bodyweight (BW) (Miller, Esterson & Shim, 2015;Dumas et al, 2019).…”

Section: Knee Load Modelingmentioning

confidence: 99%

Medial knee cartilage is unlikely to withstand a lifetime of running without positive adaptation: a theoretical biomechanical model of failure phenomena

Miller

Krupenevich

2020

PeerJ

Self Cite

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Runners on average do not have a high risk of developing knee osteoarthritis, even though running places very high loads on the knee joint. Here we used gait analysis, musculoskeletal modeling, and a discrete-element model of knee contact mechanics to estimate strains of the medial knee cartilage in walking and running in 22 young adults (age 23 ± 3 years). A phenomenological model of cartilage damage, repair, and adaptation in response to these strains then estimated the failure probability of the medial knee cartilage over an adult lifespan (age 23–83 years) for 6 km/day of walking vs. walking and running 3 km/day each. With no running, by age 55 the cumulative probability of medial knee cartilage failure averaged 36% without repair and 13% with repair, similar to reports on incidence of knee osteoarthritis in non-obese adults with no knee injuries, but the probability for running was very high without repair or adaptation (98%) and remained high after including repair (95%). Adaptation of the cartilage compressive modulus, cartilage thickness, and the tibiofemoral bone congruence in response to running (+1.15 standard deviations of their baseline values) was necessary for the failure probability of walking and running 3 km/day each to equal the failure probability of walking 6 km/day. The model results suggest two conclusions for further testing: (i) unlike previous findings on the load per unit distance, damage per unit distance on the medial knee cartilage is greater in running vs. walking, refuting the “cumulative load” hypothesis for long-term joint health; (ii) medial knee cartilage is unlikely to withstand a lifetime of mechanical loading from running without a natural adaptation process, supporting the “cartilage conditioning” hypothesis for long-term joint health.

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“…Furthermore, muscle coordination also plays a key role in contributing TF contact force [23][24][25][26]. Miller et al [27] conducted only computer simulations to predict contact forces by gait modification; they reported that gait modification can reduce the peak KAM from normal walking. From the literature review, it was found that there was little information on the study of Chinese subjects through gait modifications, especially lacking analysis by using musculoskeletal modelling.…”

Section: Introductionmentioning

confidence: 99%

Effects of Toe-Out and Toe-In Gaits on Lower-Extremity Kinematics, Dynamics, and Electromyography

et al. 2019

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Toe-in and toe-out gait modifications have received increasing attention as an effective, conservative treatment for individuals without severe osteoarthritis because of its potential for improving knee adduction moment (KAM) and knee flexion moment (KFM). Although toe-in and toe-out gaits have positive effects on tibiofemoral (TF) joint pain in the short term, negative impacts on other joints of the lower extremity may arise. The main purpose of this study was to quantitatively compare the effects of foot progression angle (FPA) gait modification with normal walking speeds in healthy individuals on lower-extremity joint, ground reaction force (GRF), muscle electromyography, joint moment, and TF contact force. Experimental measurements using the Vicon system and multi-body dynamics musculoskeletal modelling using OpenSim were conducted in this study. Gait analysis of 12 subjects (n = 12) was conducted with natural gait, toe-in gait, and toe-out gait. One-way repeated measures of ANOVA (p < 0.05) with Tukey’s test was used for statistical analysis. Results showed that the toe-in and toe-out gait modifications decreased the max angle of knee flexion by 8.8 and 12.18 degrees respectively (p < 0.05) and the max angle of hip adduction by 1.28 and 0.99 degrees respectively (p < 0.05) compared to the natural gait. Changes of TF contact forces caused by FPA gait modifications were not statistically significant; however, the effect on KAM and KFM were significant (p < 0.05). KAM or combination of KAM and KFM can be used as surrogate measures for TF medial contact force. Toe-in and toe-out gait modifications could relieve knee joint pain probably due to redistribution of TF contact forces on medial and lateral condylar through changing lateral contact centers and shifting bilateral contact locations.

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Joint contact forces when minimizing the external knee adduction moment by gait modification: A computer simulation study

Cited by 27 publications

References 54 publications

Gait alteration strategies for knee osteoarthritis: a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques

Gait alteration strategies for knee osteoarthritis: a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques

Medial knee cartilage is unlikely to withstand a lifetime of running without positive adaptation: a theoretical biomechanical model of failure phenomena

Effects of Toe-Out and Toe-In Gaits on Lower-Extremity Kinematics, Dynamics, and Electromyography

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