Partial medial meniscectomy and rotational differences at the knee during walking

Loss of meniscal function due to injury or partial meniscectomy is common and represents a significant risk factor for premature osteoarthritis. The menisci can influence the transverse plane movements (anterior–posterior (AP) translation and internal–external (IE) rotation) of the knee during walking. While walking is the most frequent activity of daily living, the kinematic differences at the knee during walking associated with the meniscal injury are not well understood. This study examined the influence of partial medial meniscectomy (PMM) on the kinematics and kinetics of the knee during the stance phase of gait by testing the differences in anterior–posterior translation, internal–external rotation, knee flexion range of movement, peak flexion/extension moments, and adduction moments between the PMM and healthy contralateral limbs. Ten patients (45±9 years old, height 1.75±0.06 m, weight 76.7±13.5 kg) who had undergone partial medial meniscectomy (33±100 months post-op) in one limb with a healthy contralateral limb were tested during normal walking. The contralateral limb was compared to a matched control group and no differences were found. The primary kinematic difference was a significantly greater external rotation (3.2°) of the tibia that existed through stance phase, with 8 of 10 subjects demonstrating the same pattern. The PMM subjects also exhibited significantly lower peak flexion and extension moments in their PMM limbs. The altered rotational position found likely results in changes of tibio-femoral contact during walking and could cause the type of degenerative changes found in the articular cartilage following meniscal injury.     

Influence of muscle activity on the forces in the femur: An in vivo study

Experiments were performed on two patients with custom-made instrumented massive proximal femoral prostheses implanted after tumour resection. In vivo axial forces transmitted along the prostheses were telemetered during level walking, single- and double-leg stance, and isometric exercises of the hip muscles. These activities varied the lever arms available to the external loads: minimum for double-leg stance and maximum for hip isometric exercises. Kinematic, force plate, EMG and telemetered force data were recorded simultaneously. The force magnification ration (FMR; the ratio of the telemetered axial force to the external force) was calculated. The FMRs ranged from 1.3 (during double-leg stance) to 29.8 (during abductors test), indicating that a major part of the axial force in the long bones is a response to muscle activity, the strength of which depends on the lever arms available to the external loads. From these results, it was shown that the bulk of the bending moment along limbs is transmitted by a combination of tensile forces in muscles and compressive forces in bones, so moments transmitted by the bones are smaller than the limb moments. It was concluded that appropriate simulation of muscle forces is important in experimental or theoretical studies of load transmission along bones.     

Effects of asymmetric load carrying on the biomechanics of walking

The purpose of the study was to investigate the effects of an asymmetric sidepack carrying system on frontal plane joint moments of force in both lower extremities and in the L5/S1 joint during level walking. Ground reaction force data and frontal plane film records were obtained from five males performing three walking conditions: 0, 10 and 20% bodyweight loads in a sidepack supported by the left shoulder. Inverse dynamics were used to calculate the lower extremity moments during stance and a static model of the pelvis was used to calculate the L5/S1 moments during single support for each limb. Normal walking was characterized by symmetric kinetics between left and right limbs and around the L5/S1 joint. The asymmetric loads produced unbalanced lateral trunk muscle dominance between left and right limb stance phases, increased right hip and knee moments and decreased left hip and knee moments. During normal walking, the L5/S1 moment was dominant on the contralateral trunk side for both limbs. The asymmetric loads applied to the left side caused a shift in L5/S1 moment dominance to the right side during left and right single support phases.     

Influences of limb proportions and body size on locomotor kinematics in terrestrial primates and fossil hominins

During locomotion, mammalian limb postures are influenced by many factors including the animal's limb length and body mass. Polk (2002) compared the gait of similar-sized cercopithecine monkeys that differed limb proportions and found that longer-limbed monkeys usually adopt more extended joint postures than shorter-limbed monkeys in order to moderate their joint moments. Studies of primates as well as non-primate mammals that vary in body mass have demonstrated that larger animals use more extended limb postures than smaller animals. Such extended postures in larger animals increase the extensor muscle mechanical advantage and allow postures to be maintained with relatively less muscular effort (Polk, 2002; Biewener 1989). The results of these previous studies are used here to address two anthropological questions. The first concerns the postural effects of body mass and limb proportion differences between australopithecines and members of the genus Homo. That is, H. erectus and later hominins all have larger body mass and longer legs than australopithecines, and these anatomical differences suggest that Homo probably used more extended postures and probably required relatively less muscular force to resist gravity than the smaller and shorter-limbed australopithecines. The second question investigates how animals with similar size but different limb proportions differ in locomotor performance. The effects of limb proportions on gait are relevant to inferring postural and locomotor differences between Neanderthals and modern Homo sapiens which differ in their crural indices and relative limb length. This study demonstrates that primates with relatively long limbs achieve higher walking speeds while using lower stride frequencies and lower angular excursions than shorter-limbed monkeys, and these kinematic differences may allow longer-limbed taxa to locomote more efficiently than shorter-limbed species of similar mass. Such differences may also have characterized the gait of Homo sapiens in comparison to Neanderthals, but more experimental data on humans that vary in limb proportions are necessary in order to evaluate this question more thoroughly.     

Quadrupedal locomotion in squirrel monkeys (Cebidae: Saimiri sciureus): a cineradiographic study of limb kinematics and related substrate reaction forces

Quadrupedal locomotion of squirrel monkeys on small-diameter support was analyzed kinematically and kinetically to specify the timing between limb movements and substrate reaction forces. Limb kinematics was studied cineradiographically, and substrate reaction forces were synchronously recorded. Squirrel monkeys resemble most other quadrupedal primates in that they utilize a diagonal sequence/diagonal couplets gait when walking on small branches. This gait pattern and the ratio between limb length and trunk length influence limb kinematics. Proximal pivots of forelimbs and hindlimbs are on the same horizontal plane, thus giving both limbs the same functional length. However, the hindlimbs are anatomically longer than the forelimbs. Therefore, hindlimb joints must be more strongly flexed during the step cycle compared to the forelimb joints. Because the timing of ipsilateral limb movements prevents an increasing amount of forelimb retraction, the forelimb must be more protracted during the initial stance phase. At this posture, gravity acts with long moment arms at proximal forelimb joints. Squirrel monkeys support most of their weight on their hindlimbs. The timing of limb movements and substrate reaction forces shows that the shift of support to the hindlimbs is mainly done to reduce the compressive load on the forelimb. The hypothesis of the posterior weight shift as a dynamic strategy to reduce load on forelimbs, proposed by Reynolds ([1985]) Am. J. Phys. Anthropol. 67:335-349; [1985] Am. J. Phys. Anthropol. 67:351-362), is supported by the high correlation of ratios between forelimb and hindlimb peak vertical forces and the range of motion of shoulder joint and scapula in primates.     

An improved inverse dynamics formulation for estimation of external and internal loads during human sagittal plane movements

Planar musculoskeletal models are common in the inverse dynamics analysis of human movements such as walking, running and jumping. The continued interest in such models is justified by their simplicity and computational efficiency. Related to a human planar model, a unified formulation for both the flying and support phases of the sagittal plane movements is developed. The actuation involves muscle forces in the lower limbs and the resultant muscle torques in the other body joints. The dynamic equations, introduced in absolute coordinates of the segments, are converted into useful compact forms using the projective technique. The solution to a determinate inverse dynamics problem allows for the explicit determination of the external reactions (presumed to vanish during the flying phases) and the resultant muscle torques in all the model joints. The indeterminate inverse dynamics problem is then focused on the assessment of muscle forces and joint reaction forces selectively in the supporting lower limb. Numerical results of the inverse dynamics simulation of sample sagittal plane movements are reported to illustrate the validity and effectiveness of the improved formulation.     

Redistribution of intra- and inter-limb support moments during downhill walking on different slopes

Downhill walking presents a greater risk of falling as a result of slipping or loss of balance in comparison with level walking. The current study aimed to investigate the effects of inclination angles on the intra-limb (inter-joint) and inter-limb sharing of the body support during downhill walking for a better understanding of the associated control strategy. Fifteen young male adults (age: 32.6±5.2 years, height: 168.9±5.5 cm, mass: 68.4±8.7 kg) performed level and downhill walking while their kinematic and kinetic data were measured for calculating joint moments and total support moments of the lower limbs using inverse dynamics analysis. The peak total support moments of both the leading and trailing limbs increased with increasing inclination angles (p<0.05) with different sharing patterns among individual joints. Being the major contributor to the peak total support moment during early single-limb support, the contribution of the knee remained unaltered (p>0.05), but the contributions of the hip increased with reduced contributions from the ankle (p<0.05). For the increased peak total support moment during late single-limb support, the intra-limb sharing changed from a major ankle contribution to a major knee contribution strategy. The hip contribution was also increased (p<0.05) but the hip flexor moment remained unaltered (p>0.05). During double-limb support, the main contributor to the whole body support changed from the trailing limb to the leading limb with increasing inclination angles (p<0.05).     

Effects of suppressing arm swing on kinematics, kinetics, and energetics of human walking

Human walking is characterized by pronounced arm movement, yet computer simulation models of walking usually lump the mass of the arms with the head and torso. The implications of this simplification have not been thoroughly documented in the literature. Thus, the purpose of this study was to establish the dependence of several biomechanical and energetic variables on suppressing arm swing (AS) in walking. Eight healthy adult subjects walked with and without normal AS, with speed and stride frequency/length matched between trials. Metabolic data were collected during walking on a treadmill, while kinematic and kinetic data were collected during overground walking. Gross and net energy expenditure were significantly higher during walking without AS, with the mean differences being less than 10%. Joint angles, angular velocities, and ground reaction forces were nearly identical for walking with and without AS. Most joint moments and powers were also similar between AS conditions; however, some kinetic variables (e.g., knee joint power) exhibited larger differences, primarily during the stance phase. The variable that differed most between walking with and without AS was the free vertical moment between the foot and ground. In summary, most variables differed by less than 10% and were highly correlated (r0.90) between walking with and without normal AS. Thus, researchers may be justified in using walking models without articulated arms. However, a few variables exhibited larger differences, which might be of relevance based on the specific research question being addressed.     

Locomotor mechanics of the slender loris (Loris tardigradus)

The quadrupedal walking gaits of most primates can be distinguished from those of most other mammals by the presence of diagonal-sequence (DS) footfall patterns and higher peak vertical forces on the hindlimbs compared to the forelimbs. The walking gait of the woolly opossum (Caluromys philander), a highly arboreal marsupial, is also characterized by diagonal-sequence footfalls and relatively low peak forelimb forces. Among primates, three species--Callithrix, Nycticebus, and Loris--have been reported to frequently use lateral-sequence (LS) gaits and experience relatively higher peak vertical forces on the forelimbs. These patterns among primates and other mammals suggest a strong association between footfall patterns and force distribution on the limbs. However, current data for lorises are limited and the frequency of DS vs. LS walking gaits in Loris is still ambiguous. To test the hypothesis that patterns of footfalls and force distribution on the limbs are functionally linked, kinematic and kinetic data were collected simultaneously for three adult slender lorises (Loris tardigradus) walking on a 1.25 cm horizontal pole. All subjects in this study consistently used diagonal-sequence walking gaits and always had higher peak vertical forces on their forelimbs relative to their hindlimbs. These results call into question the hypothesis that a functional link exists between the presence of diagonal-sequence walking gaits and relatively higher peak vertical forces on the hindlimbs. In addition, this study tested models that explain patterns of force distribution based on limb protraction angle or limb compliance. None of the Loris subjects examined showed kinematic patterns that would support current models proposing that weight distribution can be adjusted by actively shifting weight posteriorly or by changing limb stiffness. These data reveal the complexity of adaptations to arboreal locomotion in primates and indicate that diagonal-sequence walking gaits and relatively low forelimb forces could have evolved independently.     

Torsion and Antero-Posterior Bending in the In Vivo Human Tibia Loading Regimes during Walking and Running

Bending, in addition to compression, is recognized to be a common loading pattern in long bones in animals. However, due to the technical difficulty of measuring bone deformation in humans, our current understanding of bone loading patterns in humans is very limited. In the present study, we hypothesized that bending and torsion are important loading regimes in the human tibia. In vivo tibia segment deformation in humans was assessed during walking and running utilizing a novel optical approach. Results suggest that the proximal tibia primarily bends to the posterior (bending angle: 0.15°–1.30°) and medial aspect (bending angle: 0.38°–0.90°) and that it twists externally (torsion angle: 0.67°–1.66°) in relation to the distal tibia during the stance phase of overground walking at a speed between 2.5 and 6.1 km/h. Peak posterior bending and peak torsion occurred during the first and second half of stance phase, respectively. The peak-to-peak antero-posterior (AP) bending angles increased linearly with vertical ground reaction force and speed. Similarly, peak-to-peak torsion angles increased with the vertical free moment in four of the five test subjects and with the speed in three of the test subjects. There was no correlation between peak-to-peak medio-lateral (ML) bending angles and ground reaction force or speed. On the treadmill, peak-to-peak AP bending angles increased with walking and running speed, but peak-to-peak torsion angles and peak-to-peak ML bending angles remained constant during walking. Peak-to-peak AP bending angle during treadmill running was speed-dependent and larger than that observed during walking. In contrast, peak-to-peak tibia torsion angle was smaller during treadmill running than during walking. To conclude, bending and torsion of substantial magnitude were observed in the human tibia during walking and running. A systematic distribution of peak amplitude was found during the first and second parts of the stance phase.     

Fibre operating lengths of human lower limb muscles during walking

Muscles actuate movement by generating forces. The forces generated by muscles are highly dependent on their fibre lengths, yet it is difficult to measure the lengths over which muscle fibres operate during movement. We combined experimental measurements of joint angles and muscle activation patterns during walking with a musculoskeletal model that captures the relationships between muscle fibre lengths, joint angles and muscle activations for muscles of the lower limb. We used this musculoskeletal model to produce a simulation of muscle-tendon dynamics during walking and calculated fibre operating lengths (i.e. the length of muscle fibres relative to their optimal fibre length) for 17 lower limb muscles. Our results indicate that when musculotendon compliance is low, the muscle fibre operating length is determined predominantly by the joint angles and muscle moment arms. If musculotendon compliance is high, muscle fibre operating length is more dependent on activation level and force-length-velocity effects. We found that muscles operate on multiple limbs of the force-length curve (i.e. ascending, plateau and descending limbs) during the gait cycle, but are active within a smaller portion of their total operating range.     

Maximum walking speed and lower limb length in hominids

In 1984, Helene (Am. J. Physics 52:656) and Alexander (Am. Scientist 72:348–354) presented equations which purported to explain how lower limb length limited maximum walking speed in humans. The equations were based on a simplified model of human walking in which the center of mass (CoM) “vaults” over the supporting leg. Increasing walking speed by increasing stride frequency or stride length would increase the upward acceleration of the CoM in the first half of stance phase, to the point that it would be greater than the downward pull of gravity, and the individual would become airborne. This constitutes running by most definitions. While these models ignored various mechanical factors, such as knee flexion during midstance, that reduce the vertical movement of the CoM, the general idea is plausible inasmuch as the CoM of the body does oscillate vertically with each step. One hypothesis tested here is whether it is indeed the interaction between the pull of gravity and the individual's own upward acceleration that determines at what speed (or cadence) he changes from walking to running. Another hypothesis considered is that increased lower limb length (L) was selected for in early hominids, because of the locomotor advantages of longer lower limbs. Results indicate, however, that while L was clearly related to maximum possible walking speed, it was not an important factor in determining maximum “comfortable” walking speed. These and other results from the recent literature suggest that increased lower limb length provided no selective advantage in locomotion, and other explanations should be sought. © 1996 Wiley-Liss, Inc.     

Two decades of biomonitoring polar bear health in Greenland: a review

Background

Different animal models are used as fracture models in orthopaedic research prior to implant use in humans, although biomechanical forces can differ to a great extend between species due to variable anatomic conditions, particularly with regard to the gait. The rabbit is an often used fracture model, but biomechanical data are very rare. The objective of the present study was to measure axial forces, bending moments, and bending axis directly in the rabbit tibia in vivo. The following hypothesis was tested: Axial forces and bending moments in the mid-diaphysis of rabbit tibia differ from other experimental animals or indirectly calculated data.

Methods

A minifixateur system with 4 force sensors was developed and attached to rabbit tibia (n = 4), which were subsequently ostectomised. Axial forces, bending moments and bending angles were calculated telemetrically during weight bearing in motion between 6 and 42 days post operation.

Results

Highest single values were 201% body weight [% bw] for axial forces and 409% bw cm for bending moments. Whereas there was a continous decrease in axial forces over time after day 10 (P = 0.03 on day 15), a decrease in bending moments was inconsistent (P = 0.03 on day 27). High values for bending moments were frequently, but not consistently, associated with high values for axial forces.

Conclusion

Axial forces in rabbit tibia exceeded axial forces in sheep, and differed from indirectly calculated data. The rabbit is an appropriate fracture model because axial loads and bending moments in rabbit tibia were more closely to human conditions than in sheep tibia as an animal model.     

Muscle contributions to support during gait in an individual with post-stroke hemiparesis

Walking requires coordination of muscles to support the body during single stance. Impaired ability to coordinate muscles following stroke frequently compromises walking performance and results in extremely low walking speeds. Slow gait in post-stroke hemiparesis is further complicated by asymmetries in lower limb muscle excitations. The objectives of the current study were: (1) to compare the muscle coordination patterns of an individual with flexed stance limb posture secondary to post-stroke hemiparesis with that of healthy adults walking very slowly, and (2) to identify how paretic and non-paretic muscles provide support of the body center of mass in this individual. Simulations were generated based on the kinematics and kinetics of a stroke survivor walking at his self-selected speed (0.3 m/s) and of three speed-matched, healthy older individuals. For each simulation, muscle forces were perturbed to determine the muscles contributing most to body weight support (i.e., height of the center of mass during midstance). Differences in muscle excitations and midstance body configuration caused paretic and non-paretic ankle plantarflexors to contribute less to midstance support than in healthy slow gait. Excitation of paretic ankle dorsiflexors and knee flexors during stance opposed support and necessitated compensation by knee and hip extensors. During gait for an individual with post-stroke hemiparesis, adequate body weight support is provided via reorganized muscle coordination patterns of the paretic and non-paretic lower limbs relative to healthy slow gait.     

Human body proportions explained on the basis of biomechanical principles

On the basis of theoretical biomechanics and of experiments, we investigated the mechanical requirements to which the body of a bipedally walking primate is subject, and the possibilities to meet these requirements with a minimum amount of energy. The least energy-consuming adaptation is clearly a body shape favourable for the preferred locomotion. Some characteristics of human body shape, in particular its proportions, could be identified as advantageous for fulfilling obvious biological roles or mechanical necessities. The characteristic length and the extended position of human hindlimbs make walking faster without additional input of energy. Mass distribution on the hindlimbs reduces the energy necessary for accelerating the swing limb after liftoff and for decelerating the swing limb before the heelstrike. Length and mass distribution in the forelimb gives it a pendulum length comparable to that of the hindlimb, so that both extremities swing at the same frequency. This swinging of the forelimbs counters in part the movements exerted by the moved hindlimbs on the trunk. The elongate and slim shape of the trunk provides great mass moments of inertia and that means stability against being flexed ventrally and dorsally by the forward and rearward movements of the heavy and long hindlimbs. Shoulder breadth in combination with the shallow shape of the thorax yield higher mass moments of inertia against the rotation of the trunk about a vertical axis than a cylindrical trunk shape. Further elongation of the hindlimbs is limited by the energy necessary for acceleration and deceleration, as well as for lifting them during the swing phase. In addition, the reaction forces exerted by the hindlimbs would expose the trunk to undue excursions if the proportions trunk length/limb length or trunk mass/limb mass would decrease. The above-noted kinetic requirements are partly in line, partly in conflict with the requirements of statics.     

In vivo and analytical studies of forces and moments in equine long bones

A study to evaluate the in vivo forces acting on equine long bones is described. Results for the maximum axial forces and bending moments are presented for the radius, metacarpus, tibia, and metatarsus. The forces and bending moments are obtained by combining in vivo strain gage readings and a mathematical model for the mechanics of the bones. Comparisons of equine activities including standing, walking, trotting, and getting up after the anesthetic indicate that one activity does not always produce the highest loads in all of the bones examined. However, for the cases considered here, recovery from the anesthetic produced the largest compressive forces in the metacarpus and the tibia. Also, large tensile forces were found during the foot-up positions during standing and trotting.     

Hip joint contact force in the emu (Dromaius novaehollandiae) during normal level walking

The emu is a large, (bipedal) flightless bird that potentially can be used to study various orthopaedic disorders in which load protection of the experimental limb is a limitation of quadrupedal models. An anatomy-based analysis of normal emu walking gait was undertaken to determine hip contact forces for comparison with human data. Kinematic and kinetic data captured for two laboratory-habituated emus were used to drive the model. Muscle attachment data were obtained by dissection, and bony geometries were obtained by CT scan. Inverse dynamics calculations at all major lower-limb joints were used in conjunction with optimization of muscle forces to determine hip contact forces. Like human walking gait, emu ground reaction forces showed a bimodal distribution over the course of the stance phase. Two-bird averaged maximum hip contact force was approximately 5.5 times body weight, directed nominally axially along the femur. This value is only modestly larger than optimization-based hip contact forces reported in literature for humans. The interspecies similarity in hip contact forces makes the emu a biomechanically attractive animal in which to model loading-dependent human orthopaedic hip disorders.     

Changes in relative work of the lower extremity joints and distal foot with walking speed

The modulation of walking speed results in adaptations to the lower limbs which can be quantified using mechanical work. A 6 degree-of-freedom (DOF) power analysis, which includes additional translations as compared to the 3 DOF (all rotational) approach, is a comprehensive approach for quantifying lower limb work during gait. The purpose of this study was to quantify the speed-related 6 DOF joint and distal foot work adaptations of all the lower extremity limb constituents (hip, knee, ankle, and distal foot) in healthy individuals. Relative constituent 6 DOF work, the amount of constituent work relative to absolute limb work, was calculated during the stance and swing phases of gait. Eight unimpaired adults walked on an instrumented split-belt treadmill at slow, moderate, and typical walking speeds (0.4, 0.6, and 0.8 statures/s, respectively). Using motion capture and force data, 6 DOF powers were calculated for each constituent. Contrary to previously published results, 6 DOF positive relative ankle work and negative relative distal foot work increased significantly with increased speed during stance phase (p < 0.05). Similar to previous rotational DOF results in the sagittal plane, negative relative ankle work decreased significantly with increased speed during stance phase (p < 0.05). Scientifically, these findings provide new insight into how healthy individuals adapt to increased walking speed and suggest limitations of the rotational DOF approach for quantifying limb work. Clinically, the data presented here for unimpaired limbs can be used to compare with speed-matched data from limbs with impairments.     

Age-related mechanical work expenditure during normal walking: The Baltimore Longitudinal Study of Aging

The aim of this cross-sectional study was to delineate age-associated kinematic and kinetic gait patterns of normal walking, and to test the hypothesis that older adults exhibit gait patterns that reduce generative mechanical work expenditures (MWEs). We studied 52 adult Baltimore Longitudinal Study of Aging participants (means age 72±9, from 60 to 92 years) who could walk 4 m unaided. Three-dimensional kinematic and kinetic parameters assessed during rotation-defined gait periods were used to estimate MWEs for the rotation of lower extremities about the medial–lateral (ML) and anterior–posterior (AP) axes of proximal joints, which represent MWEs in the AP and ML sides, respectively. Relationships between gait parameters and age were examined using regression analysis with adjustments for walking speed, sex, height, and weight. Older age was associated with slower self-selected walking speed (p<0.001), shorter stride length (p<0.001), and greater propensity of landing flat-footed (p=0.003). With older age, hip generative MWE for thigh rotation was lower about the AP axis (hip abduction and adduction) during stance (p=0.010) and higher about the ML axis (hip extension and flexion) during late stance (p<0.001). Knee absorptive MWE for shank rotation about the AP axis (knee abduction and adduction) during early stance was also lower with older age (p<0.003). These age-related gait patterns may represent a compensatory effort to maintain balance and may also reflect mobility limitations.