Cross-correlations between gluteal muscle thickness derived from ultrasound imaging and hip biomechanics during walking gait

Ultrasound imaging (USI) of muscle thickness offers different insights into musculoskeletal function than kinematics, kinetics, and surface electromyography (sEMG), however it is unknown how USI-derived measures correlate to traditional measures during walking. The purpose of this study was to compare USI-derived gluteus maximus (GMAX) and medius (GMED) thickness measures to tri-planar hip kinematics and kinetics, and GMED thickness to sEMG amplitude. Fourteen females walked on a treadmill at 1.34 m/s. GMAX and GMED thickness, hip tri-planar kinematics, kinetics, and GMED sEMG were simultaneously recorded. USI-derived thickness measures were compared to other biomechanical outcomes using cross-correlation analyses, computed at each 1% (11-ms) of the gait cycle with lag times from −20% to 20%. GMED and GMAX thickness measures were most strongly correlated with hip extension and abduction angles at 150–220-ms lags (cross-correlation coefficients [CCF]: −0.34; −0.83). GMED thickness was most correlated to abduction and external rotation moments simultaneously (CCF: −0.28; −0.47). GMAX thickness and flexion moments were most strongly correlated at a 66-ms lag (CCF: 0.33). GMED sEMG amplitude was most strongly correlated to muscle thickness at a 99-ms lag (CCF: 0.39). These results elucidate the unique information provided from USI-derived measures of gluteal muscle thickness during walking.     

Footwear affects the gearing at the ankle and knee joints during running

The objective of the study was to investigate the adjustment of running mechanics by wearing five different types of running shoes on tartan compared to barefoot running on grass focusing on the gearing at the ankle and knee joints. The gear ratio, defined as the ratio of the moment arm of the ground reaction force (GRF) to the moment arm of the counteracting muscle tendon unit, is considered to be an indicator of joint loading and mechanical efficiency. Lower extremity kinematics and kinetics of 14 healthy volunteers were quantified three dimensionally and compared between running in shoes on tartan and barefoot on grass. Results showed no differences for the gear ratios and resultant joint moments for the ankle and knee joints across the five different shoes, but showed that wearing running shoes affects the gearing at the ankle and knee joints due to changes in the moment arm of the GRF. During barefoot running the ankle joint showed a higher gear ratio in early stance and a lower ratio in the late stance, while the gear ratio at the knee joint was lower during midstance compared to shod running. Because the moment arms of the counteracting muscle tendon units did not change, the determinants of the gear ratios were the moment arms of the GRF's. The results imply higher mechanical stress in shod running for the knee joint structures during midstance but also indicate an improved mechanical advantage in force generation for the ankle extensors during the push-off phase.     

Subject-specific hip geometry and hip joint centre location affects calculated contact forces at the hip during gait

Hip loading affects the development of hip osteoarthritis, bone remodelling and osseointegration of implants. In this study, we analyzed the effect of subject-specific modelling of hip geometry and hip joint centre (HJC) location on the quantification of hip joint moments, muscle moments and hip contact forces during gait, using musculoskeletal modelling, inverse dynamic analysis and static optimization. For 10 subjects, hip joint moments, muscle moments and hip loading in terms of magnitude and orientation were quantified using three different model types, each including a different amount of subject-specific detail: (1) a generic scaled musculoskeletal model, (2) a generic scaled musculoskeletal model with subject-specific hip geometry (femoral anteversion, neck-length and neck-shaft angle) and (3) a generic scaled musculoskeletal model with subject-specific hip geometry including HJC location. Subject-specific geometry and HJC location were derived from CT. Significant differences were found between the three model types in HJC location, hip flexion–extension moment and inclination angle of the total contact force in the frontal plane. No model agreement was found between the three model types for the calculation of contact forces in terms of magnitude and orientations, and muscle moments. Therefore, we suggest that personalized models with individualized hip joint geometry and HJC location should be used for the quantification of hip loading. For biomechanical analyses aiming to understand modified hip joint loading, and planning hip surgery in patients with osteoarthritis, the amount of subject-specific detail, related to bone geometry and joint centre location in the musculoskeletal models used, needs to be considered.     

Effects of hip joint centre mislocation on gait analysis results

Methods to determine the hip joint centre (HJC) location are necessary in gait analysis. It has been demonstrated that the methods proposed in the literature involve large mislocation errors. The choice should be made according to the extent by which HJC location errors distort the estimates of angles and resultant moments at the hip and knee joints. This study aimed at quantifying how mislocation errors propagate to these gait analysis results. Angles and moments at the hip and knee joint were calculated for five able-bodied subjects during level walking. The nominal position of the HJC was determined as the position of the pivot point of a 3D movement of the thigh relative to the pelvis. Angles and moments were then re-calculated after having added to HJC co-ordinates errors in the range of +/-30 mm. Angles and moments at both hip and knee joints were affected by HJC mislocation. The hip moments showed the largest propagation error: a 30 mm HJC anterior mislocation resulted in a propagated error into flexion/extension component of about -22%. The hip abduction/adduction moment was found the second largest affected quantity: a 30 mm lateral HJC mislocation produced a propagated error of about -15%. Finally, a 30 mm posterior HJC mislocation produced a delay of the flexion-to-extension timing in the order of 25% of the stride duration. HJC estimation methods with minimum antero-posterior error should therefore be preferred.     

Analysis of surface-to-surface distance mapping during three-dimensional motion at the ankle and subtalar joints

Joint surface interaction and ligament constraints determine the kinematic characteristics of the ankle and subtalar joints. Joint surface interaction is characterized by joint contact mechanics and by relative joint surface position potentially characterized by distance mapping. While ankle contact mechanics was investigated, limited information is available on joint distance mapping and its changes during motion. The purpose of this study was to use image-based distance mapping to quantify this interaction at the ankle and subtalar joints during tri-planar rotations of the ankle complex. Five cadaveric legs were scanned using Computed Tomography and the images were processed to produce 3D bone models of the tibia, fibula, talus and calcaneus. Each leg was tested on a special linkage through which the ankle complex was loaded in dorsiflexion/plantarflexion, inversion/eversion, and internal/external rotation and the resulting bone movements were recorded. Fiduciary bone markers data and 3D bone models were combined to generate color-coded distance maps for the ankle and subtalar joints. The results were processed focusing on the changes in surface-to-surface distance maps between the extremes of the range of motion and neutral. The results provided detailed insight into the three-dimensional highly coupled nature of these joints showing significant and unique changes in distance mapping from neutral to extremes of the range of motion. The non-invasive nature of the image-based distance mapping technique could result, after proper modifications, in an effective diagnostic and clinical evaluation technique for application such as ligament injuries and quantifying the effect of arthrodesis or total ankle replacement surgery.     

Knee biomechanics of moderate OA patients measured during gait at a self-selected and fast walking speed

Osteoarthritis (OA) is a chronic disorder resulting in degenerative changes to the knee joint. Three-dimensional gait analysis provides a unique method of measuring knee dynamics during activities of daily living such as walking. The purpose of this study was to identify biomechanical features characterizing the gait of patients with mild-to-moderate knee OA and to determine if the biomechanical differences become more pronounced as the locomotor system is stressed by walking faster. Principal component analysis was used to compare the gait patterns of a moderate knee OA group (n=41) and a control group (n=43). The subjects walked at their self-selected speed as well as at 150% of that speed. The two subject groups did not differ in knee joint angles, stride length, and stride time or walking speed. Differences in the magnitude and shape of the knee joint moment waveforms were found between the two groups. The OA group had larger adduction moment magnitudes during stance and this higher magnitude was sustained for a longer portion of the gait cycle. The OA group also had a reduced flexion moment and a reduced external rotation moment during early stance. Increasing speed was associated with an increase in the magnitude of all joint moments. The fast walks did not, however, increase or bring out any biomechanical differences between the OA and control groups that did not exist at the self-selected walks.     

Strong independent associations between gait biomechanics and pain in patients with knee osteoarthritis

We investigated the simple and multivariate associations between knee pain and gait biomechanics. 279 patients with medial knee osteoarthritis (OA) and discordant changes in pain between limbs after walking completed bilateral three-dimensional gait analysis. For each limb, patients rated their pain before and after a 6-min walk and the change in pain was recorded as an increase (≥1 points) or not (≤0 points). Among paired limbs, the simple and multivariate associations between an increase in pain and the external moments in each orthogonal plane were evaluated using conditional logistic regression. The analyses were then repeated for knee angles. Univariate analyses demonstrated associations in each plane that varied in both magnitude and direction, with larger associations for the knee moments [Odds Ratio (95% confidence interval) = first peak adduction moment: 2.80 (2.02, 3.88), second peak adduction moment: 2.36 (1.73, 3.24), adduction impulse: 6.65 (3.50, 12.62), flexion moment: 0.46 (0.36, 0.60), extension moment: 0.56 (0.44, 0.71), internal rotation moment: 7.54 (3.32, 17.13), external rotation moment: 0.001 (0.00, 0.04)]. Multivariate analyses with backward elimination resulted in a model including only the adduction impulse [5.35 (2.51, 11.42)], flexion moment [0.32 (0.22, 0.46)] and extension moment [0.28 (0.19, 0.42)]. The varus, flexion and extension angles were included in the final multivariate model for the knee angles. When between-person confounding is lessened by comparing limbs within patients, there are strong independent associations between knee pain and multiple external knee moments that vary in magnitude and direction. While controlling for other knee moments, a greater adduction impulse and lower flexion and extension moments were independently associated with greater odds of an increase in pain.     

Evaluation of the kinematic parameters of normal-paced gait in subjects with gonarthrosis and the influence of gonarthrosis on the function of the ankle joint and hip joint

The aim of the study was to assess the variability of parameters characterising the gait of persons suffering from degenerative changes of the knee joint and their influence on the ankle and hip joints. The values of the angular changes in the knee, ankle and hip joints in the three planes of motion were assessed. Locomotion tests were performed on 27 persons, aged between 60 and 74, using Vicon 250, the three-dimensional analysis system. The sharpest deviations from the results of the control group were revealed in the transverse and frontal planes. Degenerative knee joint disease has changed the gait stereotype causing a reduction in the economy of gonarthrosis patients' locomotion, the influence of the disease on the function of the neighbouring joints is also distinctly marked.     

Mathematical modelling of stress in the hip during gait.

A mathematical model is developed for calculating the contact stress distribution in the hip for a known resultant hip force and characteristic geometrical parameters. Using a relatively simple single nonlinear algebraic equation, the model can be readily applied in clinical practice to estimate the stress distribution in the most frequent body positions of everyday activities. This is demonstrated by analyzing the data on the resultant hip force obtained from laboratory observations where a stance period of gait is considered.     

Humans exploit the biomechanics of bipedal gait during visually guided walking over complex terrain

How do humans achieve such remarkable energetic efficiency when walking over complex terrain such as a rocky trail? Recent research in biomechanics suggests that the efficiency of human walking over flat, obstacle-free terrain derives from the ability to exploit the physical dynamics of our bodies. In this study, we investigated whether this principle also applies to visually guided walking over complex terrain. We found that when humans can see the immediate foreground as little as two step lengths ahead, they are able to choose footholds that allow them to exploit their biomechanical structure as efficiently as they can with unlimited visual information. We conclude that when humans walk over complex terrain, they use visual information from two step lengths ahead to choose footholds that allow them to approximate the energetic efficiency of walking in flat, obstacle-free environments.     

The effect on conventional gait model kinematics and kinetics of hip joint centre equations in adult healthy gait

The Conventional Gait Model (CGM) needs to benefit from large investigations on localization of the hip joint centre (HJC). Incorrect positions from the native equations were demonstrated (Sangeux et al., 2014; Harrington et al., 2007). More accurate equations were proposed but their impact on kinematics and kinetic CGM outputs was never evaluated. This short communication aims at examining if adoption of new HJC equations would alter standard CGM outputs. Sixteen able bodied participants underwent a full 3-D optoelectronic gait analysis followed by a 3-D ultrasound localization of their hips. Data were processed through the open source python package pyCGM2 replicating kinematic and kinetic processing of the native CGM. Compared with 3D ultrasound location, Hara equations improved the accuracy of sagittal plane kinematics (0.6°) and kinetics (0.02 N m kg⁻¹) for the hip. The worst case participant exhibited Harrington’s equations reached a deviation of 3° for the sagittal kinematics. In the coronal plane, Hara and Harrington equations presented similar differences (1°) for the hip whilst Davis equations had the largest deviation for hip abduction (2.7°) and hip abductor moment (0.10 N m kg⁻¹).Both Harrington and Hara equations improved the CGM location of the HJC. Hara equations improved results in the sagittal plane, plus utilise a single anthropometrics measurement, leg length, that may be more robust. However, neither set of equations had significant effect on kinematics. We reported some effects on kinetics, particularly in the coronal plane, which warrant caution in interpreting outputs using different sets of equations.     

Chondrogenic capability of osteoarthritic chondrocytes from the trapeziometacarpal and hip joints

Osteoarthritis is the most common degenerative disease of joints like the hip and the trapeziometacarpal joint (rhizarthrosis). In this in vitro study, we compared the chondrogenesis of chondrocytes derived from the trapezium and the femoral head cartilage of osteoarthritic patients to have a deeper insight on trapezium chondrocyte behavior as autologous cell source for the repair of cartilage lesions in rhizarthrosis. Chondrocytes collected from trapezium and femoral head articular cartilage were cultured in pellets and analyzed for chondrogenic differentiation, cell proliferation, glycosaminoglycan production, gene expression of chondrogenic and fibrous markers, histological and immunohistochemical analyses. Our results showed a higher cartilaginous matrix deposition and a lower fibrocartilaginous phenotype of the femoral chondrocytes with respect to the trapezium chondrocytes assessed by a higher absolute glycosaminoglycan and type II collagen production, thus demonstrating a superior chondrogenic potential of the femoral with respect to the trapezium chondrocytes. The differences in chondrogenic potential between trapezium and femoral head chondrocytes confirmed a lower regenerative capability in the trapezium than in the femoral head cartilage due to the different environment and loading acting on these joints that affects the metabolism of the resident cells. This could represent a limitation to apply the cell therapy for rhizoarthrosis.     

Cortical and spinal control of ankle joint muscles before and during gait initiation

The purpose of this study was to investigate control of the ankle joint muscles before and during gait initiation. Seven healthy humans, aged 20-30 years old, participated in this study. Motor-evoked potentials (MEPs) were recorded from the soleus and the tibialis anterior muscles, and H-reflexes were evoked from the soleus muscle in the stance leg of gait initiation. The soleus H-reflexes were depressed throughout all the periods before and during gait initiation. The soleus MEP amplitudes were decreased in some periods before gait initiation, but were increased in other periods before and during gait initiation. The MEP amplitudes in the tibialis anterior muscle were increased before the onset of the EMG activity, and this increase persisted through gait initiation. The findings indicate that the ankle joint flexor is under intensive cortico-spinal control before and during gait initiation. Both the cortical and spinal pathways are involved in preparing and controlling the activity of the ankle joint extensor for gait initiation.