Stair climbing results in more challenging patellofemoral contact mechanics and kinematics than walking at early knee flexion under physiological-like quadriceps loading

The mechanical environment during stair climbing has been associated with patellofemoral pain, but the contribution of loading to this condition is not clearly understood. It was hypothesized that the loading conditions during stair climbing induce higher patellofemoral pressures, a more lateral force distribution on the trochlea and a more lateral shift and tilt of the patella compared to walking at early knee flexion. Optical markers for kinematic measurements were attached to eight cadaveric knees, which were loaded with muscle forces at instances of walking and stair climbing cycles at 12° and 30° knee flexion. Contact mechanics were determined using a pressure sensitive film. At 12° knee flexion, stair climbing loads resulted in higher peak pressure (p=0.012) than walking, more lateral force distribution (p=0.012) and more lateral tilt (p=0.012), whilst mean pressure (p=0.069) and contact area (p=0.123) were not significantly different. At 30° knee flexion, although stair climbing compared to walking loads resulted in significantly higher patellofemoral mean (p=0.012) and peak pressures (p=0.012), contact area (p=0.025), as well as tilt (p=0.017), the medial–lateral force distribution (p=0.674) was not significantly different. No significant differences were observed in patellar shift between walking and stair climbing at either 12° (p=0.093) or 30° (p=0.575) knee flexion. Stair climbing thus leads to more challenging patellofemoral contact mechanics and kinematics than level walking at early knee flexion. The increase in patellofemoral pressure, lateral force distribution and lateral tilt during stair climbing provides a possible biomechanical explanation for the patellofemoral pain frequently experienced during this activity.     

Differences in patellofemoral contact mechanics associated with patellofemoral pain syndrome

Patellofemoral pain syndrome (PFPS) is a disorder of the patellofemoral (PF) joint in which abnormal tracking is often cited as a factor in pain development. PF tracking is partially dependent on passive stabilizers (ex: PF geometry). Relations amongst PFPS, PF tracking, and contact mechanics are poorly understood. In-vivo investigation of passive PF joint stabilizers including PF tracking, contact mechanics, cartilage thickness, and patellar shape will allow structural characterization of the PF joint and may highlight differences associated with PFPS. This study examined the role that passive stabilizers play in PFPS (n=10) versus healthy subjects (n=10). PF tracking (contact area centroid migration), cartilage thickness, shape, congruence, and contact patterns were quantified using magnetic resonance imaging during isometric loading at 15°, 30°, and 45° of knee flexion. Distinct relationships were identified between patellar shape and tracking and contact, particularly at low flexion (15–30°). Healthy subjects exhibited distinct PF tracking and contact patterns related to Type I patella shape (80%) with increasing total contact area (p<0.001) and proximal centroid migration (15–30° p=0.012; 30–45° p<0.001) for increasing knee angles. PFPS subjects deviated from these patterns at low flexion, demonstrating higher total contact area than healthy subjects (p=0.046 at 15°), lack of proximal centroid migration (15–30°), and more Type II (30%) and III (20%) patella shapes. This study highlights a new finding that patellar shape combined with low degrees of flexion (15–30°) may be important to consider, as this is where PFPS tracking and contact patterns deviate from healthy.     

The effect of tendon loading on in-vitro carpal kinematics of the wrist joint

Measurements of in-vitro carpal kinematics of the wrist provide valuable biomechanical data. Tendon loading is often applied during cadaver experiments to simulate natural stabilizing joint compression in the wrist joint. The purpose of this study was to investigate the effect of tendon loading on carpal kinematics in-vitro.A cyclic movement was imposed on 7 cadaveric forearms while the carpal kinematics were acquired by a 4-dimensional rotational X-ray imaging system. The extensor- and flexor tendons were loaded with constant force springs of 50 N, respectively. The measurements were repeated without a load on the tendons. The effect of loading on the kinematics was tested statistically by using a linear mixed model.During flexion and extension, the proximal carpal bones were more extended with tendon loading. The lunate was on the average 2.0° (p=0.012) more extended. With tendon loading the distal carpal bones were more ulnary deviated at each angle of wrist motion. The capitate was on the average 2.4° (p=0.004) more ulnary deviated.During radioulnar deviation, the proximal carpal bones were more radially deviated with the lunate 0.7° more into radial deviation with tendon loading (p<0.001). Conversely, the bones of distal row were more flexed and supinated with the capitate 1.5° more into flexion (p=0.025) and 1.0° more into supination (p=0.011).In conclusion, the application of a constant load onto the flexor and extensor tendons in cadaver experiments has a small but statistically significant effect on the carpal kinematics during flexion–extension and radioulnar deviation.     

In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoral pain

Patellofemoral pain is a common knee disorder with a multi-factorial etiology related to abnormal patellar tracking. Our hypothesis was that the pattern of three-dimensional rotation and translation of the patella induced by selective activation of individual quadriceps components would differ between subjects with patellofemoral pain and healthy subjects. Nine female subjects with patellofemoral pain and seven healthy female subjects underwent electrical stimulation to selectively activate individual quadriceps components (vastus medialis obliquus, VMO; vastus medialis lateralis, VML; vastus lateralis, VL) with the knee at 0° and 20° flexion, while three-dimensional patellar tracking was recorded. Normalized direction of rotation and direction of translation characterized the relative amplitudes of each component of patellar movement. VMO activation in patellofemoral pain caused greater medial patellar rotation (distal patellar pole rotates medially in frontal plane) at both knee positions (p<0.01), and both VMO and VML activation caused increased anterior patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects at 20° knee flexion. VL activation caused more lateral patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects. In healthy subjects the 3-D mechanical action of the VMO is actively modulated with knee flexion angle while such modulation was not observed in PFP subjects. This could be due to anatomical differences in the VMO insertion on the patella and medial quadriceps weakness. Quantitative evaluation of the influence of individual quadriceps components on patellar tracking will aid understanding of the knee extensor mechanism and provide insight into the etiology of patellofemoral pain.     

Correlation between trochlear groove depth and patellar position during open and closed kinetic chain exercises in subjects with anterior knee pain

The purpose of this study was to correlate the trochlear shape and patellar tilt angle and lateral patellar displacement at rest and maximal voluntary isometric contraction (MVIC) exercises during open (OKC) and closed kinetic chain (CKC) in subjects with and without anterior knee pain. Subjects were all women, 20 who were clinically healthy and 19 diagnosed with anterior knee pain. All subjects were evaluated and subjected to magnetic resonance exams during OKC and CKC exercise with the knee placed at 15, 30, and 45 degrees of flexion. The parameters evaluated were sulcus angle, patellar tilt angle and patellar displacement using bisect offset. Pearson's r coefficient was used, with p < .05. Our results revealed in knee pain group during CKC and OKC at 15 degrees that the increase in the sulcus angle is associated with a tilt increase and patellar lateral displacement. Comparing sulcus angle, patellar tilt angle and bisect offset values between MVIC in OKC and CKC in the knee pain group, it was observed that patellar tilt angle increased in OKC only with the knee flexed at 30 degrees. Based on our results, we conclude that reduced trochlear depth is correlated with increased lateral patellar tilt and displacement during OKC and CKC at 15 degrees of flexion in people with anterior knee pain. By contrast, 30 degrees of knee flexion in CKC is more recommended in rehabilitation protocols because the patella was more stable than in other positions.     

In vivo tracking of the human patella using cine phase contrast magnetic resonance imaging

Improper patellar tracking is often considered to be the cause of patellar-femoral pain. Unfortunately, our knowledge of patellar-femoral-tibial (knee) joint kinematics is severely limited due to a lack of three-dimensional, noninvasive, in vivo measurement techniques. This study presents the first large-scale, dynamic, three-dimensional, noninvasive, in vivo study of nonimpaired knee joint kinematics during volitional leg extensions. Cine-phase contrast magnetic resonance imaging was used to measure the velocity profiles of the patella, femur, and tibia in 18 unimpaired knees during leg extensions, resisted by a 34 N weight. Bone displacements were calculated through integration and then converted into three-dimensional orientation angles. We found that the patella displaced laterally, superiorly, and anteriorly as the knee extended. Further, patellar flexion lagged knee flexion, patellar tilt was variable, and patellar rotation was fairly constant throughout extension.     

Iliotibial band tension affects patellofemoral and tibiofemoral kinematics

The iliotibial band (ITB) has an important role in knee mechanics and tightness can cause patellofemoral maltracking. This study investigated the effects of increasing ITB tension on knee kinematics. Nine fresh-frozen cadaveric knees had the components of the quadriceps loaded with 175 N. A Polaris optical tracking system was used to acquire joint kinematics during extension from 100° to 0° flexion. This was repeated after the following ITB loads: 30, 60 and 90 N. There was no change with 30 N load for patellar translation. On average, at 60 and 90 N, the patella translated laterally by 0.8 and 1.4 mm in the mid flexion range compared to the ITB unloaded condition. The patella became more laterally tilted with increasing ITB loads by 0.7°, 1.2° and 1.5° for 30, 60 and 90 N, respectively. There were comparable increases in patellar lateral rotation (distal patella moves laterally) towards the end of the flexion cycle. Increased external rotation of the tibia occurred from early flexion onwards and was maximal between 60° and 75° flexion. The increase was 5.2°, 9.5° and 13° in this range for 30, 60 and 90 N, respectively. Increased tibial abduction with ITB loads was not observed. The combination of increased patellar lateral translation and tilt suggests increased lateral cartilage pressure. Additionally, the increased tibial external rotation would increase the Q angle. The clinical consequences and their relationship to lateral retinacular releases may be examined, now that the effects of a tight ITB are known.     

The importance of quadriceps and hamstring muscle loading on knee kinematics and in-situ forces in the ACL

This study investigated the effect of hamstring co-contraction with quadriceps on the kinematics of the human knee joint and the in-situ forces in the anterior cruciate ligament (ACL) during a simulated isometric extension motion of the knee. Cadaveric human knee specimens (n = 10) were tested using the robotic universal force moment sensor (UFS) system and measurements of knee kinematics and in-situ forces in the ACL were based on reference positions on the path of passive flexion/extension motion of the knee. With an isolated 200 N quadriceps load, the knee underwent anterior and lateral tibial translation as well as internal tibial rotation with respect to the femur. Both translation and rotation increased when the knee was flexed from full extension to 30 of flexion; with further flexion, these motion decreased. The addition of 80 N antagonistic hamstrings load significantly reduced both anterior and lateral tibial translation as well as internal tibial rotation at knee flexion angles tested except at full extension. At 30 of flexion, the anterior tibial translation, lateral tibial translation, and internal tibial rotation were significantly reduced by 18, 46, and 30%, respectively (p<0.05). The in-situ forces in the ACL under the quadriceps load were found to increase from 27.8+/-9.3 N at full extension to a maximum of 44.9+/-13.8 N at 15 of flexion and then decrease to 10 N beyond 60 of flexion. The in-situ force at 15 was significantly higher than that at other flexion angles (p<0.05). The addition of the hamstring load of 80 N significantly reduced the in-situ forces in the ACL at 15, 30 and 60 of flexion by 30, 43, and 44%, respectively (p<0.05). These data demonstrate that maximum knee motion may not necessarily correspond to the highest in-situ forces in the ACL. The data also suggest that hamstring co-contraction with quadriceps is effective in reducing excessive forces in the ACL particularly between 15 and 60 of knee flexion.     

Consistency of patellar spin, tilt and lateral translation side-to-side and over a 1 year period in healthy young males

The purpose of this study was to determine the consistency and symmetry of in vivo measures of patellar spin, tilt, and medial/lateral translation in healthy knees. Patellofemoral joint kinematics were measured bilaterally through a range of loaded knee flexion in 10 active males (aged 19.0 (0.57) years) at baseline, 6, and 12 months using a validated magnetic resonance imaging method. Effects due to time and limb were determined using ANOVA. Variation over 12 months and from side-to-side was summarized as the average of the mean absolute deviations of the measures at 1 degrees increments of knee flexion for corresponding loading cycles for each knee. The measures did not differ over time (p>0.52) or side-to-side (p>0.17). The mean intrasubject variability over the three time points was < or = 1.17 (0.3) degrees for spin and tilt and < or = 0.83 (0.61) mm for lateral translation. The mean intrasubject variability between limbs was 2.14 (1.29) degrees for spin, 0.46 (1.96) degrees for tilt and 1.29 (1.28)mm for lateral translation. The consistency of measures of normal patellar motion over a 1 year period supports application of this methodology to evaluate changes in patellar motion in longitudinal studies involving patient populations.     

A new in vivo technique for determination of 3D kinematics and contact areas of the patello-femoral and tibio-femoral joint

Patello-femoral disorders are often caused by changes of patello-femoral and/or tibio-femoral kinematics. However, until now there has been no quantitative in vivo technique, that is able to obtain 3D kinematics and contact areas of all knee compartments simultaneously on a non-invasive basis. The aim of this study was therefore to develop and apply a technique which allows for determination of 3D kinematics and contact areas of the patello-femoral and tibio-femoral joint during different knee flexion angles and under neuromuscular activation patterns. One knee of each of the 10 healthy volunteers was examined in an open MR system under flexing isometric muscle activity at 30 degrees and 90 degrees. Three-dimensional kinematics and contact areas of the patello-femoral and tibio-femoral joints were analyzed by 3D image postprocessing. The reproducibility of the imaging technique yielded a coefficient of variation of 4.6% for patello-femoral, 4.7% for femoro-tibial displacement and 8.6% for contact areas. During knee flexion (30-90 degrees ), patella tilt (opened to medial) decreased (8.8+/-3.4 degrees vs. 4.6+/-3.1 degrees, p<0.05), while lateral patellar shift increased significantly (1.6+/-2.3mm vs. 3.4+/-3.0mm, p<0.05). Furthermore, a significant posterior translation and external rotation of the femur relative to the tibia was observed. Patello-femoral contact areas increased significantly in size (134+/-60mm(2) vs. 205+/-96 mm(2)) during knee flexion. This technique shows a high reproducibility and provides physiologic in vivo data of 3D kinematics and contact areas of the patello-femoral and the tibio-femoral joint during knee flexion. This allows for advanced in vivo diagnostics, and may help to improve therapy of patello-femoral disorders in the future.     

Variation in patellofemoral kinematics due to changes in quadriceps loading configuration during in vitro testing

This study investigated changes in patellofemoral (PF) kinematics for different loading configurations of the quadriceps muscle: single line of action (SL), physiological-based multiple lines of action (ML), weak vastus medialis (WVM), and weak vastus lateralis (WVL). Fourteen cadaveric knees were flexed from 15° to 120° knee flexion using a loading rig with the ability to load different heads of the quadriceps and hamstring muscles in their anatomical orientation. PF rotation in the sagittal plane) and medial lateral translation were significantly different (p<0.05) for SL and ML, with maximum differences of 2.8° and 0.9 mm at 15° and 45° knee flexion, respectively. Compared to the ML, the WVM induced an average lateral shift of 1.5 mm and an abduction rotation of 0.8°, whereas a 0.9 mm medial shift and 0.6° adduction rotation was seen when simulating a WVL. The difference in the sagittal plane resultant force orientation of 26° between SL and ML was the major contributor to the change in PF rotation in the sagittal plane, while the difference in the frontal plane resultant force orientation of both the WVM and WVL from the ML (17° medial and 8° lateral, respectively) were the primary reasons for the change in PF frontal plane rotation and medial lateral translation. The two PF kinematic were significantly different from the ML for WVM and WVL (p<0.05). The results suggest that quadriceps muscle loading configuration can have a large influence on PF kinematics during full extension but less in deeper flexion. Therefore, using quadriceps single line loading for simulating activities with low flexion angles might not be sufficient to accurately replicate the physiological condition.     

Loading and knee flexion after stroke: Less does not equal more

It is believed that force feedback can modulate lower extremity extensor activity during gait. The purpose of this research was to determine the role of limb loading on knee extensor excitability during the late stance/early swing phase of gait in persons post-stroke. Ten subjects with chronic hemiparesis post-stroke participated in (1) seated isolated quadriceps reflex testing with ankle loads of 0–0.4N m/kg and (2) gait analysis on a treadmill with 0%, 20% or 40% body weight support. Muscle reflex responses were recorded from vastus lateralis (VL), rectus femoris (RF), and vastus medialis (VM) during seated testing. Knee kinematics and quadriceps activity during late stance/early swing phase of gait were compared across loading conditions. Although isolated loading of the ankle plantarflexors at 0.2 N m/kg reduced VM prolonged response (p = 0.04), loading did not alter any other measure of quadriceps excitability (all p > 0.08). During gait, the use of BWS did not influence knee kinematics (p = 0.18) or muscle activity (all p > 0.17) during late stance/early swing phase. This information suggests that load sensed at the ankle has minimal effect on the ipsilateral quadriceps of individuals post-stroke during late stance. It appears that adjusting limb loading during rehabilitation may not be an effective tool to address stiff-knee gait following stroke.     

A resistance band increased internal hip abduction moments and gluteus medius activation during pre-landing and early-landing

An increased knee abduction angle during jump-landing has been identified as a risk factor for anterior cruciate ligament injuries. Activation of the hip abductors may decrease the knee abduction angle during jump-landing. The purpose of this study was to examine the effects of a resistance band on the internal hip abduction moment and gluteus medius activation during the pre-landing (100 ms before initial contact) and early-landing (100 ms after initial contact) phases of a jump–landing–jump task. Thirteen male and 15 female recreational athletes (age: 21.1±2.4 yr; mass: 73.8±14.6 kg; height: 1.76±0.1 m) participated in the study. Subjects performed jump–landing–jump tasks with or without a resistance band applied to their lower shanks. During the with-band condition, subjects were instructed to maintain their movement patterns as performing the jump-landing task without a resistance band. Lower extremity kinematics, kinetics, and gluteus medius electromyography (EMG) were collected. Applying the band increased the average hip abduction moment during pre-landing (p<0.001, Cohen?s d (d)=2.8) and early-landing (p<0.001, d=1.5), and the average gluteus medius EMG during pre-landing (p<0.001, d=1.0) and early-landing (p=0.003, d=0.55). Applying the band decreased the initial hip flexion angle (p=0.028, d=0.25), initial hip abduction angle (p<0.001, d=0.91), maximum knee flexion angle (p=0.046, d=0.17), and jump height (p=0.004, d=0.16). Applying a resistance band provides a potential strategy to train the strength and muscle activation for the gluteus medius during jump-landing. Additional instructions and feedback regarding hip abduction, hip flexion, and knee flexion may be required to minimize negative changes to other kinematic variables.     

Magnetic resonance imaging for in vivo assessment of three-dimensional patellar tracking

We have developed a non-invasive measurement technique which can ultimately be used to quantify three-dimensional patellar kinematics of human subjects for a range of static positions of loaded flexion and assessed its accuracy. Knee models obtained by segmenting and reconstructing one high-resolution scan of the knee were registered to bone outlines obtained by segmenting fast, low-resolution scans of the knee in static loaded flexion. We compared patellar tracking measurements made using the new method to measurements made using Roentgen stereophotogrammetric analysis in three cadaver knee specimens loaded through a range of flexion in a test rig. The error in patellar spin and tilt measurements was less than 1.02 degrees and the error in lateral patellar shift was 0.88 mm. Sagittal plane scans provided more accurate final measurements of patellar spin and tilt, whereas axial plane scans provided more accurate measurements of lateral translation and patellar flexion. Halving the number of slices did not increase measurement error significantly, which suggests that scan times can be reduced without reducing accuracy significantly. The method is particularly useful for multiple measurements on the same subject because the high-resolution bone-models need only be created once; thus, the potential variability in coordinate axes assignment and model segmentation during subsequent measurements is removed.     

Soldier-relevant loads impact lower limb biomechanics during anticipated and unanticipated single-leg cutting movements

This study quantified how body borne load impacts hip and knee biomechanics during anticipated and unanticipated single-leg cutting maneuvers. Fifteen male military personnel performed a series of single-leg cutting maneuvers with three different load configurations (light, ~6 kg, medium, ~20 kg, and heavy, ~40 kg). Subject-based means of the specific lower limb biomechanical variables were submitted to repeated measures ANOVA to test the main and interaction effects of body borne load and movement type. With body borne load, stance time (P<0.001) increased, while larger hip (P=0.027) and knee flexion (P=0.004), and hip adduction (P<0.001) moments, and decreased hip (P=0.002) and knee flexion (P<0.001), and hip adduction (P=0.003) postures were evident. Further, the hip (P<0.001) and ankle (P=0.024) increased energy absorption, while the knee (P=0.020) increased energy generation with body borne load. During the unanticipated maneuvers, the hip (P=0.009) and knee (P=0.032) increased energy generation, and peak hip flexion moment (P=0.002) increased relative to the anticipated movements. With the body borne load, participants adopted biomechanical patterns that decreased their locomotive ability including larger moments and reduced flexion postures of the lower limb. During the single-leg cut, participants used greater energy absorption from the large, proximal muscles of the hip and greater energy generation from the knee with the addition of load. Participant?s performance when carrying a range of loads was not compromised by anticipation, as they did not exhibit the hip and knee kinetic and kinematic adaptations previously demonstrated when reacting to an unplanned stimulus.     

Biomechanical impairments and gait adaptations post-stroke: Multi-factorial associations

Understanding the potential causes of both reduced gait speed and compensatory frontal plane kinematics during walking in individuals post-stroke may be useful in developing effective rehabilitation strategies. Multiple linear regression analysis was used to select the combination of paretic limb impairments (frontal and sagittal plane hip strength, sagittal plane knee and ankle strength, and multi-joint knee/hip torque coupling) which best estimate gait speed and compensatory pelvic obliquity velocities at toeoff. Compensatory behaviors were defined as deviations from control subjects’ values. The gait speed model (n=18; p=0.003) revealed that greater hip abduction strength and multi-joint coupling of sagittal plane knee and frontal plane hip torques were associated with decreased velocity; however, gait speed was positively associated with paretic hip extension strength. Multi-joint coupling was the most influential predictor of gait speed. The second model (n=15; p<0.001) revealed that multi-joint coupling was associated with increased compensatory pelvic movement at toeoff; while hip extension and flexion and knee flexion strength were associated with reduced frontal plane pelvic compensations. In this case, hip extension strength had the greatest influence on pelvic behavior. The analyses revealed that different yet overlapping sets of single joint strength and multi-joint coupling measures were associated with gait speed and compensatory pelvic behavior during walking post-stroke. These findings provide insight regarding the potential impact of targeted rehabilitation paradigms on improving speed and compensatory kinematics following stroke.     

Patellar cartilage deformation in vivo after static versus dynamic loading

The objective of this study was to test the hypothesis that static loading (squatting at a 90 degrees angle) and dynamic loading (30 deep knee bends) cause different extents and patterns of patellar cartilage deformation in vivo. The two activities were selected because they imply different types of joint loading and reflect a realistic and appropriate range of strenuous activity. Twelve healthy volunteers were examined and the volume and thickness of the patellar cartilage determined before and from 90 to 320s after loading, using a water excitation gradient echo MR sequence and a three-dimensional (3D) distance transformation algorithm. Following knee bends, we observed a residual reduction of the patellar cartilage volume (-5.9+/-2.1%; p<0.01) and of the maximal cartilage thickness (-2.8+/-2.6%), the maximal deformation occurring in the superior lateral and the medial patellar facet. Following squatting, the change of patellar cartilage volume was -4.7+/-1.6% (p<0.01) and that of the maximal cartilage thickness -4.9+/-1.4% (p<0.01), the maximal deformation being recorded in the central aspect of the lateral patellar facet. The volume changes were significantly lower after squatting than after knee bends (p<0.05), but the maximal thickness changes higher (p<0.05). The results obtained in this study can serve to validate computer models of joint load transfer, to guide experiments on the mechanical regulation of chondrocyte biosynthesis, and to estimate the magnitude of deformation to be encountered by tissue-engineered cartilage within its target environment.     

Loading of the knee joint during activities of daily living measured in vivo in five subjects

Detailed knowledge about loading of the knee joint is essential for preclinical testing of implants, validation of musculoskeletal models and biomechanical understanding of the knee joint. The contact forces and moments acting on the tibial component were therefore measured in 5 subjects in vivo by an instrumented knee implant during various activities of daily living.Average peak resultant forces, in percent of body weight, were highest during stair descending (346% BW), followed by stair ascending (316% BW), level walking (261% BW), one legged stance (259% BW), knee bending (253% BW), standing up (246% BW), sitting down (225% BW) and two legged stance (107% BW). Peak shear forces were about 10–20 times smaller than the axial force. Resultant forces acted almost vertically on the tibial plateau even during high flexion. Highest moments acted in the frontal plane with a typical peak to peak range ?2.91% BWm (adduction moment) to 1.61% BWm (abduction moment) throughout all activities. Peak flexion/extension moments ranged between ?0.44% BWm (extension moment) and 3.16% BWm (flexion moment). Peak external/internal torques lay between ?1.1% BWm (internal torque) and 0.53% BWm (external torque).The knee joint is highly loaded during daily life. In general, resultant contact forces during dynamic activities were lower than the ones predicted by many mathematical models, but lay in a similar range as measured in vivo by others. Some of the observed load components were much higher than those currently applied when testing knee implants.     

Joint-specific power production and fatigue during maximal cycling

Cycling power decreases substantially during a maximal cycling trial of just 30 s. It is not known whether movement patterns and joint powers produced at each joint decrease to a similar extent or if each joint exhibits an individual fatigue profile. Changes in movement patterns and/or joint powers associated with overall task fatigue could arise from several different mechanisms or from a complex interplay of these mechanisms. The purpose of this investigation was to determine the changes in movement and power at each joint during a fatiguing cycling trial. Thirteen trained cyclists performed a 30 s maximal cycling trial on an isokinetic cycle ergometer at 120 rpm. Pedal forces and limb kinematics were recorded. Joint powers were calculated using a sagittal plane inverse dynamics model and averaged for the initial, middle, and final three second intervals of the trial, and normalized to initial values. Relative ankle plantar flexion power was significantly less than all other joint actions at the middle interval (51±5% of initial power; p=0.013). Relative ankle plantar flexion power for the final interval (37±3%) was significantly less than the relative knee flexion and hip extension power (p=0.010). Relative knee extension power (41±5%) was significantly less than relative hip extension power (55±4%) during the final three second interval (p=0.045). Knee flexion power (47±5%) did not differ from relative hip extension power (p=0.06). These changes in power were accompanied by a decrease in time spent extending by each joint with fatigue (i.e., decreased duty cycle, p<0.03). While central mechanisms may have played a role across all joints, because the ankle fatigued more than the hip and knee joints, either peripheral muscle fatigue or changes in motor control strategies were identified as the potential mechanisms for joint-specific fatigue during a maximal 30 s cycling trial.     

The coupled motion of the femur and patella during in vivo weightbearing knee flexion

The movement of the knee joint consists of a coupled motion between the tibiofemoral and patellofemoral articulations. This study measured the six degrees-of-freedom kinematics of the tibia, femur, and patella using dual-orthogonal fluoroscopy and magnetic resonance imaging. Ten normal knees from ten living subjects were investigated during weightbearing flexion from full extension to maximum flexion. The femoral and the patellar motions were measured relative to the tibia. The femur externally rotated by 12.9 deg and the patella tilted laterally by 16.3 deg during the full range of knee flexion. Knee flexion was strongly correlated with patellar flexion (R(2)=0.91), posterior femoral translation was strongly correlated to the posterior patellar translation (R(2)=0.87), and internal-external rotation of the femur was correlated to patellar tilt (R(2)=0.73) and medial-lateral patellar translation (R(2)=0.63). These data quantitatively indicate a kinematic coupling between the tibia, femur, and patella, and provide base line information on normal knee joint kinematics throughout the full range of weightbearing flexion. The data also suggest that the kinematic coupling of tibia, femur, and patella should be considered when investigating patellar pathologies and when developing surgical techniques to treat knee joint diseases.