Patellofemoral joint compression forces in backward and forward running

Patellofemoral pain (PFP) is a common injury and increased patellofemoral joint compression forces (PFJCF) may aggravate symptoms. Backward running (BR) has been suggested for exercise with reduced PFJCF. The aims of this study were to (1) investigate if BR had reduced peak PFJCF compared to forward running (FR) at the same speed, and (2) if PFJCF was reduced in BR, to investigate which biomechanical parameters explained this. It was hypothesized that (1) PFJCF would be lower in BR, and (2) that this would coincide with a reduced peak knee moment caused by altered ground reaction forces (GRFs). Twenty healthy subjects ran in forward and backward directions at consistent speed. Kinematic and ground reaction force data were collected; inverse dynamic and PFJCF analyses were performed. PFJCF were higher in FR than BR (4.5±1.5; 3.4±1.4BW; p<0.01). The majority of this difference (93.1%) was predicted by increased knee moments in FR compared to BR (157±54; 124±51 Nm; p<0.01). 54.8% of differences in knee moments could be predicted by the magnitude of the GRF (2.3±0.3; 2.4±0.2BW), knee flexion angle (44±6; 41±7) and center of pressure location on the foot (25±11; 12±6%) at time of peak knee moment. Results were not consistent in all subjects. It was concluded that BR had reduced PFJCF compared to FR. This was caused by an increased knee moment, due to differences in magnitude and location of the GRF vector relative to the knee. BR can therefore be used to exercise with decreased PFJCF.     

Patellofemoral cartilage stresses are most sensitive to variations in vastus medialis muscle forces

The purpose of this study was to evaluate the effects of variations in quadriceps muscle forces on patellofemoral stress. We created subject-specific finite element models for 21 individuals with chronic patellofemoral pain and 16 pain-free control subjects. We extracted three-dimensional geometries from high resolution magnetic resonance images and registered the geometries to magnetic resonance images from an upright weight bearing squat with the knees flexed at 60°. We estimated quadriceps muscle forces corresponding to 60° knee flexion during a stair climb task from motion analysis and electromyography-driven musculoskeletal modelling. We applied the quadriceps muscle forces to our finite element models and evaluated patellofemoral cartilage stress. We quantified cartilage stress using an energy-based effective stress, a scalar quantity representing the local stress intensity in the tissue. We used probabilistic methods to evaluate the effects of variations in quadriceps muscle forces from five trials of the stair climb task for each subject. Patellofemoral effective stress was most sensitive to variations in forces in the two branches of the vastus medialis muscle. Femur cartilage effective stress was most sensitive to variations in vastus medialis forces in 29/37 (78%) subjects, and patella cartilage effective stress was most sensitive to variations in vastus medialis forces in 21/37 (57%) subjects. Femur cartilage effective stress was more sensitive to variations in vastus medialis longus forces in subjects classified as maltrackers compared to normal tracking subjects (p?=?0.006). This study provides new evidence of the importance of the vastus medialis muscle in the treatment of patellofemoral pain.     

Hip joint forces in sheep.

Testing orthopaedic implants at the proximal femur of sheep requires knowledge of the contact forces acting on this joint. Telemeterized implants were used for long-term measurements of these forces in four sheep, mostly during treadmill walking. Joint forces in the same sheep varied widely from day to day and interindividual differences were also pronounced. Forces during walking were mostly higher than in previous short-term measurements. At medium walking speed, loads in the range of 65-140% of the body weight were typical. Fast walking increased the forces by only 20%, compared to slow speed. Stomping on the ground at the beginning of the stance phase and starting to run freely led to very high forces. The highest values observed were nearly four times the body weight. As in humans, the directions of high forces varied only slightly in the frontal plane throughout the whole stance phase but much more in the transverse plane. With regard to the force magnitudes and their directions, sheep seem to be a good model for testing human implant at the proximal femur.     

Tibio-femoral joint contact forces in sheep

Although the sheep has become a standard model for understanding the mechanical conditions that occur after injury and investigating surgical treatments such as osteochondral defect healing and ligament reconstruction, no study has yet evaluated the contact forces that occur in the sheep tibio-femoral joint in vivo. In this study, bone pins, together with reflective markers, were used to measure the 3D kinematics of three sheep hind limbs, simultaneously with the ground reaction forces during repetitions of gait trials. Joint contact forces were then calculated using inverse dynamics and optimisation techniques. Whilst average peak axial tibio-femoral contact forces of 2.1 body weight (BW) were calculated across the 3 sheep, only small medio-lateral and antero-posterior shear forces, averaging 0.7 BW, were determined. Average knee flexion angles ranging from 49 degrees to 70 degrees were observed. From the forces determined in this study, we have provided a better understanding of the mechanical loading environment that occurs in sheep. This has important implications for the interpretation of knee studies in quadrupeds and their relevance to the clinical situation.     

The influence of soft tissue movement on ground reaction forces, joint torques and joint reaction forces in drop landings

The aim of this study was to determine the effects that soft tissue motion has on ground reaction forces, joint torques and joint reaction forces in drop landings. To this end a four body-segment wobbling mass model was developed to reproduce the vertical ground reaction force curve for the first 100 ms of landing. Particular attention was paid to the passive impact phase, while selecting most model parameters a priori, thus permitting examination of the rigid body assumption on system kinetics. A two-dimensional wobbling mass model was developed in DADS (version 9.00, CADSI) to simulate landing from a drop of 43 cm. Subject-specific inertia parameters were calculated for both the rigid links and the wobbling masses. The magnitude and frequency response of the soft tissue of the subject to impulsive loading was measured and used as a criterion for assessing the wobbling mass motion. The model successfully reproduced the vertical ground reaction force for the first 100 ms of the landing with a peak vertical ground reaction force error of 1.2% and root mean square errors of 5% for the first 15 ms and 12% for the first 40 ms. The resultant joint forces and torques were lower for the wobbling mass model compared with a rigid body model, up to nearly 50% lower, indicating the important contribution of the wobbling masses on reducing system loading.     

Dynamic joint and muscle forces during knee isokinetic exercise

Isokinetic exercise has been commonly used in knee rehabilitation, conditioning and research in the past two decades. Although many investigators have used various experimental and theoretical approaches to study the muscle and joint force involved in isokinetic knee extension and flexion exercises, only a few of these studies have actually distinguished between the tibiofemoral joint forces and muscle forces. Therefore, the objective of this study was to specify, via an eletromyography(EMG)-driven muscle force model of the knee, the magnitude of the tibiofemoral joint and muscle forces acting during isokinetic knee extension and flexion exercises. Fifteen subjects ranging from 21 to 36 years of age volunteered to participate in this study. A Kin Com exercise machine (Chattecx Corporation, Chattanooga, TN, U.S.A.) was used as the loading device. An EMG-driven muscle force model was used to predict muscle forces, and a biomechanical model was used to analyze two knee joint constraint forces; compression and shear force. The methods used in this study were shown to be valid and reliable (r > 0.84 andp < 0.05). The effects on the tibiofemoral joint force during knee isokinetic exercises were compared with several functional activities that were investigated by earlier researchers. The muscle forces generated during knee isokinetic exercise were also obtained. Based on the findings obtained in this study, several therapeutic justifications for knee rehabilitation are proposed.     

Experimental determination of forces transmitted through the patello-femoral joint

Tensions in the quadriceps tendon and infrapatellar ligament were measured as a function of flexion angle in eight cadaver knees using a load cell of a materials tester to determine the quadriceps force and a spring balance to quantify the patellar tendon force. The ratio between the tensions in the quadriceps tendon and the patellar tendon (FQ/FP) ranged from 1.55 at 70 degrees of flexion to 0.86 at 10 degrees of flexion. The patello-femoral joint reaction (PFJR) force for extension against resistance was maximal at 60 degrees. No change in the quadriceps force required to extend the knee occurred with changes of the Q-angle of +/- 5 degrees. This study demonstrates that FQ does not equal FP as several authors have reported (Bandi, 1972; Barry, 1979; Ficat and Hungerford, 1977; Hungerford and Barry, 1979; Reilly and Martens, 1972; Smidt, 1973). Furthermore, the difference in FQ and FP influences both the magnitude and direction of PFJR. Studies that assess the influence of surgical procedures which alter the patello-femoral joint or the extensor mechanism must take these differences into account.     

Shoulder model validation and joint contact forces during wheelchair activities

Chronic shoulder impingement is a common problem for manual wheelchair users. The loading associated with performing manual wheelchair activities of daily living is substantial and often at a high frequency. Musculoskeletal modeling and optimization techniques can be used to estimate the joint contact forces occurring at the shoulder to assess the soft tissue loading during an activity and to possibly identify activities and strategies that place manual wheelchair users at risk for shoulder injuries. The purpose of this study was to validate an upper extremity musculoskeletal model and apply the model to wheelchair activities for analysis of the estimated joint contact forces. Upper extremity kinematics and handrim wheelchair kinetics were measured over three conditions: level propulsion, ramp propulsion, and a weight relief lift. The experimental data were used as input to a subject-specific musculoskeletal model utilizing optimization to predict joint contact forces of the shoulder during all conditions. The model was validated using a mean absolute error calculation. Model results confirmed that ramp propulsion and weight relief lifts place the shoulder under significantly higher joint contact loading than level propulsion. In addition, they exhibit large superior contact forces that could contribute to impingement. This study highlights the potential impingement risk associated with both the ramp and weight relief lift activities. Level propulsion was shown to have a low relative risk of causing injury, but with consideration of the frequency with which propulsion is performed, this observation is not conclusive.     

The influence of patellofemoral joint contact geometry on the modeling of three dimensional patellofemoral joint forces

The purpose of this study was to determine the influence of patellofemoral joint contact geometry on the modeling of three-dimensional patellofemoral joint forces. To achieve this goal, patellofemoral joint reaction forces (PFJRFs) that were measured from an in-vitro cadaveric set-up were compared to PFJRFs estimated from a computer model that did not consider patellofemoral joint contact geometry. Ten cadaver knees were used in this study. Each was mounted on a custom jig that was fixed to an Instron frame. Quadriceps muscle loads were accomplished using a pulley system and weights. The force in the patellar ligament was obtained using a buckle transducer. To quantify the magnitude and direction of the PFJRF, a six-axis load cell was incorporated into the femoral fixation system so that a rigid body assumption could be made. PFJRF data were obtained at 0 degrees , 20 degrees , 40 degrees and 60 degrees of knee flexion. Following in vitro testing, SIMM modeling software was used to develop computational models based on the three-dimensional coordinates (Microscribe digitizer) of individual muscle and patellar ligament force vectors obtained from the cadaver knees. The overall magnitude of the PFJRF estimated from the computer generated models closely matched the direct measurements from the in vitro set-up (Pearson's correlation coefficient, R(2)=0.91, p<0.001). Although the computational model accurately estimated the posteriorly directed forces acting on the joint, some discrepancies were noted in the forces acting in the superior and lateral directions. These differences however, were relatively small when expressed as a total of the overall PFJRF magnitude.     

Subject-specific hip geometry affects predicted hip joint contact forces during gait

Hip loading affects bone remodeling and implant fixation. In this study, we have analyzed the effect of subject-specific modeling of hip geometry on muscle activation patterns and hip contact forces during gait, using musculoskeletal modeling, inverse dynamic analysis and static optimization. We first used sensitivity analysis to analyze the effect of isolated changes in femoral neck-length (NL) and neck-shaft angle (NSA) on calculated muscle activations and hip contact force during the stance phase of gait. A deformable generic musculoskeletal model was adjusted incrementally to adopt a physiological range of NL and NSA. In a second similar analysis, we adjusted hip geometry to the measurements from digitized radiographs of 20 subjects with primary hip osteoarthrosis. Finally, we studied the effect of hip abductor weakness on muscle activation patterns and hip contact force. This analysis showed that differences in NL (41-74 mm) and NSA (113-140 degrees ) affect the muscle activation of the hip abductors during stance phase and hence hip contact force by up to three times body weight. In conclusion, the results from both the sensitivity and subject-specific analysis showed that at the moment of peak contact force, altered NSA has only a minor effect on the loading configuration of the hip. Increased NL, however, results in an increase of the three hip contact-force components and a reduced vertical loading. The results of these analyses are essential to understand modified hip joint loading, and for planning hip surgery for patients with osteoarthrosis.     

Subject-specific knee joint geometry improves predictions of medial tibiofemoral contact forces

Estimating tibiofemoral joint contact forces is important for understanding the initiation and progression of knee osteoarthritis. However, tibiofemoral contact force predictions are influenced by many factors including muscle forces and anatomical representations of the knee joint. This study aimed to investigate the influence of subject-specific geometry and knee joint kinematics on the prediction of tibiofemoral contact forces using a calibrated EMG-driven neuromusculoskeletal model of the knee. One participant fitted with an instrumented total knee replacement walked at a self-selected speed while medial and lateral tibiofemoral contact forces, ground reaction forces, whole-body kinematics, and lower-limb muscle activity were simultaneously measured. The combination of generic and subject-specific knee joint geometry and kinematics resulted in four different OpenSim models used to estimate muscle–tendon lengths and moment arms. The subject-specific geometric model was created from CT scans and the subject-specific knee joint kinematics representing the translation of the tibia relative to the femur was obtained from fluoroscopy. The EMG-driven model was calibrated using one walking trial, but with three different cost functions that tracked the knee flexion/extension moments with and without constraint over the estimated joint contact forces. The calibrated models then predicted the medial and lateral tibiofemoral contact forces for five other different walking trials. The use of subject-specific models with minimization of the peak tibiofemoral contact forces improved the accuracy of medial contact forces by 47% and lateral contact forces by 7%, respectively compared with the use of generic musculoskeletal model.     

In vivo hip joint loads and pedal forces during ergometer cycling

The rising prevalence of osteoarthritis and an increase in total hip replacements calls for attention to potential therapeutic activities. Cycling is considered as a low impact exercise for the hip joint and hence recommended. However, there are limited data about hip joint loading to support this claim. The aim of this study was to measure synchronously the in vivo hip joint loads and pedal forces during cycling. The in vivo hip joint loads were measured in 5 patients with instrumented hip implants. Data were collected at several combinations of power and cadence, at two saddle heights.Joint loads and pedal forces showed strong linear correlation with power. So the relationship between the external pedal forces and internal joint forces was shown. While cycling at different cadences the minimum joint loads were acquired at 60 RPM. The lower saddle height configuration results in an approximately 15% increase compared to normal saddle height.The results offered new insights into the actual effects of cycling on the hip joint and can serve as useful tools while developing an optimum cycling regimen for individuals with coxarthrosis or following total hip arthroplasty. Due to the relatively low contact forces, cycling at a moderate power level of 90 W at a normal saddle height is suitable for patients.     

Effect of arm swinging on lumbar spine and hip joint forces

During level walking, arm swing plays a key role in improving dynamic stability. In vivo investigations with a telemeterized vertebral body replacement showed that spinal loads can be affected by differences in arm positions during sitting and standing. However, little is known about how arm swing could influence the lumbar spine and hip joint forces and motions during walking. The present study aims to provide better understanding of the contribution of the upper limbs to human gait, investigating ranges of motion and joint reaction forces.A three-dimensional motion analysis was carried out via a motion capturing system on six healthy males and five patients with hip instrumented implant. Each subject performed walking with different arm swing amplitudes (small, normal, and large) and arm positions (bound to the body, and folded across the chest). The motion data were imported in a commercial musculoskeletal analysis software for kinematic and inverse dynamic investigation.The range of motion of the thorax with respect to the pelvis and of the pelvis with respect to the ground in the transversal plane were significantly associated with arm position and swing amplitude during gait. The hip external-internal rotation range of motion statistically varied only for non-dominant limb. Unlike hip joint reaction forces, predicted peak spinal loads at T12-L1 and L5-S1 showed significant differences at approximately the time of contralateral toe off and contralateral heel strike.Therefore, arm position and swing amplitude have a relevant effect on kinematic variables and spinal loads, but not on hip loads during walking.     

Knee joint motion and ligament forces before and after ACL reconstruction

The goal of this in vitro study was to investigate the initial postoperative mechanical state of the knee with various types of anterior cruciate ligament (ACL) reconstructions. An experimental knee testing system was developed for the in vitro measurement of ligament forces and three-dimensional joint motion as external loads were applied to fresh knee specimens. Two groups of knee specimens were tested. In test series #1, two intraarticular reconstructions were performed in each of five specimens using semifree and free patellar tendon grafts with bone blocks. In test series #2, a more carefully controlled intraarticular reconstruction was performed in five specimens using a semifree composite graft consisting of the semitendinosus and gracilis tendons augmented with the Ligament Augmentation Device. Ligament force and joint motion data were collected as anteriorly directed tibial loads were applied to the normal joint, the joint with a cut ACL and the reconstructed joint. These knee joint states were compared on the basis of ACL or graft forces, joint motion and load sharing by the collateral ligaments. The dominate result of the study was that the forces and motions defining the mechanical state of the knee after the ACL reconstructions in both test series were highly variable and abnormal when compared to the normal knee state. The higher level of surgical control series #2 did not decrease this variability. There was a poor correlation between motion of the reconstructed knee relative to normal, and the ACL graft force. There was little consistent difference in force and motion results between the surgical procedures tested.     

Four-channel telemetry system for in vivo measurement of hip joint forces

The long-term loosening of artificial hip joints remains a serious clinical problem. Optimization of implant design and material will improve the fixation, but it requires a detailed knowledge of the forces which act on the implant. A four-channel telemetric transmitter was developed and arranged completely inside a hermetically closed artificial hip joint. This permits long term in vivo measurements of the three-dimensional forces without endangering the patient. The external telemetry system consists of an inductive power supply, an RF receiver, a microcomputer with hardware extension and a VHS video system. The personal computer offers real-time data processing of three orthogonal force components as well as slow motion analysis of recorded measurements. After several years of animal tests, two instrumented prostheses were implanted in the first patient (male) in May and August of 1988. In March 1990 a third prosthesis was implanted in a second patient (female). Joint force measurements have regularly been performed from the first post-operative day until now for several kinds of activity.     

Influence of altered gait patterns on the hip joint contact forces

Children who exhibit gait deviations often present a range of bone deformities, particularly at the proximal femur. Altered gait may affect bone growth and lead to deformities by exerting abnormal stresses on the developing bones. The objective of this study was to calculate variations in the hip joint contact forces with different gait patterns. Muscle and hip joint contact forces of four children with different walking characteristics were calculated using an inverse dynamic analysis and a static optimisation algorithm. Kinematic and kinetic analyses were based on a generic musculoskeletal model scaled down to accommodate the dimensions of each child. Results showed that for all the children with altered gaits both the orientation and magnitude of the hip joint contact force deviated from normal. The child with the most severe gait deviations had hip joint contact forces 30% greater than normal, most likely due to the increase in muscle forces required to sustain his crouched stance. Determining how altered gait affects joint loading may help in planning treatment strategies to preserve correct loading on the bone from a young age.     

Three-dimensional knee joint contact forces during walking in unilateral transtibial amputees

Individuals with unilateral transtibial amputations have greater prevalence of osteoarthritis in the intact knee joint relative to the residual leg and non-amputees, but the cause of this greater prevalence is unclear. The purpose of this study was to compare knee joint contact forces and the muscles contributing to these forces between amputees and non-amputees during walking using forward dynamics simulations. We predicted that the intact knee contact forces would be higher than those of the residual leg and non-amputees. In the axial and mediolateral directions, the intact and non-amputee legs had greater peak tibio-femoral contact forces and impulses relative to the residual leg. The peak axial contact force was greater in the intact leg relative to the non-amputee leg, but the stance phase impulse was greater in the non-amputee leg. The vasti and hamstrings muscles in early stance and gastrocnemius in late stance were the largest contributors to the joint contact forces in the non-amputee and intact legs. Through dynamic coupling, the soleus and gluteus medius also had large contributions, even though they do not span the knee joint. In the residual leg, the prosthesis had large contributions to the joint forces, similar to the soleus in the intact and non-amputee legs. These results identify the muscles that contribute to knee joint contact forces during transtibial amputee walking and suggest that the peak knee contact forces may be more important than the knee contact impulses in explaining the high prevalence of intact leg osteoarthritis.     

A system for modelling forces on the hip joint in one-legged stance

We describe a method of testing hip prostheses. The prosthesis is implanted in a proximal section of femur, which is loaded to model the forces applied through the acetabulum via the greater trochanter.     

Elbow and wrist joint contact forces during occupational pick and place activities

A three-dimensional, mathematical model of the elbow and wrist joints, including 15 muscle units, 3 ligaments and 4 joint forces, has been developed. A new strain gauge transducer has been developed to measure functional grip forces. The device measures radial forces divided into six components and forces of up to 250N per segment can be measured with an accuracy of +/-1%. Ten normal volunteers were asked to complete four tasks representing occupational activities, during which time their grip force was monitored. Together with kinematic information from the six-camera Vicon data, the moment effect of these loads at the joints was calculated. These external moments are assumed to be balanced by the internal moments, generated by the muscles, passive soft tissue and bone contact. The effectiveness of the body's internal structures in generating joint moments was assessed by studying the geometry of a simplified model of the structures, where information about the lines of action and moment arms of muscles, tendons and ligaments is contained. The assumption of equilibrium between these external and internal joint moments allows formulation of a set of equations from which muscle and joint forces can be calculated. A two stage, linear optimisation routine minimising the overall muscle stress and the sum of the joint forces has been used to overcome the force-sharing problem. Humero-ulnar forces of up to 1600N, humero-radial forces of up to 800N and wrist joint forces of up to 2800N were found for moderate level activity. The model was validated by comparison with other studies.