Patellar mechanics during simulated kneeling in the natural and implanted knee

Kneeling is required during daily living for many patients after total knee replacement (TKR), yet many patients have reported that they cannot kneel due to pain, or avoid kneeling due to discomfort, which critically impacts quality of life and perceived success of the TKR procedure. The objective of this study was to evaluate the effect of component design on patellofemoral (PF) mechanics during a kneeling activity. A computational model to predict natural and implanted PF kinematics and bone strains after kneeling was developed and kinematics were validated with experimental cadaveric studies. PF joint kinematics and patellar bone strains were compared for implants with dome, medialized dome, and anatomic components. Due to the less conforming nature of the designs, change in sagittal plane tilt as a result of kneeling at 90° knee flexion was approximately twice as large for the medialized-dome and dome implants as the natural case or anatomic implant, which may result in additional stretching of the quadriceps. All implanted cases resulted in substantial increases in bone strains compared with the natural knee, but increased strains in different regions. The anatomic patella demonstrated increased strains inferiorly, while the dome and medialized dome showed increases centrally. An understanding of the effect of implant design on patellar mechanics during kneeling may ultimately provide guidance to component designs that reduces the likelihood of knee pain and patellar fracture during kneeling.     

In vitro forces in the normal and cruciate-deficient knee during simulated squatting motion

Three orthogonal components of the tibiofemoral and patellofemoral forces were measured simultaneously for knees with intact cruciate ligaments (nine knees), following anterior cruciate ligament resection (six knees), and subsequent posterior cruciate ligament resection (six knees). The knees were loaded using an experimental protocol that modeled static double-leg squat. The mean compressive tibial force increased with flexion angle. The mean anteroposterior tibial shear force acted posteriorly on the tibia below 50 deg flexion and anteriorly above 55 deg. Mediolateral shear forces were low compared to the other force components and tended to be directed medially on both the patella and tibia. The mean value of the ratio of the resultant tibial force divided by the quadriceps force decreased with increasing flexion angle and was between 0.6 and 0.7 above 70 deg flexion. The mean value of the ratio of the resultant tibiofemoral contact force divided by the resultant patellofemoral contact force decreased with increasing flexion and was between 0.8 and 1.0 above 55 deg flexion. Cruciate ligament resection resulted in no significant changes in the patellar contact forces. Following resection of the anterior cruciate ligament, the tibial anteroposterior shear force was directed anteriorly over all flexion angles tested. Subsequent resection of the posterior cruciate ligament resulted in an approximately 10 percent increase in the quadriceps tendon and tibial compressive force.     

Forces and moments telemetered from two distal femoral replacements during various activities.

Two distal femoral replacements were instrumented to measure axial force, torque and bending moments in the prosthesis shaft. Data are reported up to 2.5 years for the following activities: uni- and bi-lateral standing, walking, stair climbing and descending, treadmill walking, jogging and jumping. In the first subject the greatest averaged peak shaft forces found were: jogging 3.6Bodyweight (BW), stair descending 3.1BW, walking 2.8BW, treadmill walking 2.75BW, and stair ascending 2.8BW. Bending moments about the antero-posterior axis (varus-valgus) and medio-lateral axis (flexion-extension) peaked in the range 8.5-9.8 and 4.7-7.6BWcm respectively, over the follow-up period. Axial torques peaked in the range 0.2-1.3BWcm, outwardly directed. At most follow-up sessions, forces and moments during jogging were generally greater than those for other gait activities. In the second subject forces and moments were generally only 45-70% of those in the first subject, due to inadequate musculature around the knee. The data can be applied to the design and testing of distal femoral replacements and even to total knee replacements, and contributes to the knowledge of forces acting in the distal femur during activity.     

In vivo knee moments and shear after total knee arthroplasty

Tibiofemoral loading is very important in cartilage degeneration as well as in component survivorship after total knee arthroplasty. We have previously reported the axial knee forces in vivo. In this study, a second-generation force-sensing device that measured all six components of tibial forces was implanted in a 74-kg, 83-year-old male. Video motion analysis, ground reaction forces, and knee forces were measured during walking, stair climbing, chair-rise, and squat activities. Peak total force was 2.3 times body weight (BW) during walking, 2.5 x BW during chair rise, 3.0 x BW during stair climbing, and 2.1 x BW during squatting. Peak anterior shear force at the tibial tray was 0.30 x BW during walking, 0.17 x BW during chair rise, 0.26 x BW during stair climbing, and 0.15 x BW during squatting. Peak flexion moment at the tray was 1.9% BW x Ht (percentage of body weight multiplied by height) for chair-rise activity and 1.7% BW x Ht for squat activity. Peak adduction moment at the tray was -1.1% BW x Ht during chair-rise, -1.3% BW x Ht during squatting. External knee flexion and adduction moments were substantially greater than flexion and adduction moments at the tray. The axial component of forces predominated especially during the stance phase of walking. Shear forces and moments at the tray were very modest compared to total knee forces. These findings indicate that the soft tissues around the knee absorbed most of the external shear forces. Our results highlight the importance of direct measurements of knee forces.     

Comparison of the angles and corresponding moments in the knee and hip during restricted and unrestricted squats

ABSTRACT: Lorenzetti, S, Gülay, T, Stoop, M, List, R, Gerber, H, Schellenberg, F, and Stüssi, E. Comparison of the angles and corresponding moments in the knee and hip during restricted and unrestricted squats. J Strength Cond Res 26(10): 2829-2836, 2012-The aim of this study was to compare the angles and corresponding moments in the knee and hip during squats. Twenty subjects performed restricted and unrestricted squats with barbell loads that were 0, ?, and ? their body weight. The experimental setup consisted of a motion capture system and 2 force plates. The moments were calculated using inverse dynamics. During the unrestricted squats, the maximum moments in the knee were significantly higher, and those in the hip were significantly lower than during restricted squats. At the lowest position, the maximum knee flexion angles were approximately 86° for the restricted and approximately 106° for the unrestricted techniques, whereas the maximum hip flexion angle was between 95° and 100°. The higher moments in the hip during restricted squats suggest a higher load of the lower back. Athletes who aim to strengthen their quadriceps should consider unrestricted squats because of the larger knee load and smaller back load.     

The influence of knee varus and valgus on quadriceps muscle activity changes induced by stretching and kneeling

This study aimed to determine the influence of knee varus (VARUS) and valgus (VALGUS) on the differences in individual quadriceps muscle (QM) activity during knee extension maximum voluntary isometric contractions (MVICs) and sit/stand transitions and on the changes in individual QM activity during sit/stand transitions after QM stretching and kneeling. Ten young healthy males each with VARUS and VALGUS were included. The electromyography signals of the vastus medialis (VM), vastus lateralis, and rectus femoris were recorded during sit/stand transitions before and after rest, stretching, and kneeling and during knee extension MVICs after rest. The individual muscle-to-total muscle activity ratio was assessed. The VARUS group exhibited a significantly higher VM muscle activity ratio in the sit-to-stand and stand-to-sit tasks than in knee extension MVICs (p = 0.004 and p = 0.044, respectively) and a tendency that the VM muscle activity ratio increased in the sit-to-stand task after stretching (p = 0.051), whereas the VALGUS group exhibited no significance. Individuals with VARUS required high VM muscle activity ratios during sit/stand transitions. Future studies should be conducted to determine whether habitual sit-to-stand exercises after QM stretching are effective in preventing knee medial osteoarthritis development in individuals with VARUS.     

Shoulder muscular activity during isometric three-point kneeling exercise on stable and unstable surfaces

The purpose of this study was to determine if performing isometric 3-point kneeling exercises on a Swiss ball influenced the isometric force output and EMG activities of the shoulder muscles when compared with performing the same exercises on a stable base of support. Twenty healthy adults performed the isometric 3-point kneeling exercises with the hand placed either on a stable surface or on a Swiss ball. Surface EMG was recorded from the posterior deltoid, pectoralis major, biceps brachii, triceps brachii, upper trapezius, and serratus anterior muscles using surface differential electrodes. All EMG data were reported as percentages of the average root mean square (RMS) values obtained in maximum voluntary contractions for each muscle studied. The highest load value was obtained during exercise on a stable surface. A significant increase was observed in the activation of glenohumeral muscles during exercises on a Swiss ball. However, there were no differences in EMG activities of the scapulothoracic muscles. These results suggest that exercises performed on unstable surfaces may provide muscular activity levels similar to those performed on stable surfaces, without the need to apply greater external loads to the musculoskeletal system. Therefore, exercises on unstable surfaces may be useful during the process of tissue regeneration.     

Kinematic, kinetic and EMG patterns during downward squatting.

The aim of this study was to investigate the kinematic, kinetic, and electromyographic pattern before, during and after downward squatting when the trunk movement is restricted in the sagittal plane. Eight healthy subjects performed downward squatting at two different positions, semisquatting (40 degrees knee flexion) and half squatting (70 degrees knee flexion). Electromyographic responses of the vastus medialis oblique, vastus medialis longus, rectus femoris, vastus lateralis, biceps femoris, semitendineous, gastrocnemius lateralis, and tibialis anterior were recorded. The kinematics of the major joints were reconstructed using an optoelectronic system. The center of pressure (COP) was obtained using data collected from one force plate, and the ankle and knee joint torques were calculated using inverse dynamics. In the upright position there were small changes in the COP and in the knee and ankle joint torques. The tibialis anterior provoked the disruption of this upright position initiating the squat. During the acceleration phase of the squat the COP moved posteriorly, the knee joint torque remained in flexion and there was no measurable muscle activation. As the body went into the deceleration phase, the knee joint torque increased towards extension with major muscle activities being observed in the four heads of the quadriceps. Understanding these kinematic, kinetic and EMG strategies before, during and after the squat is expected to be beneficial to practitioners for utilizing squatting as a task for improving motor function.     

Parental attendance and squatting in the Kittiwake Rissa tridactyla during the rearing period

Parental attendance was studied in 1991 in the Cap Sizun Kittiwake colonies (Brittany, France). After a period of continuous guarding lasting on average 22 days, parents left their chicks unattended. Thereafter, parental attendance decreased regularly until fledging. The chick age when first left alone was on average 3 days lower for large broods than for single-chick broods. Moreover, whatever the brood size, chicks from late nests were younger when left unattended. Parental age affected the initiation of first absence. Younger parents reduced their attendance sooner than older parents. About 80% of the nests with chicks were visited by other adults at least once during the absence of the parents, and 50% were visited in the 3 days following the first absence of the breeders. These squatters were mainly failed breeders and prebreeders looking for a future breeding site. The results are discussed in terms of costs and benefits of chick neglect and comparisons were made with data from other studies in North Atlantic and Alaskan colonies. This reflected the flexibility of adult behaviour in relation to brood size and food availability.     

Influence of additional load on the moments of the agonist and antagonist muscle groups at the knee joint during closed chain exercise

The present study investigated the influence of additional loads on the knee net joint moment, flexor and extensor muscle group moments, and cocontraction index during a closed chain exercise. Loads of 8, 28, or 48 kg (i.e., respectively, 11.1 ± 1.5%, 38.8 ± 5.3%, and 66.4 ± 9.0% of body mass) were added to subjects during dynamic half squats. The flexor and extensor muscular moments and the amount of cocontraction were estimated at the knee joint using an EMG-and-optimization model that includes kinematics, ground reaction, and EMG measurements as inputs. In general, our results showed a significant influence of the Load factor on the net knee joint moment, the extensor muscular moment, and the flexor muscle group moment (all Anova p < .05). Hence we confirmed an increase in muscle moments with increasing load and moreover, we also showed an original “more than proportional” evolution of the flexor and extensor muscle group moments relative to the knee net joint moment. An influence of the Phase (i.e., descent vs. ascent) factor was also seen, revealing different activation strategies from the central nervous system depending on the mode of contraction of the agonist muscle group. The results of the present work could find applications in clinical fields, especially for rehabilitation protocols.     

蹲跳、反向跳和下落跳的膝关节屈伸肌群肌电信号分析

目的：通过观察肌电图（EMG）的变化,了解运动员与普通中学生在纵跳过程中,膝关节屈伸肌群工作特点,为运动员科学选材提供依据。方法：30名男女青少年运动员和30名男女普通中学生进行各种形式纵跳（蹲跳、反向跳、下落跳）,测试膝关节屈伸肌群的EMG变化情况。结果：主动肌（股外肌）EMG的变化存在性别差异,随着下肢工作强度的增加,男运动员积分肌电图（iEMG)和平均功率频率（Fmean)均没有显著变化,女运动员iEMG增加,Fmean没有显著变化,对抗肌（股二头肌）,随着下肢工作强度的增加。青少年运动员EMG活动变化较小,而普通中学生的EMG活动明显增加。结论：在增加工作负荷的过程中,男运动员膝关节伸肌群以提高效率为主,女运动员以提高肌肉的募集数量为主;运动员的对抗肌协调水平高于普通中学生。     

The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis

PurposeExternal knee moments are reliable to measure knee load but it does not take into account muscle activity. Considering that muscle co-activation increases compressive forces at the knee joint, identifying relationships between muscle co-activations and knee joint load would complement the investigation of the knee loading in subjects with knee osteoarthritis. The purpose of this study was to identify relationships between muscle co-activation and external knee moments during walking in subjects with medial knee osteoarthritis.Methods19 controls (11 males, aged 56.6 ± 5, and BMI 25.2 ± 3.3) and 25 subjects with medial knee osteoarthritis (12 males, aged 57.3 ± 5.3, and BMI 28.2 ± 4) were included in this study. Knee adduction and flexion moments, and co-activation (ratios and sums of quadriceps, hamstring, and gastrocnemius) were assessed during walking and compared between groups. The relationship between knee moments and co-activation was investigated in both groups.FindingsSubjects with knee osteoarthritis presented a moderate and strong correlation between co-activation (ratios and sums) and knee moments.InterpretationMuscle co-activation should be used to measure the contribution of quadriceps, hamstring, and gastrocnemius on knee loading. This information would cooperate to develop a more comprehensive approach of knee loading in this population.     

Use of muscle synergies and wavelet transforms to identify fatigue during squatting

The objective of this study was to supplement continuous wavelet transforms with muscle synergies in a fatigue analysis to better describe the combination of decreased firing frequency and altered activation profiles during dynamic muscle contractions. Nine healthy young individuals completed the dynamic tasks before and after they squatted with a standard Olympic bar until complete exhaustion. Electromyography (EMG) profiles were analyzed with a novel concatenated non-negative matrix factorization method that decomposed EMG signals into muscle synergies. Muscle synergy analysis provides the activation pattern of the muscles while continuous wavelet transforms output the temporal frequency content of the EMG signals. Synergy analysis revealed subtle changes in two-legged squatting after fatigue while differences in one-legged squatting were more pronounced and included the shift from a general co-activation of muscles in the pre-fatigue state to a knee extensor dominant weighting post-fatigue. Continuous wavelet transforms showed major frequency content decreases in two-legged squatting after fatigue while very few frequency changes occurred in one-legged squatting. It was observed that the combination of methods is an effective way of describing muscle fatigue and that muscle activation patterns play a very important role in maintaining the overall joint kinetics after fatigue.     

Spinal loading during manual materials handling in a kneeling posture.

Stooped, restricted, kneeling, and other awkward postures adopted during manual materials handling have frequently been associated with LBP onset. However, lift assessment tools have focused on materials handling performed in an upright, or nearly upright standing posture. Unfortunately, many of the tools designed to analyze standing postures are not easily adapted to jobs requiring restricted postures. Therefore, the objective of this study was to evaluate spinal loading during manual materials handing in kneeling postures and determine if those loads can be predicted using simple regression. An EMG-driven biomechanical model, previously validated for upright lifting, was adapted for use in kneeling tasks. Subjects knelt under a 1.07m ceiling and lifted luggage of six weights (6.8, 10.9, 15.0, 19.1, 23.1 and, 27.2kgf) to one of four destination heights (0, 25.4, 53.3, 78.7cm). Spine loading was significantly affected by both destination height and load weight. Destination height increased compression, AP shear and lateral shear by an average of 14.5, 3.7 and 6.6N respectively per cm height increase. Load weight increased compression, AP shear and lateral shear by an average of 83.8, 27.0 and 13.1N respectively per kgf lifted. Regression equations were developed to predict peak spine loading using subject height, load weight and destination height with R(2) values of 0.62, 0.51 and 0.57 for compression, AP and lateral shear respectively.     

Forces acting on the patella during maximal voluntary contraction of the quadriceps femoris muscle at different knee flexion/extension angles

From knee extension moments measured with a dynamometer, the quadriceps muscle force, the patellar ligament force and the reaction force in the patellofemoral joint at various knee angles (0-90 degrees) were estimated. The information needed to calculate the combined effect of both patellofemoral and tibiofemoral joint on the mechanical advantage of the muscle was obtained from lateral-view radiographs of autopsy knees. The results show that the smallest quadriceps force (2,000 N) is exerted at maximal extension, and the largest force (8,000 N) at about 75 degrees of flexion. The patellar ligament force reaches a maximum (5,000 N) at 60 degrees. The reaction force in the patellofemoral joint is the smallest (1,000 N) at extension and is of the same values as the muscle force in a range from 75 to 90 degrees. Especially at large flexion angles, the value of the estimated forces is considerably larger (by 100%) than reported in the literature. This difference is attributed to the influence of the patellofemoral joint on the mechanical advantage of the muscle, which has not been taken into account in other studies.     

Effect of knee position on hip and knee torques during the barbell squat

Some recommendations suggest keeping the shank as vertical as possible during the barbell squat, thus keeping the knees from moving past the toes. This study examined joint kinetics occurring when forward displacement of the knees is restricted vs. when such movement is not restricted. Seven weight-trained men (mean +/- SD; age = 27.9 +/- 5.2 years) were videotaped while performing 2 variations of parallel barbell squats (barbell load = body weight). Either the knees were permitted to move anteriorly past the toes (unrestricted) or a wooden barrier prevented the knees from moving anteriorly past the toes (restricted). Differences resulted between static knee and hip torques for both types of squat as well as when both squat variations were compared with each other (p < 0.05). For the unrestricted squat, knee torque (N.m; mean +/- SD) = 150.1 +/- 50.8 and hip torque = 28.2 +/- 65.0. For the restricted squat, knee torque = 117.3 +/- 34.2 and hip torque = 302.7 +/- 71.2. Restricted squats also produced more anterior lean of the trunk and shank and a greater internal angle at the knees and ankles. The squat technique used can affect the distribution of forces between the knees and hips and on the kinematic properties of the exercise. PRACTICAL APPLICATIONS: Although restricting forward movement of the knees may minimize stress on the knees, it is likely that forces are inappropriately transferred to the hips and low-back region. Thus, appropriate joint loading during this exercise may require the knees to move slightly past the toes.     

The effects of movement velocity during squatting on energy expenditure and substrate utilization in whole-body vibration

The purpose of this study was to examine whether and how cycle time duration affects energy expenditure and substrate utilization during whole-body vibration (WBV). Nine men performed 3 squatting exercises in execution frequency cycles of 6, 4, and 2 seconds to 90 degrees knee flexion with vibration (Vb+) (frequency was set at 30 Hz and the amplitude of vibration was 4 mm) and without vibration (Vb-) during 3 minutes, each with an additional load of 30% of the subject's body weight. A 2-way analysis of variance for VO2 revealed a significant vibration condition main effect (p < 0.001) and a cycle time duration effect (p < 0.001). When differences were analyzed by Fisher's LSD test, cycle time duration of 2 seconds was significantly different from 4 and 6 seconds, both in Vb+ and Vb-. Total energy expenditure (EE(tot)), carbohydrate oxidation rate (EE(cho)), and fat oxidation rate (EE(fat)) demonstrated a significant vibration condition main effect (EE(tot): p < 0.01; EE(cho): p < 0.001; EE(fat): p < 0.001) and cycle time duration main effect (EE(tot) and EE(cho): p < 0.001; EE(fat): p < 0.01). EE(tot), EE(cho), and EE(fat) post hoc comparisons indicated that values for the 2-second test significantly differed from 4 and 6 seconds when compared in the same vibration condition. VO2 and EE values were greater in Vb+ than in Vb- conditions with the same cycle time duration. Our study confirms that squatting at a greater frequency helps to maximize energy expenditure during exercise with or without vibration. Therefore, cycle time duration must be controlled when vibration exercise is prescribed.     

Forces in the knee joint whilst rising from a seated position

Knee joint forces were determined by kinesiological techniques, using a high speed cine camera, a force platform, a specially constructed dynamometerized chair, and EMG recorders; so that a comparison could be made for rising from a normal chair with and without the aid of arms, and for rising from high and low chairs. For rising from the seated position, the knee joint forces parallel to the long axis of the tibia at the point of contact between the tibia and femur were found to be up to seven times body weight at about the time when the body left contact with the chair. When rising from a chair with the aid of arms, the knee joint forces were reduced to less than three times body weight. Knee joint and muscle forces were also reduced when rising from a high seat compared with rising from a low seat.     

Forces on chromosomal DNA during anaphase.

In the course of anaphase, the chromosomal DNA is submitted to the traction of the spindle. Several physical problems are associated with this action. In particular, the sister chromatids are generally topologically intertwined at the onset of anaphase, and the removal of the intertwinings results from a coupling between the enzymatic action of type II DNA topoisomerases and the force exerted by the spindle. We propose a physical analysis of some of these problems: 1) We compare the maximum force the spindle can produce with the force required to break a DNA molecule, and define the conditions compatible with biological safety during anaphase. 2) We show that the behavior of the sister chromatids in the absence of type II DNA topoisomerases can be described by two distinct models: a chain pullout model accounts for the experimental observations made in the budding yeast, and a model of the mechanical rupture of rubbers accounts for the nondisjunction in standard cases. 3) Using the fluctuation-dissipation theorem, we introduce an effective protein friction associated with the strand-passing activity of type II DNA topoisomerases. We show that this friction can be used to describe the situation in which one chromosome passes entirely through another one. Possible experiments that could test these theoretical analyses are discussed.