A wearable system to assess risk for anterior cruciate ligament injury during jump landing: measurements of temporal events, jump height, and sagittal plane kinematics

The incidence of anterior cruciate ligament (ACL) injury remains high, and there is a need for simple, cost effective methods to identify athletes at a higher risk for ACL injury. Wearable measurement systems offer potential methods to assess the risk of ACL injury during jumping tasks. The objective of this study was to assess the capacity of a wearable inertial-based system to evaluate ACL injury risk during jumping tasks. The system accuracy for measuring temporal events (initial contact, toe-off), jump height, and sagittal plane angles (knee, trunk) was assessed by comparing results obtained with the wearable system to simultaneous measurements obtained with a marker-based optoelectronic reference system. Thirty-eight healthy participants (20 male and 18 female) performed drop jumps with bilateral and unilateral support landing. The mean differences between the temporal events obtained with both systems were below 5 ms, and the precisions were below 24 ms. The mean jump heights measured with both systems differed by less than 1 mm, and the associations (Pearson correlation coefficients) were above 0.9. For the discrete angle parameters, there was an average association of 0.91 and precision of 3.5° for the knee flexion angle and an association of 0.77 and precision of 5.5° for the trunk lean. The results based on the receiver-operating characteristic (ROC) also demonstrated that the proposed wearable system could identify movements at higher risk for ACL injury. The area under the ROC plots was between 0.89 and 0.99 for the knee flexion angle and between 0.83 and 0.95 for the trunk lean. The wearable system demonstrated good concurrent validity with marker-based measurements and good discriminative performance in terms of the known risk factors for ACL injury. This study suggests that a wearable system could be a simple cost-effective tool for conducting risk screening or for providing focused feedback.     

Amplitude and phasing of trunk motion is critical for the efficacy of gait training aimed at reducing ambulatory loads at the knee

The purpose of this study was to determine the contribution of changes in amplitude and phasing of medio-lateral trunk sway to a change in the knee adduction moment when walking with increased medio-lateral trunk sway. Kinematic and kinetic data of walking trials with normal and with increased trunk sway were collected for 19 healthy volunteers using a standard motion analysis system. The relationship between the change in first peak knee adduction moment (ΔKAM) and change in trunk sway amplitude (ΔSA; difference between maximum contralateral trunk lean and maximum ipsilateral trunk lean) and phasing (SP; time of heel-strike relative to time of maximum contralateral and time of maximum ipsilateral trunk lean) was determined using nonlinear regression analysis. On average, subjects increased their SA by 9.7?±?3.6 deg (P?相似文献   

Plasma proteins present in osteoarthritic synovial fluid can stimulate cytokine production via Toll-like receptor 4

Introduction

Osteoarthritis (OA) is a degenerative disease characterized by cartilage breakdown in the synovial joints. The presence of low-grade inflammation in OA joints is receiving increasing attention, with synovitis shown to be present even in the early stages of the disease. How the synovial inflammation arises is unclear, but proteins in the synovial fluid of affected joints could conceivably contribute. We therefore surveyed the proteins present in OA synovial fluid and assessed their immunostimulatory properties.

Methods

We used mass spectrometry to survey the proteins present in the synovial fluid of patients with knee OA. We used a multiplex bead-based immunoassay to measure levels of inflammatory cytokines in serum and synovial fluid from patients with knee OA and from patients with rheumatoid arthritis (RA), as well as in sera from healthy individuals. Significant differences in cytokine levels between groups were determined by significance analysis of microarrays, and relations were determined by unsupervised hierarchic clustering. To assess the immunostimulatory properties of a subset of the identified proteins, we tested the proteins' ability to induce the production of inflammatory cytokines by macrophages. For proteins found to be stimulatory, the macrophage stimulation assays were repeated by using Toll-like receptor 4 (TLR4)-deficient macrophages.

Results

We identified 108 proteins in OA synovial fluid, including plasma proteins, serine protease inhibitors, proteins indicative of cartilage turnover, and proteins involved in inflammation and immunity. Multiplex cytokine analysis revealed that levels of several inflammatory cytokines were significantly higher in OA sera than in normal sera, and levels of inflammatory cytokines in synovial fluid and serum were, as expected, higher in RA samples than in OA samples. As much as 36% of the proteins identified in OA synovial fluid were plasma proteins. Testing a subset of these plasma proteins in macrophage stimulation assays, we found that Gc-globulin, α₁-microglobulin, and α₂-macroglobulin can signal via TLR4 to induce macrophage production of inflammatory cytokines implicated in OA.

Conclusions

Our findings suggest that plasma proteins present in OA synovial fluid, whether through exudation from plasma or production by synovial tissues, could contribute to low-grade inflammation in OA by functioning as so-called damage-associated molecular patterns in the synovial joint.     

Kinematic adaptations to a variable stiffness shoe: mechanisms for reducing joint loading

A recently described variable-stiffness shoe has been shown to reduce the adduction moment and pain in patients with medial-compartment knee osteoarthritis. The mechanism associated with how this device modifies overall gait patterns to reduce the adduction moment is not well understood. Yet this information is important for applying load modifying intervention for the treatment of knee osteoarthritis. A principal component analysis (PCA) was used to test the hypothesis that there are differences in the frontal plane kinematics that are correlated with differences in the ground reaction forces (GRFs) and center of pressure (COP) for a variable-stiffness compared to a constant-stiffness control shoe. Eleven healthy adults were tested in a constant-stiffness control shoe and a variable-stiffness shoe while walking at self-selected speeds. The PCA was performed on trial vectors consisting of all kinematic, GRF and COP data. The projection of trial vectors onto the linear combination of four PCs showed there were significant differences between shoes. The interpretation of the PCs indicated an increase in the ankle eversion, knee abduction and adduction, decreases in the hip adduction and pelvic obliquity angles and reduced excursion of both the COP and peak medial-lateral GRFs for the variable-stiffness compared to the control shoe. The variable-stiffness shoe produced a unique dynamic change in the frontal plane motion of the ankle, hip and pelvis that contributed to changes in the GRF and COP and thus reduced the adduction moment at a critical instant during gait suggesting a different mechanism that was seen with fixed interventions (e.g. wedges).     

Posturographic analysis through markerless motion capture without ground reaction forces measurement

The ability of the central nervous system to control posture and balance has been used with increasing frequency for the diagnosis and/or treatment evaluation of various neuromuscular diseases. Typically this analysis (Posturographic Analysis) is based on tracking the motion of the center of mass (COM) during quiet standing, however direct measurement of the COM has been commonly approximated using the movement of the center of pressure (COP). The purpose of this study was to apply and validate a new method to track the COM (center of mass) and COP (center of pressure) from a visual hull measured using a markerless motion capture (MMC) method. The method was tested by comparing the calculation of the COP from direct measurements of the COP. The deviations between the methods, below 2 mm, were small relative to the average range of movement guaranteeing a satisfactory signal to noise ratio. This new method requires only kinematic data through MMC method and without the need of a force plate can identify the influence of individual body segments to motion of the COM.     

Tibiofemoral joint contact force in deep knee flexion and its consideration in knee osteoarthritis and joint replacement

The aim of the study was to estimate the tibiofemoral joint force in deep flexion to consider how the mechanical load affects the knee. We hypothesize that the joint force should not become sufficiently large to damage the joint under normal contact area, but should become deleterious to the joint under the limited contact area. Sixteen healthy knees were analyzed using a motion capture system, a force plate, a surface electromyography, and a knee model, and then tibiofemoral joint contact forces were calculated. Also, a contact stress simulation using the contact areas from the literature was performed. The peak joint contact forces (M +/- SD) were 4566 +/- 1932 N at 140 degrees in rising from full squat and 4479 +/- 1478 N at 90 degrees in rising from kneeling. Under normal contact area, the tibiofemoral contact stresses in deep flexion were less than 5 MPa and did not exceed the stress to damage the cartilage. The contact stress simulation suggests that knee prosthesis having the contact area smaller than 200 mm2 may be problematic since the contact stress in deep flexion would become larger than 21 MPa, and it would lead damage or wear of the polyethylene.     

The knee joint center of rotation is predominantly on the lateral side during normal walking

The purpose of this study was to test the hypothesis of whether the center of rotation (COR) in the transverse plane of the knee is in the medial side during normal walking in a manner similar to that previously described during non-ambulatory activities. The kinematics for normal knees was obtained from 46 knees during normal walking using the point cluster technique. The COR of the medial-lateral axis of the femur relative to the tibia was determined during the stance phase of walking. The hypothesis that the COR is in the medial side during stance was not supported by this study. The average COR during the stance phase of walking was in the lateral compartment for all 46 knees. In addition, the instantaneous COR occurred on the medial side on average <25% of the time during the stance phase. Thus, while the COR is predominantly on the lateral side of the knee during walking, the normal function of the knee during walking is associated with both lateral and medial pivoting. These results also demonstrate the importance of describing knee kinematics in the context of a specific activity or the constraints of the test conditions.     

Study on effect of graded facetectomy on change in lumbar motion segment torsional flexibility using three-dimensional continuum contact representation for facet joints

Facet joints provide rigidity to the lumbar motion segment and thus protect the disk, particularly against torsional injury. A surgical procedure that fully or partially removes the facet joints (facetectomy) will decrease the mechanical stiffness of the motion segment, and potentially place the disk at risk of injury. Analytical models can be used to understand the effect of facet joints on motion segment stability. Using a facet joint model that represents the contact area as contact between two surfaces rather than as point contact, it was concluded that a substantial sudden change in rotational motion, due to applied torsion moment, was observed after 75 percent of any one of the facet joints was removed. Applied torsional moment loading produced coupled extension motion in the intact motion segment. This coupled motion also experienced a large change following complete unilateral facetectomy. Clinically, the present study showed that surgical intervention in the form of unilateral or bilateral total facetectomy might require fusion to reduce the primary torsion motion.     

Evolution and phylogenetic utility of the period gene in Lepidoptera

Evolution and phylogenetic utility of the period gene are explored through sequence analysis of a relatively conserved 909-bp fragment in 26 lepidopteran species. Taxa range from tribes to superfamilies, primarily within the putative clade Macrolepidotera plus near outgroups, and include both strongly established and problematic groupings. Their divergence dates probably range from the late Cretaceous through much of the Tertiary. Comparisons within the same set of closely related species show that amino acid substitutions in period occur 4.9 and 44 times as frequently as they do in two other nuclear genes--dopa decarboxylase and elongation factor-1 alpha, respectively. In contrast, rates of observed synonymous substitution are within 60% of each other for these three genes. Synonymous changes in period approach saturation by the family level, whereas nonsynonymous and amino acid divergences across the Macrolepidoptera are less than half the maximal values reported for this gene. Phylogenetic analyses of period strongly supported groupings at the family level and below. In contrast to previous analyses at this level with other nuclear genes, much of the information lies in nonsynonymous change. Relationships up to the superfamily level were recovered with decreasing effectiveness, and little, if any, signal was apparent regarding relationships among superfamilies. This could reflect rapid radiation of the superfamilies, however, rather than saturation in the period locus; thus, period, in combination with other genes, remains a plausible candidate for approaching the difficult problems of lepidopteran family and superfamily relationships.