Kristian M. O'Connor

Differences in Cutting Knee Mechanics Based on Principal Components Analysis

PURPOSE The increased number of women participating in sports has led to a higher knee injury rate in women compared with men. Analysis of injury risk is limited to identification of discrete-dependent variables, but analysis of the entire waveform using principal components analysis (PCA) may provide greater insight. The purpose of this study was to examine gender differences in cutting knee mechanics using PCA and to compare these findings to those based on traditional discrete measures. METHODS Sixteen male and 17 female recreational athletes were recruited to perform unanticipated run and cutting tasks. Three-dimensional joint dynamics were recorded, and discrete variables were extracted. PCA analyses were also performed on the angle and moment waveforms in all three planes. The PCA used an eigenvalue analysis on the data covariance matrix. Gender differences in the principal component (PC) scores generated by the PCA were assessed using a MANOVA (P < 0.05). RESULTS On the basis of the discrete variables, flexion range of motion for females was less than for males. From the PCA analysis, females were less internally rotated during late stance and exhibited a relatively greater peak adduction moment that was not apparent in the original time series. This peak moment correlated with a greater abduction oscillation during early stance. There was also less variability for females in the sagittal and frontal plane moment PC. CONCLUSIONS The PCA analysis did not significantly detect the decreased flexion, but PCA did reveal gender differences in movement patterns and variability that were not apparent in the discrete variables. The results of this study demonstrate the potential of PCA to provide deeper understand of movement dynamics that may help in detecting injury risk factors.

Anticipatory effects on anterior cruciate ligament loading during sidestep cutting

BACKGROUND A key to understanding potential anterior cruciate ligament injury mechanisms is to determine joint loading characteristics associated with an injury-causing event. However, direct measurement of anterior cruciate ligament loading during athletic tasks is invasive. Thus, previous research has been unable to study the association between neuromuscular variables and anterior cruciate ligament loading. Therefore, the purpose of this study was to determine the influence of movement anticipation on anterior cruciate ligament loading using a musculoskeletal modeling approach. METHODS Twenty healthy recreationally active females were recruited to perform anticipated and unanticipated sidestep cutting. Three-dimensional kinematics and kinetics of the right leg were calculated. Muscle, joint and anterior cruciate ligament forces were then estimated using a musculoskeletal model. Dependent t-tests were conducted to investigate differences between the two cutting conditions. FINDINGS ACL loading significantly increased during unanticipated sidestep cutting (p<0.05). This increase was primarily due to a significant increase in the sagittal plane ACL loading, which contributed 62% of the total loading. Frontal plane ACL loading contributed 26% and transverse plane ACL loading contributed 12%. INTERPRETATION These results suggest that anterior cruciate ligament loading resulted from a multifaceted interaction of the sagittal plane shear forces (i.e., quadriceps, hamstrings, and tibiofemoral), as well as the frontal and transverse plane knee moments. Additionally, the results of this study confirm the hypothesis in the current literature that unanticipated movements such as sidestep cutting increase anterior cruciate ligament loading.

Reduced hamstring strength increases anterior cruciate ligament loading during anticipated sidestep cutting.

BACKGROUND Dynamic knee stability is considered a critical factor in reducing anterior cruciate ligament loads. While the relationships between hamstring force production and anterior cruciate ligament loading are well known in vitro, the influence of hamstring strength to anterior cruciate ligament loading during athletic maneuvers remains unknown. Therefore, the purpose of this study was to determine the influence of hamstring strength on anterior cruciate ligament loading during anticipated sidestep cut. METHODS Seventeen recreationally active females were recruited to perform sidestep cutting maneuvers pre/post an acute hamstring strength reduction protocol. Kinematics and kinetics were calculated during the cut and a musculoskeletal model was used to estimate muscle, joint, and anterior cruciate ligament loads. Dependent t-tests were conducted to investigate differences between the two cutting conditions. FINDINGS Anterior cruciate ligament loading increased by 36% due to reduced hamstring strength. This was mostly due to a 44% increase in sagittal plane loading and a 24% increase in frontal plane loading. Post strength reduction sidestep cuts were also performed with decreased anterior tibiofemoral shear force, an outcome that would theoretically reduce anterior cruciate ligament loading. However, the overall decrease in hamstring force production coupled with a more axial hamstring line of action yielded a net increase in anterior cruciate ligament loading. INTERPRETATION These results suggest that decreased hamstring strength significantly increases anterior cruciate ligament loading during anticipated sidestep cutting. Additionally, these results support the premise that preseason screening programs should monitor hamstring strength to identify female athletes with potential deficits and increased injury risk.

The effects of fatigue and anticipation on the mechanics of the knee during cutting in female athletes.

BACKGROUND Unanticipated cutting tasks which do not allow for pre-planning of a movement have been reported to promote knee mechanics which may increase the risk of anterior cruciate ligament injury. Fatigue has also been reported to have similar effects. Athletes must often perform unanticipated tasks when they are fatigued. Previous studies have reported that the effects of anticipation become more prominent as an athlete progresses through a fatigue protocol. However, the protocols previously utilized may not mimic the demands of sports participation. METHODS Three-dimensional knee joint kinematics and kinetics were collected from 13 female athletes while they performed a run-and-cut task, before and after completion of an intermittent shuttle run. Trials were further divided (pre-planned, unanticipated) to assess the effects of anticipation. FINDINGS There were no significant interactions between the effects of fatigue and anticipation for the peak knee angles or moments of the knee joint in any plane. Subjects did demonstrate a 68% increase in their peak knee abduction angles following completion of the intermittent shuttle run. Anticipation also had a significant effect on the mechanics of the knee in all planes. Most notably, there was a 23% increase in peak knee abduction angles and a 33% increase in the peak internal knee adduction moments. INTERPRETATION Both fatigue and anticipation promoted knee mechanics which are associated with an increased risk of knee injury. However, it does not appear that their effects combine when athletes are at a level of fatigue which is thought to reflect sports participation.

The effect of a prefabricated foot orthotic on frontal plane joint mechanics in healthy runners.

The mechanism of action of a foot orthotic is poorly understood. The purpose of this study was to use principal components analysis (PCA) to analyze the effects of a prefabricated foot orthotic on frontal plane knee and ankle mechanics during running. Thirty-one healthy subjects performed running trials with and without a foot orthotic and PCA was performed on the knee and ankle joint angles and moments to identify the dominant modes of variation. MANOVAs were conducted on the retained principal components of each waveform and dependent t tests (P < .05) were performed in the case of significance. Mechanics of the ankle were not affected by the foot orthotic. However, mechanics of the knee were significantly altered as subjects demonstrated an increase in the magnitude of the knee abduction moment waveform in an orthotic condition. Subjects also demonstrated a significant shift in the timing of the knee abduction moment waveform toward later in the stance phase in the orthotic condition. These orthotic effects were not related to subjects foot mobility, measured using the navicular drop test. The mechanism of action of a foot orthotic may be related to their effect on the timing of frontal plane knee loading.

The Effect of Isolated Hamstrings Fatigue on Landing and Cutting Mechanics

The function of the hamstrings in protecting the ACL is not fully understood. The purpose of this study was to determine how landing knee mechanics were affected by hamstrings fatigue, analyzed with principal components analysis (PCA). Knee joint mechanics were collected during single-leg stride landings that were followed by lateral and vertical jumps. An isokinetic fatigue protocol was employed to reduce hamstrings strength by 75% at the cessation of the exercise protocol. On the landing test day, participants performed the stride landing maneuvers before and after the fatigue protocol. PCA was performed on the landing knee joint angle, moment, and power waveforms, and MANOVAs were conducted on the retained PCs of each waveform (P < .05). On the strength test day, hamstrings strength recovery was assessed with an identical fatigue protocol followed by strength assessment ~75 s after the cessation of exercise. Pre- and postexercise hamstrings strength on this day was assessed with a dependent t test (P < .05). The hamstrings strength remained significantly reduced by ~8% postexercise (75 s). For stride landings followed by vertical jumps, there were significantly reduced knee flexion angles, extensor moments, and energy absorption. This was indicative of a stiffer landing strategy postfatigue, which has been associated with increased ACL loading.

Quantifying knee mechanics during balance training exercises

Patellofemoral pain (PFP) is common among runners and those recovering from anterior cruciate ligament reconstruction. Training programs designed to prevent or treat injuries often include balance training, although balance interventions have been reported to coincide with more knee injuries. Knowledge of the effect of balance exercises on knee mechanics may be useful when designing training programs. High knee abduction moment has been implicated in the development of PFP, and imbalance between vastus lateralis (VL) and vastus medialis oblique (VMO) may contribute to patellofemoral stress. The purpose was to quantify knee abduction moment and vasti muscle activity during balance exercises. Muscle activity of VMO and VL, three-dimensional lower-extremity kinematics, and ground reaction forces of healthy recreational athletes (12M, 13F) were recorded during five exercises. Peak knee abduction moment, ratio of VMO:VL activity, and delay in onset of VMO relative to VL were quantified for each exercise. The influence of sex and exercise on each variable was determined using a mixed-model ANOVA. All analyses indicated a significant main effect of exercise, p<0.05. Follow-up comparisons showed low peak knee abduction moment and high VMO:VL ratio for the task with anterior-posterior motion. Delay of VMO relative to VL was similar among balance board tasks.

The Influence of a Prefabricated Foot Orthosis on Lower Extremity Mechanics During Running in Individuals With Varying Dynamic Foot Motion

Study Design Controlled laboratory study, cross-sectional. Background Orthotic prescription is often based on the premise that the mechanical effects will be more prominent in individuals with greater calcaneal eversion. Objective To compare the effects of a prefabricated foot orthosis on lower extremity kinematics and kinetics between recreational athletes with high and low calcaneal eversion during running. Methods Thirty-one recreational athletes were included in this study. Three-dimensional kinematic and kinetic data were collected while running with and without a foot orthosis. Participants were grouped based on the degree of calcaneal eversion during the running trials relative to a standing trial (dynamic foot motion). The effects of the orthosis on the frontal and transverse plane angles and moments of the hip and knee were compared between the 10 participants with the greatest and least amount of dynamic foot motion. Results There were no significant interactions (group by orthotic condition) for any of the kinematic or kinetic variables of interest. Conclusion The effects of an orthosis on the mechanics of the hip and knee do not appear to be dependent on an individuals dynamic foot motion. J Orthop Sports Phys Ther 2016;46(9):749-755. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6253.

Lower extremity muscle activity during descent from varying step heights

During step descent, lower extremity musculature is critical for positioning the foot and ankle for initial contact and stabilizing the structures following contact. Although continuous stair descent has been extensively examined, curb/single transition steps where many injuries occur requires further study. The purpose of this study was to identify the influence of landing strategy and step height on lower extremity muscle activity of uninjured individuals during transition step descent. Twenty-two participants walked along a level walkway, stepped down a single step (heights: 5-cm, 15-cm, 25-cm) landed with the heel or forefoot, and continued walking. Muscle activity of the leading legs peroneals, tibialis anterior, and medial gastrocnemius were recorded 200 ms before and after initial contact. Two-way Repeated Measures ANOVAs within the three step heights and two landing strategies were run for both the pre- and post-contact periods. Step height by landing strategy interactions existed during the pre-contact periods for all three muscles. During the post-contact period, all muscle activity increased with each step height increment. Additionally, the medial gastrocnemius and tibialis anterior demonstrated significant landing strategy differences. This study highlights the importance of considering both landing strategy and step height when designing or interpreting investigations of transition step negotiation.

Identifying trippers and non-trippers based on knee kinematics during obstacle-free walking

Trips are a major cause of falls. Sagittal-plane kinematics affect clearance between the foot and obstacles, however, it is unclear which kinematic measures during obstacle-free walking are associated with avoiding a trip when encountering an obstacle. The purpose of this study was to determine kinematic factors during obstacle-free walking that are related to obstacle avoidance ability. It was expected that successful obstacle avoidance would be associated with greater peak flexion/dorsiflexion and range of motion (ROM), and differences in timing of peak flexion/dorsiflexion during swing of obstacle-free walking for the hip, knee and ankle. Three-dimensional kinematics were recorded as 35 participants (young adults age 18-45 (N = 10), older adults age 65+ without a history of falls (N = 10), older adults age 65+ who had fallen in the last six months (N = 10), and individuals who had experienced a stroke more than six months earlier (N = 5)) walked on a treadmill, under obstacle-free walking conditions with kinematic features calculated for each stride. A separate obstacle avoidance task identified trippers (multiple obstacle contact) and non-trippers. Linear discriminant analysis with sequential feature selection classified trippers and non-trippers based on kinematics during obstacle-free walking. Differences in classification performance and selected features (knee ROM and timing of peak knee flexion during swing) were evaluated between trippers and non-trippers. Non-trippers had greater knee ROM (P = .001). There was no significant difference in classification performance (P = .193). Individuals with reduced knee ROM during obstacle-free walking may have greater difficulty avoiding obstacles.