Peter Vee Sin Lee

Sagittal knee joint kinematics and energetics in response to different landing heights and techniques.

Single-leg and double-leg landing techniques are common athletic maneuvers typically performed from various landing heights during intensive sports activities. However, it is still unclear how the knee joint responds in terms of kinematics and energetics to the combined effects of different landing heights and techniques. We hypothesized that the knee displays greater flexion angles and angular velocities, joint power and work in response to the larger peak ground reaction force from 0.6-m height, compared to 0.3-m height. We further hypothesized that the knee exhibits elevated flexion angles and angular velocities, joint power and work during double-leg landing, relative to single-leg landing. Ground reaction force, knee joint kinematics and energetics data were obtained from 10 subjects performing single-leg and double-leg landing from 0.3-m to 0.6-m heights, using motion-capture system and force-plates. Higher peak ground reaction force (p<0.05) was observed during single-leg landing and/or at greater landing height. We found greater knee flexion angles and angular velocities (p<0.05) during double-leg landing and/or at greater landing height. Elevated knee joint power and work were noted (p<0.05) during double-leg landing and/or at greater landing height. The knee joint is able to respond more effectively in terms of kinematics and energetics to a larger landing impact from an elevated height during double-leg landing, compared to single-leg landing. This allows better shock absorption and thus minimizes the risk of sustaining lower extremity injuries.

Effects of internal stress concentrations in plantar soft-tissue—A preliminary three-dimensional finite element analysis

It has been hypothesized that diabetic foot ulceration might be internally initiated. This study established a three-dimensional and nonlinear finite element model of a human foot complex with comprehensive skeletal and soft-tissue components. The model was validated by experimental data of subject-specific barefoot plantar pressure measurements. The feasibility of the model to predict the 3D, internal, plantar soft-tissue deformation and stress was evaluated. The preliminary results indicate that large von Mises stress occurs where plantar soft-tissue contacts with geometrically irregular bony structures, thus internal stress distribution within the plantar soft-tissue was dramatically influenced by bony prominences due to stress concentration. At the forefoot part, an average stress magnification factor of 3.01 was quantified. The lateral sesamoid bone associated to the 1st MTH showed the largest effect of stress concentration. The modeling approach presented provides a possible way to explore the complexity of the mechanical environment inside the plantar soft-tissue.

Effect of landing height on frontal plane kinematics, kinetics and energy dissipation at lower extremity joints

Lack of the necessary magnitude of energy dissipation by lower extremity joint muscles may be implicated in elevated impact stresses present during landing from greater heights. These increased stresses are experienced by supporting tissues like cartilage, ligaments and bones, thus aggravating injury risk. This study sought to investigate frontal plane kinematics, kinetics and energetics of lower extremity joints during landing from different heights. Eighteen male recreational athletes were instructed to perform drop-landing tasks from 0.3- to 0.6-m heights. Force plates and motion-capture system were used to capture ground reaction force and kinematics data, respectively. Joint moment was calculated using inverse dynamics. Joint power was computed as a product of joint moment and angular velocity. Work was defined as joint power integrated over time. Hip and knee joints delivered significantly greater joint power and eccentric work (p<0.05) than the ankle joint at both landing heights. Substantial increase (p<0.05) in eccentric work was noted at the hip joint in response to increasing landing height. Knee and hip joints acted as key contributors to total energy dissipation in the frontal plane with increase in peak ground reaction force (GRF). The hip joint was the top contributor to energy absorption, which indicated a hip-dominant strategy in the frontal plane in response to peak GRF during landing. Future studies should investigate joint motions that can maximize energy dissipation or reduce the need for energy dissipation in the frontal plane at the various joints, and to evaluate their effects on the attenuation of lower extremity injury risk during landing.

An investigation of lower extremity energy dissipation strategies during single-leg and double-leg landing based on sagittal and frontal plane biomechanics.

There is limited understanding of the differences in lower extremity energy dissipation strategies between single-leg and double-leg landing maneuvers. This study sought to investigate these differences in sagittal and frontal planes, and explain the differences using kinematics and kinetics. We hypothesized that single-leg and double-leg landing maneuvers involve different lower extremity energy dissipation strategies in both planes. Ten recreational athletes were recruited and instructed to perform double-leg and single-leg landing from 0.60-m height. Force-plates and motion-capture system were used to obtain kinetics and kinematics data respectively. Joint power was taken as product of joint moment and angular velocity. Joint work was computed as integral of joint power over time, whereby negative work represented energy dissipation. In the sagittal plane, the hip and knee showed major contributions to energy dissipation during double-leg landing; the hip and ankle were the dominant energy dissipaters during single-leg landing. In the frontal plane, the hip acted as the key energy dissipater during double-leg landing; the knee contributed the most energy dissipation during single-leg landing. The knee also exhibited greater frontal plane joint ROM, moment and energy dissipation during single-leg landing than double-leg landing. Our findings indicated that different energy dissipation strategies were adopted for double-leg and single-leg landing in sagittal and frontal planes. Considering the prominent frontal plane biomechanics exhibited by the knee during single-leg landing, we expect that this maneuver may have greater likelihood of leading to traumatic knee injuries, particularly non-contact ACL injuries, compared to the double-leg landing maneuver.

Anterior cruciate ligament failure and cartilage damage during knee joint compression: a preliminary study based on the porcine model.

Background Anterior cruciate ligament (ACL) injury incurred from high-impact activities leads to an increased risk of osteoarthritis. Hypothesis Impact forces that cause ACL failure can also inflict cartilage damage, whereby its extent and distribution may be influenced by the ligament failure mechanism. Study Design Descriptive laboratory study. Methods Six porcine knee specimens were mounted to a material testing system at 70° of flexion. During compression, rotational and translational data of the specimens were recorded with a motion-capture system. Compression was successively repeated with increasing actuator displacement until a significant drop in compressive force response was observed; ligament failure was assessed by dissection. Osteocartilage expiants were extracted from the meniscus-covered sites (anterior, exterior, and posterior) and exposed (interior) sites on both tibial compartments. The expiants were sectioned, stained, and histologically scored using the modified Mankin grading system. Results Five of the 6 specimens incurred ACL failure. On failure, a significant compressive force drop (1812.5–2659.3 N) was observed together with considerable posterior femoral translation; 2 specimens underwent external rotation, while 2 had internal rotation and 1 had no substantial rotation. Generally, the meniscus-covered sites displayed significant surface fraying and occasional deep clefts; the exposed site did not present substantial surface irregularities but indicated more tidemark disruption. Higher Mankin scores observed at certain sites illustrated a localized presence of contact and shear forces, which may be caused by pivoting and sliding of the femoral condyles during rotation. Conclusion The porcine model can be a tenable preliminary option for assessing the role of the human ACL during joint compression. Impact loads that result in ligament failure can potentially inflict considerable cartilage damage; the damage profile may be affected by the type of failure mechanism. Clinical Relevance Cartilage injury arising at the time of ACL injury may lead to an accelerated risk of joint degeneration.

Regression relationships of landing height with ground reaction forces, knee flexion angles, angular velocities and joint powers during double-leg landing

Ground reaction forces (GRF), knee flexion angles, angular velocities and joint powers are unknown at large landing heights, which are infeasible for laboratory testing. However, this information is important for understanding lower extremity injury mechanisms. We sought to determine regression relationships of landing height with these parameters during landing so as to facilitate estimation of these parameters at large landing heights. Five healthy male subjects performed landing tasks from heights of 0.15-1.05 m onto a force-plate. Motion capture system was used to obtain knee flexion angles during landing via passive markers placed on the lower body. An iterative regression model, involving simple linear/exponential/natural logarithmic functions, was used to fit regression equations to experimental data. Peak GRF followed an exponential regression relationship (R(2)=0.90-0.99, p<0.001; power=0.987-0.998). Peak GRF slope and impulse also had an exponential relationship (R(2)=0.90-0.96, p<0.001; power=0.980-0.997 and R(2)=0.90-0.99, p<0.001; power=0.990-1.000 respectively) with landing height. Knee flexion angle at initial contact and at peak GRF had an inverse-exponential regression relationship (R(2)=0.81-0.99, p<0.001-p=0.006; power=0.834-0.978 and R(2)=0.84-0.97, p<0.001-p=0.004; power=0.873-0.999 respectively). There was also an inverse-exponential relationship between peak knee flexion angular velocity and landing height (R(2)=0.86-0.96, p<0.001; power=0.935-0.994). Peak knee joint power demonstrated a substantial linear relationship (R(2)=0.98-1.00, p<0.001; power=0.990-1.000). The parameters analyzed in this study are highly dependent on landing height. The exponential increase in peak GRF parameters and the relatively slower increase in knee flexion angles, angular velocities and joint power may synergistically lead to an exacerbated lower extremity injury risk at large landing heights.

Transforming Growth Factor–β–Induced Differentiation of Airway Smooth Muscle Cells Is Inhibited by Fibroblast Growth Factor–2

In asthma, basic fibroblast growth factor (FGF-2) plays an important (patho)physiological role. This study examines the effects of FGF-2 on the transforming growth factor-β (TGF-β)-stimulated differentiation of airway smooth muscle (ASM) cells in vitro. The differentiation of human ASM cells after incubation with TGF-β (100 pM) and/or FGF-2 (300 pM) for 48 hours was assessed by increases in contractile protein expression, actin-cytoskeleton reorganization, enhancements in cell stiffness, and collagen remodeling. FGF-2 inhibited TGF-β-stimulated increases in transgelin (SM22) and calponin gene expression (n = 15, P < 0.01) in an extracellular signal-regulated kinase 1/2 (ERK1/2) signal transduction-dependent manner. The abundance of ordered α-smooth muscle actin (α-SMA) filaments formed in the presence of TGF-β were also reduced by FGF-2, as was the ratio of F-actin to G-actin (n = 8, P < 0.01). Furthermore, FGF-2 attenuated TGF-β-stimulated increases in ASM cell stiffness and the ASM-mediated contraction of lattices, composed of collagen fibrils (n = 5, P < 0.01). However, the TGF-β-stimulated production of IL-6 was not influenced by FGF-2 (n = 4, P > 0.05), suggesting that FGF-2 antagonism is selective for the regulation of ASM cell contractile protein expression, organization, and function. Another mitogen, thrombin (0.3 U ml(-1)), exerted no effect on TGF-β-regulated contractile protein expression (n = 8, P > 0.05), α-SMA organization, or the ratio of F-actin to G-actin (n = 4, P > 0.05), suggesting that the inhibitory effect of FGF-2 is dissociated from its mitogenic actions. The addition of FGF-2, 24 hours after TGF-β treatment, still reduced contractile protein expression, even when the TGF-β-receptor kinase inhibitor, SB431542 (10 μM), was added 1 hour before FGF-2. We conclude that the ASM cell differentiation promoted by TGF-β is antagonized by FGF-2. A better understanding of the mechanism of action for FGF-2 is necessary to develop a strategy for therapeutic exploitation in the treatment of asthma.

Comparative study between patellar-tendon-bearing and pressure cast prosthetic sockets.

This study compared the pressure distribution at the residual limb and socket interface in amputees wearing a pressure cast (PCast) socket system with amputees wearing the patellar-tendon-bearing (PTB) socket. The PCast system requires the subject to place his or her residual limb in a pressure chamber. Pressure is applied to the residual limb while the subject adopts a normal standing position. Four unilateral male amputees were fitted with both PTB and PCast sockets. Using a specially built strain-gauge-type pressure transducer, we recorded residual limb and socket pressure profiles for each subject wearing the two types of sockets during standing and walking. While some subjects exhibited similar anterior-posterior or medial-lateral pressure profiles for both prostheses, especially during push-off, other subjects exhibited high pressure distally in the PCast socket or higher-pressure concentration at the proximal region in the PTB socket.

A novel gait platform to measure isolated plantar metatarsal forces during walking

A new gait platform described in this report allows an isolated measurement of the vertical and shear forces under an individual metatarsal head during barefoot walking. The apparatus incorporated a customized tactile force sensor and a high-speed camera system, which enabled easy identification of a single anatomical landmark at the forefoots plantar surface that is in contact with the sensor throughout stance. After calibration, the measured peak forces under the 2nd MTH showed variability of 3.7%, 9.2%, and 8.9% in vertical, anterior-posterior, and medial-lateral directions, respectively. The device therefore provides information about the magnitude and timing of such local metatarsal forces, and has been shown to be of significant research and clinical interest. Its ability to achieve this with a high degree of accuracy ensures its potential as a valuable research tool.

Stump/socket pressure profiles of the pressure cast prosthetic socket

OBJECTIVE The aim was to evaluate stump/socket interface pressure in amputees wearing a socket developed by a pressure casting system.Design. Five unilateral transtibial amputees wore a pressure cast socket and walked at a self-selected speed. BACKGROUND The socket produces equally distributed pressure at the stump/socket interface, deviating from the conventional belief that pressure varies in proportion to the pain threshold of different tissues in the stump. METHODS The socket was fabricated while the subject placed his stump in a pressure chamber. Pressure was applied while he adopted a normal standing position. A specially built strain gauged type pressure transducer was used for measuring pressure distribution. Pressure and gait parameters were measured simultaneously while the subjects were standing and walking. RESULTS AND CONCLUSION The pressure cast technique was able to provide comfortable fitting sockets. A hydrostatic pressure profile was not evident during standing or gait. Results also showed that no standard pressure profile for the pressure cast socket was observed. This was expected as no rectifications were done on the pressure cast socket. Pressure profiles at 10%, 25% and 50% of gait cycle did not correlate with the pressure profiles previously proposed. RELEVANCE The hydrostatic theory is an attractive concept in socket design as it produces a stump/socket pressure profile that is evenly distributed. Furthermore, it is a method that is easily implemented, independent of a prosthetists skill and experience and reduces manufacturing time. However, there is still controversy surrounding the efficacy of this hydrostatic theory.