The Reproducibility of a Kinematically-Derived Axis of the Knee versus Digitized Anatomical Landmarks using a Knee Navigation System

Component position is critical to longevity of knee arthroplasties. Femoral component rotation is typically referenced from the transepicondylar axis (TEA), the anterior-posterior (AP) axis or the posterior condylar axis. Other studies have shown high variability in locating the TEA while proposing digitization of other landmarks such as the AP axis as a less-variable reference. This study uses a navigation system to compare the reproducibility of computing a kinematically-derived, navigated knee axis (NKA) to digitizing the TEA and AP axis. Twelve knees from unembalmed cadavers were tested. Four arthroplasty surgeons digitized the femoral epicondyles and the AP axis direction as well as flexed and extended the knee repeatedly to allow for NKA determination. The variance of the NKA axis determined under neutral loading conditions was smaller than the variance of the TEA axis when the kinematics were measured in the closed surgical condition (P<0.001). However, varus, valgus, and internal loading of the leg increased the variability of the NKA. Distraction of the leg during knee flexion and extension preserved the low variability of the NKA. In conclusion, a kinematically-derived NKA under neutral or distraction loading is more reproducible than the TEA and AP axis determined by digitization

GLOBAL STABILITY AND BIFURCATIONS ANALYSIS OF AN EPIDEMIC MODEL WITH CONSTANT REMOVAL RATE OF THE INFECTIVE

In this thesis we consider an epidemic model with a constant removal rate of infective individuals is proposed to understand the effect of limited resources for treatment of infective on the disease spread. It is found that it is unnecessary to take such a large treatment capacity that endemic equilibria disappear to eradicate the disease. It is shown that the outcome of disease spread may depend on the position of the initial states for certain range of parameters. It is also shown that the model undergoes a sequence of bifurcations including saddle-node bifurcation, subcritical Hopf bifurcation. Keyword: Epidemic model, nonlinear incidence rate, basic reproduction number, local and global stabilit

Effects of prophylactic knee bracing on patellar tendon loading parameters during functional sports tasks in recreational athletes

Purpose This study investigated the efects of prophylactic knee bracing on patellar tendon loading parameters. Methods Twenty recreational athletes (10 male and 10 female) from diferent athletic disciplines performed run, cut and single leg hop movements under two conditions (prophylactic knee brace/no-brace). Lower extremity kinetics and kinematics were examined using a piezoelectric force plate and three-dimensional motion capture system. Patellar tendon loading was explored using a mathematical modelling approach, which accounted for co-contraction of the knee lexors. Tendon loading parameters were examined using 2 (brace) × 3 (movement) × 2 (sex) mixed ANOVAs. Results Tendon instantaneous load rate was signiicantly reduced in female athletes in the run (brace 289.14 BW/s no-brace 370.06 BW/s) and cut (brace 353.17 BW/s/no-brace 422.01 BW/s) conditions whilst wearing the brace. Conclusions Female athletes may be able to attenuate their risk from patellar tendinopathy during athletic movements, through utilization of knee bracing, although further prospective research into the prophylactic efects of knee bracing is required before this can be clinically substantiated

Effects of barefoot and shod running on lower extremity joint loading, a musculoskeletal simulation study

PURPOSE: The aim of the current investigation was to utilize a musculoskeletal simulation based approach, to examine the effects of barefoot and shod running on lower extremity joint loading during the stance phase. METHODS: Twelve male runners, ran over an embedded force plate at 4.0 m/s, in both barefoot and shod conditions. Kinematics of the lower extremities were collected using an eight camera motion capture system. Lower extremity joint loading was also explored using a musculoskeletal simulation and mathematical modelling approach, and differences between footwear conditions were examined using paired samples t-tests. RESULTS: Peak Achilles tendon force was significantly larger (P=0.039) when running barefoot (6.85 BW) compared to shod (6.07 BW). In addition, both medial (P=0.013) and lateral (P=0.007) tibiofemoral instantaneous load rates were significantly larger in the barefoot (medial = 289.17 BW/s & lateral = 179.59 BW/s) in relation to the shod (medial = 167.57 BW/s & lateral = 116.40 BW/s) condition. Finally, the barefoot condition (9.70 BW) was associated with a significantly larger (P=0.037) peak hip force compared to running shod (8.51 BW). CONCLUSIONS: The current investigation indicates that running barefoot may place runners at increased risk from the biomechanical factors linked to the aetiology of chronic lower extremity pathologies. However, future analyses using habitual barefoot runners, are required before more definitive affirmations regarding injury predisposition can be made

Effects of second-generation and indoor sports surfaces on knee joint kinetics and kinematics during 45° and 180° cutting manoeuvres, and exploration using statistical parametric mapping and Bayesian analyses

Purpose: The aim of the current investigation was to examine the influence of second generation (2G) and indoor surfaces on knee joint kinetics, kinematics, frictional and muscle force parameters during 45° and 180° change of direction movements using statistical parametric mapping (SPM) and Bayesian analyses. Methods: Twenty male participants performed 45° and 180° change of direction movements on 2G and indoor surfaces. Lower limb kinematics were collected using an eight-camera motion capture system and ground reaction forces were quantified using an embedded force platform. ACL, patellar tendon and patellofemoral loading was examined via a musculoskeletal modelling approaches and the frictional properties of the surfaces were examined using ground reaction force information. Differences between surfaces were examined using SPM and Bayesian analyses. Results: Both SPM and Bayesian analyses showed that ACL loading parameters were greater in the 2G condition in relation to the indoor surface. Conversely, SPM and Bayesian analyses confirmed that patellofemoral/ patellar tendon loading alongside the coefficient of friction and peak rotational moment were larger in the indoor condition compared to the 2G surface. Conclusions: This study indicates that the indoor surface may improve change of direction performance owing to enhanced friction at the shoe-surface interface but augment the risk from patellar tendon/ patellofemoral injuries; whereas the 2G condition may enhance the risk from ACL pathologies

A model study of muscle forces and joint-force direction in normal and dysplastic neonatal hips

Orthopaedic treatment of congenital hip dysplasia does not always give the desired result. With the present model, prediction of the effects of various treatments on the force direction in the hip joint could help to improve and select treatment (the force direction is presumed to control the collum growth direction). The model contains three-dimensional mathematical descriptions of all muscles passing the hip joint, for various degrees of femoral dysplasia, and for various hip postures. Muscles run straight or curve round some skeletal parts. Muscle forces (all isometric) are calculated from muscle mass, density, pennation angle, mean fibre length, muscle elongation, and assumed activation levels. The latter serve as parameters for optimization. Resting lengths are taken from an assumed fetal posture, and from the observed neonatal posture. Differences between force directions before and after birth, as calculated with the model, agree with collum direction changes described by von Lanz and Mayet (1953).</p

An experimental setup for the measurement of forces on a human cadaveric foot during inversion

An experimental setup was developed for statically measuring seven vertical and three horizontal reaction forces on the foot. In the setup, the leg can be simultaneously loaded (1) by a vertical force, (2) by an externally applied axial moment, and (3) by simulated muscle forces. The foot is free to invert under influence of the external loads. Statical analysis and test experiments were used for evaluation. The setup can be used in combination with Roentgen photogrammetry to measure bone positions simultaneously with forces.</p