In vivo human lower limb muscle architecture dataset obtained using diffusion tensor imaging.

'Gold standard' reference sets of human muscle architecture are based on elderly cadaveric specimens, which are unlikely to be representative of a large proportion of the human population. This is important for musculoskeletal modeling, where the muscle force-generating properties of generic models are defined by these data but may not be valid when applied to models of young, healthy individuals. Obtaining individualized muscle architecture data in vivo is difficult, however diffusion tensor magnetic resonance imaging (DTI) has recently emerged as a valid method of achieving this. DTI was used here to provide an architecture data set of 20 lower limb muscles from 10 healthy adults, including muscle fiber lengths, which are important inputs for Hill-type muscle models commonly used in musculoskeletal modeling. Maximum isometric force and muscle fiber lengths were found not to scale with subject anthropometry, suggesting that these factors may be difficult to predict using scaling or optimization algorithms. These data also highlight the high level of anatomical variation that exists between individuals in terms of lower limb muscle architecture, which supports the need of incorporating subject-specific force-generating properties into musculoskeletal models to optimize their accuracy for clinical evaluation

LOAD CARRIAGE ALTERS TIBIOFEMORAL KINEMATICS DURING SLOW JOGGING IN ADULT MEN AND WOMEN

The purpose of this investigation was to determine the effects of load carriage on tibiofemoral kinematics during running. Nineteen healthy, recreationally active adults completed dynamic biplane radiography trials of the dominant limb knee with no load (BW), and an additional 55% of body weight (+55%BW) while running 10% above gait transition velocity. A volumetric model-based tracking technique was utilized to derive medial translation excursion, proximal (inferior-superior) translation excursion, anterior translation excursion, flexion, internal rotation and abduction. At heel strike, running with +55%BW exhibited a more flexed knee compared to BW. However, BW exhibited more proximal translation excursion compared to +55%BW. By contrast, +55%BW had greater anterior translation excursion compared to BW. There were no significant differences between BW and +55%BW for medial translation excursion, internal rotation angle/excursion or abduction angle/excursion The greater knee flexion angle at heel strike for +55%BW may serve as a mechanism to better attenuate the greater impact force via eccentric muscle action. However, reduced proximal translation excursion during +55%BW could suggest greater loading of the soft tissues

Predictions of Anterior Cruciate Ligament Dynamics From Subject-Specific Musculoskeletal Models and Dynamic Biplane Radiography

In vivo knee ligament forces are important to consider for informing rehabilitation or clinical interventions. However, they are difficult to directly measure during functional activities. Musculoskeletal models and simulations have become the primary methods by which to estimate in vivo ligament loading. Previous estimates of anterior cruciate ligament (ACL) forces range widely, suggesting that individualized anatomy may have an impact on these predictions. Using ten subject-specific (SS) lower limb musculoskeletal models, which include individualized musculoskeletal geometry, muscle architecture, and six degree-of-freedom knee joint kinematics from dynamic biplane radiography (DBR), this study provides SS estimates of ACL force (anteromedial-aACL; and posterolateral-pACL bundles) during the full gait cycle of treadmill walking. These forces are compared to estimates from scaled-generic (SG) musculoskeletal models to assess the effect of musculoskeletal knee joint anatomy on predicted forces and the benefit of SS modeling in this context. On average, the SS models demonstrated a double force peak during stance (0.39–0.43 xBW per bundle), while only a single force peak during stance was observed in the SG aACL. No significant differences were observed between continuous SG and SS ACL forces; however, root mean-squared differences between SS and SG predictions ranged from 0.08 xBW to 0.27 xBW, suggesting SG models do not reliably reflect forces predicted by SS models. Force predictions were also found to be highly sensitive to ligament resting length, with ±10% variations resulting in force differences of up to 84%. Overall, this study demonstrates the sensitivity of ACL force predictions to SS anatomy, specifically musculoskeletal joint geometry and ligament resting lengths, as well as the feasibility for generating SS musculoskeletal models for a group of subjects to predict in vivo tissue loading during functional activities

Assessment of the Sheffield Support Snood, an innovative cervical orthosis designed for people affected by neck weakness

The aim of this study was to quantify the biomechanical features of the Sheffield Support Snood (SSS), a cervical orthosis specifically designed for patients with neck weakness. The orthosis is designed to be adaptable to a patient’s level of functional limitation using adjustable removable supports, which contribute support and restrict movement only in desired anatomical planes. Methods: The SSS was evaluated along with two commercially available orthoses, the Vista and Headmaster. The orthoses were compared in a series of flexion, extension, axial-rotation and lateral bending movements. Characterisation was performed with twelve healthy subjects with and without the orthoses. Two Inertial-Magneto sensors, placed on forehead and sternum, were used to quantify the neck range of motion (ROM). Findings: In its less rigid configuration, the SSS was effective in limiting movements only in the desired planes, preserving free movement in other planes, whereas the headmaster was only effective in limiting the flexion. The percentage of ROM achieved with the SSS in its rigid configuration is equivalent (P > 0.05, effect size < 0.4) to that achieved with the Vista, both in trials performed reaching the maximum amplitude (ROM reduction: 25%-34% vs 24%-47%) and at maximum speed (ROM reduction: 24%-29% vs 25%-43%). Interpretation: The SSS is effectively adaptable to different tasks and in its rigid configuration offers a support comparable to the Vista, although it has a less bulky structure. The chosen method is suitable for the assessment of ROM movements while wearing neck orthoses and easily translatable in a clinical context

Statistical Methods Used to Test for Agreement of Medical Instruments Measuring Continuous Variables in Method Comparison Studies: A Systematic Review

BACKGROUND: Accurate values are a must in medicine. An important parameter in determining the quality of a medical instrument is agreement with a gold standard. Various statistical methods have been used to test for agreement. Some of these methods have been shown to be inappropriate. This can result in misleading conclusions about the validity of an instrument. The Bland-Altman method is the most popular method judging by the many citations of the article proposing this method. However, the number of citations does not necessarily mean that this method has been applied in agreement research. No previous study has been conducted to look into this. This is the first systematic review to identify statistical methods used to test for agreement of medical instruments. The proportion of various statistical methods found in this review will also reflect the proportion of medical instruments that have been validated using those particular methods in current clinical practice. METHODOLOGY/FINDINGS: Five electronic databases were searched between 2007 and 2009 to look for agreement studies. A total of 3,260 titles were initially identified. Only 412 titles were potentially related, and finally 210 fitted the inclusion criteria. The Bland-Altman method is the most popular method with 178 (85%) studies having used this method, followed by the correlation coefficient (27%) and means comparison (18%). Some of the inappropriate methods highlighted by Altman and Bland since the 1980s are still in use. CONCLUSIONS: This study finds that the Bland-Altman method is the most popular method used in agreement research. There are still inappropriate applications of statistical methods in some studies. It is important for a clinician or medical researcher to be aware of this issue because misleading conclusions from inappropriate analyses will jeopardize the quality of the evidence, which in turn will influence quality of care given to patients in the future

Load carriage changes tibiofemoral arthrokinematics during ambulatory tasks in recruit-aged women

The introduction of women into U.S. military ground close combat roles requires research into sex-specific effects of military training and operational activities. Knee osteoarthritis is prevalent among military service members; its progression has been linked to occupational tasks such as load carriage. Analyzing tibiofemoral arthrokinematics during load carriage is important to understand potentially injurious motion and osteoarthritis progression. The study purpose was to identify effects of load carriage on knee arthrokinematics during walking and running in recruit-aged women. Twelve healthy recruit-aged women walked and ran while unloaded (bodyweight [BW]) and carrying additional + 25%BW and + 45%BW. Using dynamic biplane radiography and subject-specific bone models, tibiofemoral arthrokinematics, subchondral joint space and center of closest contact location between subchondral bone surfaces were analyzed over 0–30% stance (separate one-way repeated measures analysis of variance, load by locomotion). While walking, medial compartment contact location was 5% (~ 1.6 mm) more medial for BW than + 45%BW at foot strike (p = 0.03). While running, medial compartment contact location was 4% (~ 1.3 mm) more lateral during BW than + 25%BW at 30% stance (p = 0.04). Internal rotation was greater at + 45%BW compared to + 25%BW (p < 0.01) at 30% stance. Carried load affects tibiofemoral arthrokinematics in recruit-aged women. Prolonged load carriage could increase the risk of degenerative joint injury in physically active women

Consensus statement on abusive head trauma in infants and young children

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature