Clinical Biomechanics最新文献

{"title":"Mid-vastus approach induces milder short-term effects on postural control compared to parapatellar approach in total knee arthroplasty.","authors":"","doi":"10.1016/j.clinbiomech.2024.106354","DOIUrl":"10.1016/j.clinbiomech.2024.106354","url":null,"abstract":"<div><h3>Background</h3><div>Mid-Vastus and Medial Parapatellar techniques are used for total knee arthroplasty. Their short-term effects within the first month after surgery are yet unexplored. The purpose of this study was to compare Mid-Vastus and Medial Parapatellar effects on knee strength and balance control, at 5 days, 2 weeks and one month after surgery. It was hypothesized that Mid-Vastus would induce milder effects on the dependent variables due to its less invasive nature.</div></div><div><h3>Methods</h3><div>Twenty females, randomly assigned to either the Mid-Vastus or the Medial Parapatellar group performed knee flexion-extension force and 30 s of bipedal stance before, 5 days, 2 weeks and one month after surgery. Maximum force, weight distribution and travel distance of the Center of Pressure were calculated.</div></div><div><h3>Findings</h3><div>Both groups showed decreased force output at all post-measurements compared to before surgery. Medial Parapatellar group showcased significantly higher travel distance at the 2 weeks measurement (Z = −2.268, <em>p</em> = .023, <em>|r|</em> <em>= 0</em>.507) compared to before surgery. This result was also imprinted on the travel distance of the non-surgical knee limb in the post (<em>t</em> = 3.259, <em>p</em> = .004, <em>d</em> <em>=</em> 1.456), 2 weeks (Z = −2.570, <em>p</em> = .009, <em>|r|</em> <em>= 0</em>.574) and one month measurement (<em>t</em> = 2.653, <em>p</em> = .016, <em>d</em> <em>=</em> 1.185).</div></div><div><h3>Interpretation</h3><div>While force is affected for both approaches, Mid-Vastus approach does not affect postural control. Therefore, Mid-Vastus is a less invasive technique compared to Medial Parapatellar. This work highlights the differences between Mid-Vastus and Medial Parapatellar approaches at least until the first month of rehabilitation.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142318621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between-limb difference in peak knee flexion angle can identify persons post-stroke with Stiff-Knee gait","authors":"","doi":"10.1016/j.clinbiomech.2024.106351","DOIUrl":"10.1016/j.clinbiomech.2024.106351","url":null,"abstract":"<div><h3>Background</h3><div>Stiff-Knee gait affects 25–75 % of individuals with post-stroke gait impairment and is typically defined as reduced swing phase knee flexion. Different studies use various measures to identify Stiff-Knee gait, such as peak swing knee flexion angle, timing of peak knee flexion, knee range of motion, and ankle push-off acceleration, leading to inconsistent results.</div></div><div><h3>Methods</h3><div>This study used univariate cluster analysis to examine the independence, consistency, validity, and accuracy of different definitions in 50 post-stroke individuals (24 with and 26 without Stiff-Knee gait), as determined by a physiatrist. Spearman's rank correlation was used for correlation analysis, and five clustering techniques along with clinician evaluations were used for validity analysis.</div></div><div><h3>Findings</h3><div>Correlation analysis showed that peak knee flexion timing and knee hyperextension are poorly correlated with reduced swing-phase knee flexion angle (ρ = −0.09 and ρ = −0.26 respectively). Validity analysis indicated that the between-limb difference in peak swing knee flexion angle and peak swing knee flexion angle at self-selected gait speeds were the most valid differentiators. At the fastest comfortable gait speed, the between-limb difference of peak knee flexion angle had the highest sensitivity, lowest specificity, and highest F1 scores.</div></div><div><h3>Interpretation</h3><div>We determined thresholds of less than 44.3° for peak swing knee flexion angle and greater than 17.0° for the between-limb difference of peak knee flexion angle identify Stiff-Knee gait during self-selected walking. We recommend using the difference in peak swing knee flexion angle between limbs to diagnose post-stroke Stiff-Knee gait due to its robustness to changes in gait speed.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0268003324001839/pdfft?md5=8b8d6d5104fe90a420720631b7611e8b&pid=1-s2.0-S0268003324001839-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fall assessment in healthy older adults: Approach using rambling-trembling decomposition method","authors":"","doi":"10.1016/j.clinbiomech.2024.106355","DOIUrl":"10.1016/j.clinbiomech.2024.106355","url":null,"abstract":"<div><h3>Background</h3><div>This study explored useful indices of potential fall risk in healthy older adults based on comprehensive clinical and simple quantitative posturographic measurements.</div></div><div><h3>Methods</h3><div>A total of 64 community-dwelling older adults aged ≥65 years were classified into fallers and non-fallers based on previous fall history. After excluding two participants due to missing data, 16 and 46 participants were included in the faller and non-faller groups, respectively. We conducted major clinical measurements, including timed up and go test, 10-m walk test, functional reach test, one-leg stand test, isometric muscle strength tests, open-close stepping test, and sit-to-stand test. For quantitative posturographic measurements, participants performed standing tasks with their eyes open and closed. In the standing tasks, the time series of the center of pressure in the anteroposterior and mediolateral directions were measured and decomposed into rambling and trembling components to evaluate postural control in detail, separately. The mean velocity and root mean square of the center of pressure, rambling, and trembling were calculated and compared between fallers and non-fallers.</div></div><div><h3>Findings</h3><div>A significant fall-related difference was found only in the mean velocity of the rambling in the anteroposterior direction; fallers displayed greater values than non-fallers, especially while standing with their eyes closed.</div></div><div><h3>Interpretation</h3><div>The clinical measures failed to distinguish differences in fall risk, whereas the rambling component in the anteroposterior direction could detect substantial differences. The mean velocity of the rambling component could be useful as a sensitive screening biomarker for potential fall risks in healthy older adults.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142318622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical analysis of the effect of postero-latero-central tibial plateau fractures in the knee joint: Can posterior soft tissues prevent instability? A finite element study.","authors":"","doi":"10.1016/j.clinbiomech.2024.106353","DOIUrl":"10.1016/j.clinbiomech.2024.106353","url":null,"abstract":"<div><h3>Background</h3><div>Almost 86 % of all tibial plateau fractures involves the failure of the postero-latero-central region of the tibial plateau. Surgical treatment of this region is technically demanding and in case of limited depression, it's occasionally chosen to leave them untreated. The aim of the study is to numerically check to what extent this choice can be accepted avoiding inferior outcomes (i.e. joint instability), and to analyze posterior soft tissues role in presence of this fractures.</div></div><div><h3>Methods</h3><div>Starting from a previous validated finite element model with baseline structures, several configurations were developed by inserting posterior soft tissues and postero-latero-central fracture, with different articular depressions. Squat motion was numerically simulated and tibio-femoral kinematics were compared among configurations.</div></div><div><h3>Findings</h3><div>An increasing step-off led to a progressive joint instability, especially in the first 35°-40° of flexion. Posterior soft tissues showed to be beneficial in initial stabilization and early flexion. Tibial Axial Rotation didn't show any restorative effect of posterior soft tissues on knee kinematics. Tibial Antero-Posterior Translation is the most significant biomechanical parameter, showing posterior soft tissues restoring native antero-posterior translation, completely for 1-mm step-off fracture, only partially for 2-mm step-off fracture, and not sufficiently for 3-mm step-off fracture, at least in the first 30° of flexion.</div></div><div><h3>Interpretation</h3><div>The results suggest that postero-latero-central fractures with step-off ≥2 mm should be treated to restore articular kinematic, whereas fractures with step-off &lt;2 mm need a broad evaluation to assess the effective need of surgery. These information can be valuable for surgeons, to aid their decision to surgically operate or not.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical modelling of indirect decompression in oblique lumbar intervertebral fusions – A finite element study","authors":"","doi":"10.1016/j.clinbiomech.2024.106352","DOIUrl":"10.1016/j.clinbiomech.2024.106352","url":null,"abstract":"<div><h3>Background</h3><div>Oblique lumbar intervertebral fusion aims to decompress spinal nerves via an interbody fusion cage, but the optimal surgical strategy, including implant selection for specific patient characteristics, remains unclear. A biomechanical model was developed to assess how pathophysiological characteristics and instrumentation impact spinal realignment, indirect decompression, and cage subsidence risk.</div></div><div><h3>Methods</h3><div>A finite element model of the L4-L5 segment was derived from a validated asymptomatic T1-S1 spine model. Five cases of grade I spondylolisthesis with normal or osteoporotic bone densities and initial disc heights of 4.3 to 8.3 mm were simulated. Oblique lumbar intervertebral fusion with cage heights of 10, 12, and 14 mm (12° lordosis) was examined. Postoperative changes in disc height, foraminal and spinal canal dimensions, segmental lordosis, and vertebral slip were assessed. Vertebral stresses and displacements under 10 Nm flexion and 400 N gravitational load were compared between stand-alone constructs and bilateral pedicle screw fixation using rods of 4.75, 5.5, and 6 mm diameters.</div></div><div><h3>Findings</h3><div>Oblique lumbar intervertebral fusion significantly improved postoperative disc height, foraminal and spinal canal dimensions, with the greatest enhancements observed with 14 mm cages. Bilateral pedicle screw fixation markedly reduced cortical endplate stresses and displacements compared to stand-alone constructs, with added benefits from larger rod diameters. Low bone density increased displacements by 63 %.</div></div><div><h3>Interpretation</h3><div>Thicker cages achieve better decompression but increase subsidence risk. Bilateral pedicle screw fixation with 6 mm rods minimizes endplate stresses and displacements, especially in osteoporotic cases. Future research will validate these findings and explore the model's potential for surgical planning.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0268003324001840/pdfft?md5=4af0124a21469945931be9cc0d98da41&pid=1-s2.0-S0268003324001840-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of pivot kinematics in posterior stabilized total knee arthroplasty","authors":"","doi":"10.1016/j.clinbiomech.2024.106350","DOIUrl":"10.1016/j.clinbiomech.2024.106350","url":null,"abstract":"<div><h3>Background</h3><div>Restoring medial knee pivot kinematics post-total knee arthroplasty is widely recognized to enhance patient satisfaction. Our study investigates the kinematics of patients who received posterior stabilized implants via robotic-arm assisted surgery, specifically analyzing effects of implant alignment and soft tissue balance on pivot location.</div></div><div><h3>Methods</h3><div>Twelve high-functioning patients with unilateral posterior stabilizing knee implants underwent CT-guided robotic-arm assisted surgery. We then evaluated their knee kinematics using stereo radiography during gait, stair descent, lunge, seated knee extension and leg press. Femoral low-point condylar kinematics were used to calculate the transverse center of rotation, or pivot, using principal component analysis. Linear mixed effects regression was used to identify surgical parameters that influence pivot location across a flexion range.</div></div><div><h3>Findings</h3><div>Across all five activities a central pivot pattern emerged as the primary pivot location (40 %) followed by medial (25 %), no pivot (22 %) and lateral (14 %). Tibial medial resection depth and Tibial implant flexion-extension placement were significantly associated with shifting the pivot location laterally prior to cam-post engagement. Femoral implant external-internal implant placement, and medial compartment laxity in extension were significantly associated with shifting the pivot location laterally during the cam-post engagement, while femoral distal-lateral resection depth was associated with a medial shift.</div></div><div><h3>Interpretation</h3><div>Central and medial pivot locations are predominant in patients with posterior stabilized total knee arthroplasty, facilitated by robotic-arm assisted surgery. Despite significant associations between surgical parameters such as tibial medial resection depth and lateral compartment laxity with medial pivot, these variables explained a small portion of the variability in pivot location. This suggests that while surgical precision influences pivot kinematics, individual patient factors may play a more critical role, suggesting a need for further research into patient-specific biomechanics to optimize post-surgical outcomes.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An acoustic bellows-type round window transducer for middle-ear implants","authors":"","doi":"10.1016/j.clinbiomech.2024.106349","DOIUrl":"10.1016/j.clinbiomech.2024.106349","url":null,"abstract":"<div><h3>Background</h3><p>This study describes the development of output devices for round window middle-ear. To overcome the problems of output devices that apply sound pressure directly to the round window, an acoustic bellows-type round window transducer was implemented by combining a small bellows, acoustic tube, and balanced armature driver.</p></div><div><h3>Methods</h3><p>The output characteristics of the proposed acoustic bellows-type round window transducer were confirmed through bench tests and distortion measurements. To compare the vibration transmission characteristics of the proposed transducer with those of sound pressure stimulation devices, an experiment was performed using four human temporal bones.</p></div><div><h3>Findings</h3><p>The average output magnitude of the acoustic bellows-type round window transducer was equivalent to sound pressure levels of 92, 96, and 108 dB for frequency ranges of &lt;1, 1–2, and &gt; 2 kHz, respectively. The results showed that the proposed transducer delivered vibration consistently without reducing the sound pressure level due to leakage, unlike the sound pressure stimulation device.</p></div><div><h3>Interpretation</h3><p>Therefore, the acoustic bellows-type round window transducer is a more stable and suitable output device for round window middle-ear implants than a sound pressure stimulation device. It is expected to overcome the limitations of sound pressure stimulation devices and to contribute to new technical solutions in the field of round window middle-ear implants development.</p></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0268003324001815/pdfft?md5=814429f427855b445390e28b493e9f46&pid=1-s2.0-S0268003324001815-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In response to “The type of gait disturbance in COVID-19 survivors depends on its etiology”","authors":"","doi":"10.1016/j.clinbiomech.2024.106348","DOIUrl":"10.1016/j.clinbiomech.2024.106348","url":null,"abstract":"","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the cadaveric model valid for examining orthopaedic manual therapy techniques? A cross-sectional comparative study in vivo and in vitro","authors":"","doi":"10.1016/j.clinbiomech.2024.106347","DOIUrl":"10.1016/j.clinbiomech.2024.106347","url":null,"abstract":"<div><h3>Background</h3><p>Cadaveric models are sometimes used to test the effect of manual techniques. We have not found any studies comparing the effect of tibiotarsal joint distraction on cadaveric models versus live models for clinical use. The aim was to compare the effect on tibiotarsal joint distraction movement when applying three force magnitudes of tibiotarsal axial traction technique force between a cadaveric model and volunteers. In addition, to compare the magnitude of force applied between the cadaveric model and volunteers. Finally, to assess the reliability of applying the same magnitude of force in three magnitudes of tibiotarsal axial traction force.</p></div><div><h3>Methods</h3><p>A cross-sectional comparative study was conducted. Sixty ankle joints were in open-packed position and three magnitudes of tibiotarsal axial traction technique force were applied. Tibiotarsal joint distraction movement was measured with ultrasound.</p></div><div><h3>Findings</h3><p>No differences were found in applied force or tibiotarsal joint distraction between volunteers and cadavers in each magnitude of force (<em>p</em> &gt; 0.05). The application of the technique showed moderate reliability for detecting low forces in both models. For medium and high force, it showed good reliability in the in vitro model and excellent reliability in the live model.</p></div><div><h3>Interpretation</h3><p>The amount of distraction produced in the tibiotarsal joint was similar in volunteers and cadavers. The cadaveric model is a valid model for testing and investigating orthopaedic manual therapy techniques. The force applied was similar in the two models. Medium and high force detection showed good reliability, while low force showed moderate<strong>.</strong></p></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The biomechanical assessment of two stemless shoulder arthroplasty prostheses in uniformly poor-quality bone mineral density cadaveric specimens","authors":"","doi":"10.1016/j.clinbiomech.2024.106346","DOIUrl":"10.1016/j.clinbiomech.2024.106346","url":null,"abstract":"<div><h3>Background</h3><p>Stemless shoulder arthroplasty offers several advantages, such as preserving bone stock and reducing periprosthetic fracture risk. However, implant motion can deter osteointegration and increase bone resorption, where micromotion less than 0.150 mm is crucial for bony ingrowth and vital to the success of the implant. The interaction between the implant and the metaphyseal bone and its effects on stability remains unclear. Therefore, this cadaveric study aims to assess the immediate stability of two stemless prostheses in low bone density specimens.</p></div><div><h3>Methods</h3><p>Twenty cadaveric shoulders were used to compare the stability of two stemless shoulder implants by Zimmer-Biomet (model A) and Exactech (model B), subjected to loads of 220 N, 520 N, and 820 N to assess strain and micromotion.</p></div><div><h3>Findings</h3><p>Micromotion at 220 N load was 0.061 ± 0.080 mm and 0.053 ± 0.050 mm, and at 520 N load, 0.279 ± 0.37 mm and 0.311 ± 0.35 mm for models A and B, respectively. The estimated mean force required to achieve a 150 μm micromotion was 356 ± 116 N and 315 ± 61 N for models A and B, respectively. Motion analysis revealed distinct movement patterns for each implant, with model B demonstrating better force distribution on the bone despite no significance.</p></div><div><h3>Interpretation</h3><p>Forces over 520 N (high postoperative rehabilitation force) could hinder bone integration with prostheses due to excessive micromotion. Conversely, forces around 220 N (preconditioning loading force) are considered safe for prosthesis stability even with low bone density. These insights may caution against using stemless implants when bone density is low, and help guide clinical decisions on the duration of rehabilitation and sling use after stemless arthroplasty.</p></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}