Clinical Biomechanics最新文献

{"title":"Load carriage influences intact limb knee loading estimate associated with osteoarthritis in individuals with transtibial amputation","authors":"Satria Ardianuari ,&nbsp;David C. Morgenroth ,&nbsp;Richard R. Neptune ,&nbsp;Glenn K. Klute","doi":"10.1016/j.clinbiomech.2025.106486","DOIUrl":"10.1016/j.clinbiomech.2025.106486","url":null,"abstract":"<div><h3>Background</h3><div>Load carriage can exacerbate the elevated intact limb knee loading in individuals with transtibial amputation, potentially contributing to osteoarthritis. Prosthetic foot mechanical properties like push-off power have the potential to reduce this elevated knee loading. This study investigated how load carriage position and prosthetic foot type affect intact limb knee loading measures for these individuals.</div></div><div><h3>Methods</h3><div>Twelve participants with unilateral transtibial amputation were recruited. Intact limb external knee adduction and flexion moments were analyzed, with prosthetic push-off power and work quantified for effects on first peak knee adduction moment. A linear mixed-effects regression evaluated the effects of load position and prosthetic foot on these metrics.</div></div><div><h3>Findings</h3><div>Participants exhibited the smallest first peak knee adduction moment and impulse with the intact-side load condition, followed by the back load and front load conditions, with the prosthetic-side load condition having the highest magnitude (20–35 % increase). However, we found no significant differences in these metrics by prosthetic foot. Additionally, load position and prosthetic foot did not significantly affect peak knee flexion moment. Only a negative trend toward correlation (<em>P</em> = 0.089) was observed between first peak knee adduction moment and prosthetic push-off work in the back load condition.</div></div><div><h3>Interpretation</h3><div>Intact-side load carriage may be more clinically beneficial for mitigating the risk of increased intact limb knee loading. Further, load carriage strategy affects intact limb knee loading more than specific prosthetic foot type. These biomechanical findings can help guide rehabilitative load carriage strategies to minimize the elevated risk of knee osteoarthritis in individuals with transtibial amputation.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106486"},"PeriodicalIF":1.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578774","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 adaptation to compensate balance recovery in people with knee osteoarthritis","authors":"Calum Downie ,&nbsp;Pazit Levinger ,&nbsp;Rezaul Begg","doi":"10.1016/j.clinbiomech.2025.106475","DOIUrl":"10.1016/j.clinbiomech.2025.106475","url":null,"abstract":"<div><h3>Background</h3><div>Older adults with knee osteoarthritis are twice as likely to fall compared to healthy counterparts. Furthermore, in healthy older adults, greater trunk flexion is associated with increased falling. While spatio-temporal and strength measures have been connected to balance dysfunction in osteoarthritis, to date no studies have investigated compensation of both upper and lower body kinematics on balance recovery in this population.</div></div><div><h3>Methods</h3><div>Forty-eight older people with knee osteoarthritis (age 71.02 ± 6.76 years, 54 % females, BMI 29.10 ± 4.58) and 15 asymptomatic controls (age 72.47 ± 4.81, 27 % females, BMI 26.17 ± 3.06) completed balance recovery during a simulated forwards fall. Ankle, knee, hip, trunk and head kinematics were collected and analysed using three trial types (no additional, cognitive dual-task and physical dual-task). Two-way MANCOVA were conducted to identify group differences in ankle, knee, hip, and trunk angle, and head position (control and knee osteoarthritis), trial differences (no additional, cognitive and physical dual-task) and group by trial differences.</div></div><div><h3>Findings</h3><div>Postural differences in older adults with knee osteoarthritis included greater knee flexion (<em>p</em> = .02) and lower hip and trunk flexion (<em>p</em> &lt; .01).</div></div><div><h3>Interpretation</h3><div>Following a simulated fall, older adults with knee osteoarthritis showed greater knee flexion at first contact which might suggest inability to resist forwards motion of the body.The more extended hip in this group and the resulting compensation of the upper body posture may lead to no difference in number of steps taken when compared to controls.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106475"},"PeriodicalIF":1.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519420","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":"Altered cumulative joint moments and increased joint moment symmetry during sit-to-stand transitions for transfemoral bone-anchored limb users: A case series","authors":"Peter B. Thomsen-Freitas ,&nbsp;Jason W. Stoneback ,&nbsp;James B. Tracy ,&nbsp;Mohamed E. Awad ,&nbsp;Danielle H. Melton ,&nbsp;Brecca M.M. Gaffney ,&nbsp;Cory L. Christiansen","doi":"10.1016/j.clinbiomech.2025.106476","DOIUrl":"10.1016/j.clinbiomech.2025.106476","url":null,"abstract":"<div><h3>Background</h3><div>Sit-to-stand transitions are demanding activities for people with unilateral transfemoral amputation. Movement asymmetries during sit-to-stand place greater stresses on the intact limb joints compared to the amputated limb joints, potentially contributing to musculoskeletal overuse injury and pain. Bone-anchored limbs address socket-related prosthesis issues, but their impact on cumulative joint moments during sit-to-stand is yet to be fully understood. The purpose of this study was to investigate changes in cumulative joint moments and moment symmetry during sit-to-stand transitions among transfemoral bone-anchored limb users.</div></div><div><h3>Methods</h3><div>A case-series of eight participants who underwent secondary bone-anchored limb implantation surgery were included. Ten consecutive days of physical activity monitoring (daily sit-to-stand) and motion capture during a 5-times sit-to-stand task were collected preoperatively (using socket prosthesis) and 12-months postoperatively. Cumulative low back, hip, and knee joint moments ([absolute joint moment impulse] x [average daily sit-to-stand]) were calculated. Between-limb symmetry was assessed using the Normalized Symmetry Index. Longitudinal changes in cumulative joint moments and moment symmetry were estimated with Hedge's <em>g</em> effect sizes.</div></div><div><h3>Findings</h3><div>Medium-to-large effects (<em>g</em> &gt; 0.5) were observed for increased frontal-plane amputated-limb hip moment and increased sagittal-plane cumulative low back and intact-limb knee moments. Small-to-medium effects (<em>g</em> &lt; 0.5) were observed for improved between-limb frontal-plane hip moment symmetry.</div></div><div><h3>Interpretation</h3><div>Despite improved between-limb symmetry, persistent overloading of the intact limb was present one-year after bone-anchored limb implantation. Changes in loading without meaningful changes in average number of daily sit-to-stands suggest potential needs for advanced prosthetic component prescription and more effective movement pattern training for bone-anchored limb users.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106476"},"PeriodicalIF":1.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552055","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":"Aseptic loosening is associated with medial tilting and anterior translational migration of the tibial implant in mechanically aligned total knee arthroplasty","authors":"Matthew D. Hickey ,&nbsp;Bart L. Kaptein ,&nbsp;Carolyn Anglin ,&nbsp;Bassam A. Masri ,&nbsp;Antony J. Hodgson","doi":"10.1016/j.clinbiomech.2025.106474","DOIUrl":"10.1016/j.clinbiomech.2025.106474","url":null,"abstract":"<div><h3>Background</h3><div>Aseptic loosening is a significant cause of implant revision in total knee arthroplasty, and radiostereometric analysis has been used to predict loosening by measuring implant migration over time relative to its position at the time of the index surgery. Studies have suggested that analyzing specific migration patterns may improve prediction of loosening, compared to using measures of the Maximum Total Point Motion alone. Therefore, the objective of this study was to determine whether patients monitored using radiostereometric analysis who experienced either aseptic loosening or revision exhibited distinctive tibial implant migration patterns.</div></div><div><h3>Methods</h3><div>Extending a previous study using radiostereometric analysis, we calculated the 6-degree-of-freedom tibial implant migration patterns for seven patients with cemented mechanically aligned total knee arthroplasty implants who either developed aseptic loosening or were candidates for revision. We used simple linear regression to identify trends over time.</div></div><div><h3>Findings</h3><div>We observed two trends that achieved statistical significance: negative rotation in the coronal plane (medial tilting) of the tibial implant (b = 0.26⁰/month, <em>p</em> &lt; 0.001) and anterior translation (b = 0.67 mm/month, <em>p</em> = 0.005).</div></div><div><h3>Interpretation</h3><div>Our study showed two statistically detectable migration trends associated with tibial component aseptic loosening. Although we were unable to assess in this study whether focusing on migration patterns in these directions provides greater predictive value than using Maximum Total Point Motion, the results suggest that certain migration mechanisms are more prevalent than others, which could motivate further research into the causes of such migration patterns.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106474"},"PeriodicalIF":1.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563536","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":"Investigating the effect of distal screw and peg length on stability in volar plating of comminuted, intra-articular distal radius fractures in a cadaveric model","authors":"Francine Zeng ,&nbsp;Raghunandan Nayak ,&nbsp;Martinus Megalla ,&nbsp;Mehreen Pasha ,&nbsp;Shiza Bari ,&nbsp;Dashun Liu ,&nbsp;Joel V. Ferreira ,&nbsp;Anthony Parrino ,&nbsp;Craig M. Rodner","doi":"10.1016/j.clinbiomech.2025.106472","DOIUrl":"10.1016/j.clinbiomech.2025.106472","url":null,"abstract":"<div><h3>Background</h3><div>Volar plating is the preferred surgical treatment for distal radius fractures. Many have adopted unicortical distal fixation to prevent extensor tendon injury. This study aimed to determine the biomechanical effect of distal locking screws and pegs on stability in comminuted, intra-articular distal radius fracture cadavers.</div></div><div><h3>Methods</h3><div>We applied volar-locking distal radius plates to 24 cadaveric radiuses, which were divided into 4 groups based on distal fixation: 100 % length screws, 75 % length screws, 100 % length pegs, and 75 % length pegs. Osteotomies simulated dorsally comminuted, intra-articular fractures. We determined each construct's stiffness under physiologic loads (axial compression, dorsal bending, and volar bending) before and after 1000 cycles of axial conditioning, and before axial load to clinical failure (2 mm of displacement) and catastrophic failure.</div></div><div><h3>Findings</h3><div>Stiffness to volar and dorsal bending were equivalent between groups before and after cycling loading. Final stiffness under axial load was equivalent for all groups. Force to clinical failure was equivalent between 100 % (308 N) and 75 % screw length (351 N) constructs, and equivalent between 100 % (127 N) and 75 % peg length (150 N) constructs. Forces to clinical failure were greater for 100 % and 75 % screw lengths compared to their peg counterparts. Force to clinical failure was greater for 75 % screw lengths than 100 % smooth pegs. Force to catastrophic failure was equivalent between all groups.</div></div><div><h3>Interpretation</h3><div>We recommend the use of 75 % length screws or pegs over their bicortical counterparts to prevent dorsal penetration without compromising fixation. Surgeons may consider using locking screws over pegs in complex, intra-articular distal radius fractures.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106472"},"PeriodicalIF":1.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510315","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":"Dynamic femoral head coverage following periacetabular osteotomy for developmental dysplasia of the hip","authors":"Christina A. Bourantas ,&nbsp;Emma C. Behrman ,&nbsp;Molly C. Shepherd ,&nbsp;Keith R. Lohse ,&nbsp;John C. Clohisy ,&nbsp;Michael D. Harris","doi":"10.1016/j.clinbiomech.2025.106471","DOIUrl":"10.1016/j.clinbiomech.2025.106471","url":null,"abstract":"<div><h3>Background</h3><div>Developmental dysplasia of the hip reduces hip stability due to insufficient femoral head coverage. Periacetabular osteotomy surgery aims to increase this coverage. Typically measured using radiographs, most coverage assessments are limited to static hip positions and cannot capture 3D anatomy. This study quantified how dynamic 3D femoral coverage changes during gait and squat after periacetabular osteotomy surgery and compared dynamic coverage to static measures.</div></div><div><h3>Methods</h3><div>Pre- and post-surgery CT scans from 38 patients with hip dysplasia were used to reconstruct 3D femur and pelvis bones with which gait and squat were simulated. Models of 38 control subjects were also created. The femoral head was divided into anteromedial, anterolateral, posteromedial, and posterolateral regions. Regional coverage was compared pre- and post-surgery, and against controls, in a static neutral position, during the stance phase of gait, and throughout the squat cycle.</div></div><div><h3>Findings</h3><div>Lateral coverage increased post-surgery in the static neutral position (anterolateral: 4.9 ± 3.6 % to 13.8 ± 5.6 %; posterolateral: 22.9 ± 15.4 % to 39.8 ± 15.2 % (<em>p</em> ≤ 0.001)) and throughout gait and squat (p ≤ 0.001). Average changes in neutral anterolateral coverage (+8.9 ± 4.5 %) were similar to average changes during gait (+8.1 ± 3.0 %), but not squat (+12.0 ± 1.9 %). Static neutral coverage post-surgery differed significantly from dynamic coverage in every region of the femoral head during all of gait, and most of squat.</div></div><div><h3>Interpretation</h3><div>While static measures follow some patterns of dynamic coverage after surgery, they miss important variations that can impact joint loading. Understanding how periacetabular osteotomy changes dynamic femoral head coverage can aid with operative planning and assessment to optimize outcomes during daily activities.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106471"},"PeriodicalIF":1.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519419","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":"Meta-analysis on effects of trip-based perturbation training reducing fall risk","authors":"Sara Mahmoudzadeh Khalili,&nbsp;Feng Yang","doi":"10.1016/j.clinbiomech.2025.106470","DOIUrl":"10.1016/j.clinbiomech.2025.106470","url":null,"abstract":"<div><h3>Background</h3><div>Falls are a key cause of injury across all age groups. Perturbation-based training, particularly trip-induced perturbation, has shown promise in enhancing balance recovery in lab and real-world scenarios. This study aimed to synthesize the effects of trip-based perturbation training on fall risk, quantified by the fall rate, recovery step length, margin of stability, and maximum trunk flexion angle in healthy adults.</div></div><div><h3>Methods</h3><div>A literature search in major databases led to 11 qualified studies. Meta-analyses were conducted on the lab-induced fall rate, recovery step length, and maximum trunk flexion angle. Other outcome measures, such as fall rate in daily living conditions and margin of stability, were systematically reviewed to further assess the effects of trip-based perturbation training.</div></div><div><h3>Findings</h3><div>The pooled effect size was −0.30 (<em>p</em> &lt; 0.001) for the lab-induced fall rate, 0.27 (<em>p</em> = 0.38) for the recovery step length, and − 9.81 (<em>p</em> = 0.20) for the maximum trunk flexion angle. The review also revealed that the training reduced all-cause prospective falls and improved the margin of stability after a trip.</div></div><div><h3>Interpretation</h3><div>Trip-based perturbation training significantly reduces the fall rate and enhances postural stability, as evidenced by improvements in the recovery step length, margin of stability, and trunk kinematics.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106470"},"PeriodicalIF":1.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552053","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":"Does joint hypermobility exacerbate altered landing and jumping strategies in adolescents with fibromyalgia syndrome compared to controls?","authors":"Tessa C. Hulburt ,&nbsp;William R. Black ,&nbsp;Scott Bonnette ,&nbsp;Staci Thomas ,&nbsp;Andrew Schille ,&nbsp;Chris DiCesare ,&nbsp;Matthew S. Briggs ,&nbsp;Sylvia Ounpuu ,&nbsp;Susmita Kashikar-Zuck ,&nbsp;Greg D. Myer","doi":"10.1016/j.clinbiomech.2025.106466","DOIUrl":"10.1016/j.clinbiomech.2025.106466","url":null,"abstract":"<div><h3>Background</h3><div>Joint hypermobility is common in children and persists in various genetic and connective tissue disorders, including conditions characterized by chronic musculoskeletal pain (i.e. Juvenile Fibromyalgia Syndrome), which involves movement dysfunction. It is unclear if joint hypermobility contributes to this dysfunction. This study investigated whether generalized joint hypermobility is associated with altered landing/jumping biomechanics in adolescents with juvenile fibromyalgia syndrome compared to controls.</div></div><div><h3>Methods</h3><div>Adolescents with juvenile fibromyalgia syndrome and hypermobility (<em>n</em> = 17), juvenile fibromyalgia syndrome without hypermobility (n = 17), and non-hypermobile controls (n = 17) performed a landing/jumping task while 3D-motion capture and ground reaction force data were collected. Timewise data were compared using statistical parametric mapping.</div></div><div><h3>Findings</h3><div>Both groups with juvenile fibromyalgia syndrome exhibited altered lower extremity biomechanics compared to controls, including increased sagittal hip and ankle kinematics (<em>P</em> &lt; 0.0001), ∼25 % reduced sagittal knee and ankle kinetics (<em>P</em> ≤ 0.038) and ∼ 2.5× greater knee internal rotation (<em>P</em> &lt; 0.0001) during landing/jumping, as well as ∼75 % and ∼ 20 % reduced ground reaction force during initial landing and jumping (<em>P</em> &lt; 0.0001), respectively. Both groups with juvenile fibromyalgia syndrome, demonstrated 17–26 % reduced landing depth (<em>P</em> &lt; 0.0001;d ≤ 1.79) and 26 % reduced jump height (<em>P</em> ≤ 0.01;d ≤ 0.86), indicating inefficient momentum absorption.</div></div><div><h3>Interpretation</h3><div>Altered biomechanics observed in both groups with juvenile fibromyalgia syndrome may reflect an attempt to avoid pain. While hypermobility did not significantly differentiate the groups with juvenile fibromyalgia syndrome overall, it was associated with more inefficiencies. This study highlights the need for hypermobility-specific movement assessments to understand movement-associated pain, strength, and kinesthetics to improve early identification and treatment of youth with hypermobility at risk for chronic pain and functional limitations.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106466"},"PeriodicalIF":1.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552056","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 and radiographic advantages of double-level osteotomy over single-level osteotomy for medial knee osteoarthritis with double-level deformity: A retrospective analysis","authors":"Hiroaki Tsukamoto ,&nbsp;Manabu Akagawa ,&nbsp;Hidetomo Saito ,&nbsp;Kimio Saito ,&nbsp;Akira Komatsu ,&nbsp;Takehiro Iwami ,&nbsp;Hiroaki Kijima ,&nbsp;Koji Nozaka ,&nbsp;Naohisa Miyakoshi","doi":"10.1016/j.clinbiomech.2025.106469","DOIUrl":"10.1016/j.clinbiomech.2025.106469","url":null,"abstract":"<div><h3>Background</h3><div>Double-level osteotomy is hypothesized to provide superior biomechanical outcomes compared to single-level osteotomy for medial knee osteoarthritis with double-level deformity. However, its advantages remain underexplored.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 20 knees treated with medial open wedge high tibial osteotomy alone or combined with lateral closed wedge distal femoral osteotomy. Patients were categorized into three groups: Single-level osteotomy for single deformity, single-level osteotomy for double deformity, and double-level osteotomy for double deformity. Radiographic parameters, including Hip-Knee-Ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle and joint line convergence angle, and gait biomechanics using nine-axis inertial measurement units were evaluated pre- and postoperatively.</div></div><div><h3>Findings</h3><div>The postoperative mechanical lateral distal femoral angle was better corrected in the double-level osteotomy for double deformity group compared to the single-level osteotomy for double deformity group (<em>P</em> = 0.012). Peak thigh varus acceleration was significantly reduced in both the double-level osteotomy for double deformity and single-level osteotomy for single deformity groups (<em>P</em> = 0.014), but not in the single-level osteotomy for double deformity group. No significant differences were observed in medial proximal tibial angle among groups.</div></div><div><h3>Interpretation</h3><div>Double-level osteotomy demonstrated superior biomechanical and radiographic outcomes in medial knee osteoarthritis with double-level deformity, emphasizing its role in mitigating joint line obliquity and in optimizing dynamic knee stability.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"123 ","pages":"Article 106469"},"PeriodicalIF":1.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464587","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":"A novel acoustic emission screwdriver reduces surgeons´ cancellous screw stripping rate - A biomechanical study","authors":"Bryan Joseph Wright ,&nbsp;Stephen Grigg ,&nbsp;John McCrory ,&nbsp;Rhys Pullin ,&nbsp;Jan Egil Brattgjerd","doi":"10.1016/j.clinbiomech.2025.106467","DOIUrl":"10.1016/j.clinbiomech.2025.106467","url":null,"abstract":"<div><h3>Background</h3><div>Orthopedic surgeons refine their torque sensitive skills from tightening cancellous screws. Still, experienced surgeons exhibit surprisingly high screw stripping rates in osteopenic cancellous bone. Whether Acoustic-Emission technology, detecting energy waves from microstructural damage during screw purchase, can reduce these rates is unclear. Our aim was to evaluate if surgeons, irrespective of their experience, reduced cancellous screw stripping rate by combining their skills with feedback from an innovative Acoustic-Emission screwdriver.</div></div><div><h3>Methods</h3><div>Thirteen orthopedic surgeons with 0–23 years´ experience inserted 468 large fragment cancellous screws through plates into synthetic osteoporotic bone. The 1st stage, surgeons tightened 9 screws each without Acoustic-Emission feedback. The 2nd stage, each tightened 18 screws using the Acoustic-Emission feedback modified screwdriver. The last stage, surgeons tightened 9 screws each, again without Acoustic-Emission feedback. A strain gauge on the screwdriver was used to verify screw stripping.</div></div><div><h3>Findings</h3><div>Surgeons stripped 36 out of 115 screws (31 %) in stage 1, 37 out of 227 screws (16 %) in stage 2, and 26 out of 114 screws (23 %) in stage 3. A significant reduced screw stripping rate was found in stage 2 compared to in stage 1 (<em>p</em> &lt; 0.001). Neither the individual surgeon nor experience of the surgeon contributed to screw stripping probability in a mixed effect logistical regression model.</div></div><div><h3>Interpretations</h3><div>Acoustic-Emission technology is superior to the torque sensitive skills of surgeons, demonstrating its potential to assist surgeons in real time, regardless of their experience, in reducing screw stripping rates in cancellous bone.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"123 ","pages":"Article 106467"},"PeriodicalIF":1.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464501","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}