Clinical Biomechanics最新文献

{"title":"Feasibility of automatic knee kinematic feature learning for discriminating between individuals with and without a history of an anterior cruciate ligament reconstruction","authors":"Benjamin R. Butler ,&nbsp;Behnam Gholami ,&nbsp;Benedict Z.W. Low ,&nbsp;Qichang Mei ,&nbsp;David Hollinger ,&nbsp;Zainab Altai ,&nbsp;David W. Evans ,&nbsp;Bernard X.W. Liew","doi":"10.1016/j.clinbiomech.2025.106673","DOIUrl":"10.1016/j.clinbiomech.2025.106673","url":null,"abstract":"<div><h3>Background</h3><div>Knee osteoarthritis is a degenerative joint disease that often develops following an anterior cruciate ligament (ACL) injury, even following surgical reconstruction (ACLr). This research evaluated whether biomechanical biomarkers, derived from wearable sensors, could differentiate people with an ACLr, who are at risk of early knee osteoarthritis, from healthy controls.</div></div><div><h3>Methods</h3><div>Twelve participants with an ACLr and 19 controls participated. Continuous three-dimensional (3D) knee kinematics were captured using inertial measurement unit (IMU) sensors during sequential daily living tasks comprising sit-to-stand, walking, obstacle crossing, squatting, and stand-to-sit. Using a least absolute shrinkage and selection operator regression model, 468 knee time-series features were extracted to classify individuals with an ACLr from controls. Cohen's <em>d</em> effect sizes were calculated for features selected by the regression model to quantify between-group differences.</div></div><div><h3>Findings</h3><div>The model achieved an accuracy of 80.7 %, with 92 % sensitivity and 74 % specificity. Seven features were retained from the model. The top two features with the greatest effect sizes when compared to controls were: a reduction in peak-to-peak knee axial rotation and maximum knee axial rotation angle (<em>d</em> = 1.35 and <em>d</em> = 1.31, respectively).</div></div><div><h3>Interpretation</h3><div>The present study found that axial knee kinematics could serve as important biomarkers of an ACLr, potentially representing a modifiable feature for osteoarthritis treatment and prevention. These findings demonstrate the feasibility of early knee osteoarthritis detection using biomechanical biomarkers, providing preliminary evidence for the use of wearable sensors outside clinical settings and underscoring the possibilities for at-home monitoring.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106673"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159456","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":"Correlation between arch height index, spatiotemporal gait parameters and plantar pressure in children with spastic hemiplegia cerebral palsy","authors":"Young-Hwan Kwag","doi":"10.1016/j.clinbiomech.2025.106670","DOIUrl":"10.1016/j.clinbiomech.2025.106670","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate the correlations between the arch height index (AHI), spatiotemporal gait parameters, and plantar pressure in children with spastic hemiplegic cerebral palsy.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with 15 children diagnosed with spastic hemiplegic cerebral palsy. The AHI was measured using the method developed by Williams and McClay. Spatiotemporal gait parameters were assessed using the GAITRite system, and plantar pressure was evaluated with the Dynafoot platform.</div></div><div><h3>Findings</h3><div>On the affected side, the AHI showed moderate positive correlations with step length (0.522) and stride length (0.529). On the non-affected side, the AHI demonstrated a moderate negative correlation with plantar pressure in the medial heel region (−0.629).</div></div><div><h3>Interpretation</h3><div>The findings suggest that the AHI is associated with shorter step and stride lengths and plantar pressure distribution in children with spastic hemiplegic cerebral palsy. These results support the clinical utility of AHI as an assessment tool and its potential role in guiding interventions to improve gait and foot posture in this population.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106670"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050222","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":"Associations of quadriceps activation during step-up with pain during movement and physical function in people with knee osteoarthritis","authors":"Ehyun Kim,&nbsp;Soyoung Lee,&nbsp;Jason Dolinsky,&nbsp;Baekdong Cha,&nbsp;Deepak Kumar","doi":"10.1016/j.clinbiomech.2025.106683","DOIUrl":"10.1016/j.clinbiomech.2025.106683","url":null,"abstract":"<div><h3>Background</h3><div>Movement-evoked pain, and excessive muscle activation and co-activation during daily activities such as stair climbing are characteristic of knee osteoarthritis. Our objective was to examine the association between muscle activation and coactivation during step-up with pain during step-up and self-reported physical function in people with knee osteoarthritis.</div></div><div><h3>Methods</h3><div>We used data from participants with symptomatic knee OA (<em>n</em> = 43) who performed five 30-s step-up bouts. Maximum pain during step-up (range 0–10) was recorded as movement-evoked pain. We assessed mean vastus medialis and medial hamstrings activation during the ascent phase of step-up, normalized to activation during a maximum voluntary isometric contraction, using surface electromyography (EMG). We also derived muscle coactivation over the same period. Physical function was assessed using the McMaster Universities Osteoarthritis Index (WOMAC) Physical Function scale. We used hierarchical regression models to examine the additional contributions of EMG measures to movement-evoked pain and WOMAC scores in addition to age, sex, BMI, and quadriceps peak torque.</div></div><div><h3>Findings</h3><div>Greater vastus medialis activation during step-up was associated with lower movement-evoked pain (β = −0.47, <em>p</em> &lt; 0.01, model R² = 0.28), explaining 18 % additional variance beyond age, sex, BMI, and isometric quadriceps torque. Similarly, greater vastus medialis activation was related to better WOMAC physical function (β = −0.35, <em>p</em> = 0.04, model R² = 0.36), explaining 8 % additional variance beyond age, sex, BMI, isometric quadriceps torque, and movement-evoked pain.</div></div><div><h3>Interpretation</h3><div>Greater vastus medialis activation may be a compensatory strategy to reduce pain during step-up and improve function in knee osteoarthritis.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106683"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379715","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":"Ultrasound elastography in the assessment of rigidity in Parkinson's disease: A scoping review","authors":"Mahyar Behraznia ,&nbsp;Massimiliano Ditroilo ,&nbsp;Tina Smith","doi":"10.1016/j.clinbiomech.2025.106680","DOIUrl":"10.1016/j.clinbiomech.2025.106680","url":null,"abstract":"<div><h3>Background</h3><div>In individuals with Parkinson's disease (PD), rigidity is a form of muscle hypertonia which manifests as muscular stiffness, leading to altered mechanical properties of muscle tissue. Ultrasound elastography (UE) is an emerging diagnostic imaging technology that can assess muscle stiffness. This scoping review aims to evaluate the current literature on muscular rigidity in PD as measured by UE, examine existing UE assessment methodologies, and propose future directions when measuring muscular rigidity in PD using UE.</div></div><div><h3>Methods</h3><div>This scoping review was conducted following specific guidelines and searching these databases: Scopus, PubMed, Web of Science Core Collection, MEDLINE and CINAHL Ultimate.</div></div><div><h3>Findings</h3><div>Ten studies were included after screening, using either strain elastography (SE) or shear wave elastography (SWE) to measure muscular rigidity in PD. Muscular rigidity was typically greater in individuals with PD compared to controls, with minimal bilateral differences within PD patients. UE-derived muscular rigidity was associated with clinical manifestations of PD, and rigidity was influenced by joint angle, medications, and therapeutic interventions. However, the included studies assessed rigidity using a wide range of methodologies (e.g., protocol design, system specification, and acquisition methods), which restricts comparability.</div></div><div><h3>Significance and interpretation</h3><div>UE demonstrates strong potential as a non-invasive tool for quantifying muscular rigidity in PD, which is increased in these patients. Nevertheless, small sample sizes and inconsistent methodologies undermine definitive conclusions. Future studies should adhere to the methodological recommendations outlined in this review, including the adoption of standardised protocols, larger sample sizes, and robust longitudinal and reliability designs.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106680"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333276","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":"Wearable monitoring for rehabilitation: Deep learning-driven vertical ground reaction force estimation for anterior cruciate ligament reconstruction","authors":"Tianxiao Chen ,&nbsp;Datao Xu ,&nbsp;Meizi Wang ,&nbsp;Zhifeng Zhou ,&nbsp;Tianle Jie ,&nbsp;Huiyu Zhou ,&nbsp;Yi Yuan ,&nbsp;Julien S. Baker ,&nbsp;Zixiang Gao ,&nbsp;Yaodong Gu","doi":"10.1016/j.clinbiomech.2025.106663","DOIUrl":"10.1016/j.clinbiomech.2025.106663","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cruciate ligament reconstruction (ACLR) can restore knee stability, yet many patients fail to regain pre-injury function or develop secondary injuries. Vertical ground reaction force (vGRF) reflects joint loading and recovery but is typically measured via lab-based force plates, limiting real-world use. Wearable sensors and deep learning could enable portable monitoring, but current studies lack accuracy in complex movements and patient-specific adaptations.</div></div><div><h3>Methods</h3><div>Lower-limb kinematics and vGRF data from 25 ACLR patients during three daily activities (walking, running, descending stairs) was collected by wearable sensors and Vicon system. Three deep learning models were developed and optimized for the prediction tasks. The collected data was used to train the three developed models and the performance of each model was evaluated.</div></div><div><h3>Findings</h3><div>Among the three deep learning models, CNN-BiGRU-Attention model demonstrated the best predictive performance across all three movement tasks (R²_{<em>walking</em>} = 0.953 ± 0.006, R²_{<em>running</em>} = 0.971 ± 0.005, R²_{<em>descending stairs</em>} = 0.979 ± 0.003). Additionally, for the three selected daily activities, all models showed superior vGRF prediction performance in running and stair descending tasks compared to walking.</div></div><div><h3>Interpretation</h3><div>By integrating data from wearable sensors with a hybrid deep learning framework, the proposed CNN-BiGRU-Attention model successfully achieved accurate estimation of vGRFs of ACLR patients in various movements. This provides a key technical reference for optimizing personalized rehabilitation strategies and improving patient outcomes, demonstrating significant clinical application value and social benefits.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106663"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050220","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":"Recurrent Neural Networks model for injury prevention within a professional rugby union club: a proof of concept over one season","authors":"Maxence Duffuler ,&nbsp;Maxime Bourgain ,&nbsp;Zehira Haddad ,&nbsp;Renaud Heraud ,&nbsp;Sylvain Blanchard ,&nbsp;Philippe Rouch","doi":"10.1016/j.clinbiomech.2025.106600","DOIUrl":"10.1016/j.clinbiomech.2025.106600","url":null,"abstract":"<div><h3>Background</h3><div>In professional rugby, injury prevention and player availability are major challenges. Sports analytics use data from trainings and matches to address these issues. This study leveraged comprehensive daily data from a professional rugby club to predict players' readiness for training. Using this metric helped assess its effectiveness in predicting intrinsic injuries and improving injury prevention strategies.</div></div><div><h3>Methods</h3><div>Models including logistic regression, decision trees, and Long Short-Term Memory-based neural networks, were evaluated for their predictive accuracy and ability to discern patterns indicative of injury risks or readiness for physical activities.</div></div><div><h3>Findings</h3><div>The study demonstrated that long-short term memory and convolutional one-dimension models outperform traditional machine learning methods in analyzing players' physical conditions. This approach may support earlier identification of injury risks and inform workload management. Using model evaluation and interpretability techniques, including Local Interpretable Model-Agnostic Explanations (LIME) module, the study provided a framework for sports scientists, coaches, and medical staff to mitigate injury risks and optimize training sessions.</div></div><div><h3>Interpretation</h3><div>As a preliminary exploration, this study paves the way for further research into the integration of machine learning and neural networks in sports science, promising transformative impacts on injury prevention strategies in rugby.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106600"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309953","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":"How does the collar in cementless hip stems work? Comparison of the strain distribution in the cortex of the proximal femur","authors":"Katja Brand ,&nbsp;Golzar Dakhili ,&nbsp;Frank Lampe ,&nbsp;Benjamin Ondruschka ,&nbsp;Michael M. Morlock ,&nbsp;Gerd Huber","doi":"10.1016/j.clinbiomech.2025.106671","DOIUrl":"10.1016/j.clinbiomech.2025.106671","url":null,"abstract":"<div><h3>Background</h3><div>Collared cementless hip stems have demonstrated a reduced incidence of periprosthetic femoral fractures compared to collarless counterparts. Many fractures occur during implantation, when collarless stems are seated to achieve press-fit, causing critical tensile strains in the femur. Collared stems can limit excessive seating and subsidence through calcar-collar contact.</div><div>This study aimed to explain the clinically observed smaller fracture rates with collared stems by comparing strain distributions during implantation and loading between collared and collarless stems. It was hypothesized that collared stems distribute applied forces through both the collar and stem, increasing compressive axial and shear strains, allowing higher load tolerance.</div></div><div><h3>Methods</h3><div>Seven collared and seven collarless stems were implanted with constant velocity (0.1 mm/s) in porcine femurs until failure. Two human cadaveric femurs were tested as proof of concept. Shear, axial compressive and tangential tensile strains were compared alongside fracture patterns, subsidence and forces.</div></div><div><h3>Findings</h3><div>Collared stems in porcine femurs resisted approximately twice as much force until failure occurred (collared: 4187 N, collarless: 1980 N; <em>p</em> &lt; 0.001), with similar tangential tensile strains (1 % to 1.4 % <em>p</em> = 0.805) and subsidence of 1.6 mm for collarless and 1.1 mm for collared stems at different failure forces (<em>p</em> = 0.288). Axial compressive strain was heavily increased by 1147 % with collared stems (collared: 1.2 %, collarless: 0.1 %; <em>p</em> = 0.026). Human femurs exhibited similar trends.</div></div><div><h3>Interpretation</h3><div>During loading, the collar prevents periprosthetic femoral fractures by increasing axial compressive strains instead of causing critical excessive tangential tensile strains (hoop strains) that can result in fractures.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106671"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092713","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":"Association of the center of pressure position, trunk and lower limb joint kinematics with knee extensor moment during single-leg squatting after anterior cruciate ligament reconstruction","authors":"Masato Chijimatsu ,&nbsp;Rui Henmi ,&nbsp;Hiroko Yokoyama ,&nbsp;Takeshi Hoshi ,&nbsp;Gai Maeda ,&nbsp;Yuka Kimura ,&nbsp;Yasuyuki Ishibashi ,&nbsp;Eiichi Tsuda","doi":"10.1016/j.clinbiomech.2025.106669","DOIUrl":"10.1016/j.clinbiomech.2025.106669","url":null,"abstract":"<div><h3>Background</h3><div>Reduced knee extensor moment after anterior cruciate ligament reconstruction is associated with quadriceps weakness, increased risk of second anterior cruciate ligament injuries, and early onset of knee osteoarthritis. This study investigated the association between the knee extensor moment, anterior-posterior center of pressure, and trunk and lower limb joint angles during single-leg squatting following anterior cruciate ligament reconstruction.</div></div><div><h3>Methods</h3><div>Twenty-one patients who underwent anterior cruciate ligament reconstruction performed a single-leg squatting with both legs. Regression analyses were performed to examine the association between the knee extensor moment, anterior-posterior center of pressure, and trunk and lower limb joint angles, all of which were measured using a 3-dimensional motion analysis system.</div></div><div><h3>Findings</h3><div>The knee extensor moment was predicted by the anterior-posterior center of pressure in the involved limb (<em>P</em> = 0.038, <em>R</em>² = 0.208). The knee extensor moment was significantly predicted by the knee flexion angle (involved: <em>P</em> = 0.003, <em>R</em>² = 0.373; uninvolved: <em>P</em> &lt; 0.001, <em>R</em>² = 0.557) and ankle dorsiflexion angle (involved: <em>P</em> = 0.035, <em>R</em>² = 0.214; uninvolved: <em>P</em> &lt; 0.001, <em>R</em>² = 0.554). The anterior-posterior center of pressure and ankle dorsiflexion angle significantly predicted the knee extensor moment in the involved limb in multivariate regression analysis (<em>P</em> = 0.006, model <em>R</em>² = 0.429).</div></div><div><h3>Interpretation</h3><div>The knee extensor moment was associated with the anterior-posterior center of pressure, knee flexion angle, and ankle dorsiflexion angle. Evaluating these parameters may enhance our understanding of the knee extensor moment during single-leg squatting after anterior cruciate ligament reconstruction in a clinical setting.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106669"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151665","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":"ASTM biomechanical study comparing the AxioMed lumbar viscoelastic disc to human lumbar disc data","authors":"Kingsley R. Chin ,&nbsp;Sukanya Chebrolu ,&nbsp;Roger D. Sung ,&nbsp;Jeffrey R. Carlson ,&nbsp;Mark W. McFarland ,&nbsp;Erik Spayde ,&nbsp;William M. Costigan ,&nbsp;Sandra Thompson ,&nbsp;Vito Lore ,&nbsp;Kari B. Zimmers ,&nbsp;Hope Estevez ,&nbsp;Swapnil Pangarkar ,&nbsp;Aditya Humad ,&nbsp;Chukwunonso C. Ilogu ,&nbsp;Jason A. Seale","doi":"10.1016/j.clinbiomech.2025.106686","DOIUrl":"10.1016/j.clinbiomech.2025.106686","url":null,"abstract":"<div><h3>Background</h3><div>Artificial disc replacements aim to preserve motion in patients with lumbar disc degeneration, but most do not replicate the natural stiffness of the healthy human lumbar disc. Existing ball-and-socket designs often permit excessive motion and fail to provide the nonlinear, load-dependent stiffness that characterize native spinal biomechanics. To date, no in vitro study has directly compared the stiffness of a viscoelastic total disc replacement (VTDR) to that of the natural lumbar disc under physiologic conditions.</div></div><div><h3>Methods</h3><div>Ten AxioMed® lumbar VTDRs were tested using standardized ASTM protocols in a physiologic environment (PBS at 37 ± 3 °C). Axial compression, flexion-extension, axial rotation and compressive shear stiffness were measured using servohydraulic test systems. An additional five implants underwent static axial loading up to 20,000 N. All values were compared to published stiffness ranges for the healthy human lumbar disc.</div></div><div><h3>Findings</h3><div>Axial stiffness ranged from 2.56 to 3.48 kN/mm, overlapping the reported native range of 0.5 to 2.5 kN/mm. Flexion-extension stiffness (1.69–2.14 Nm/deg) matched the physiologic range (0.8–2.5 Nm/deg). Rotation stiffness (0.79–0.83 Nm/deg) was lower than native values (2.0–9.6 Nm/deg), resulting in greater rotational mobility. <strong>Compressive shear stiffness (0.49–0.59 kN/mm) fell within the native lumbar disc range (0.4–0.7 kN/mm).</strong> All implants withstood static compression to 20,000 N without structural failure.</div></div><div><h3>Interpretation</h3><div>These findings show that the AxioMed® VTDR reproduces lumbar disc stiffness more closely than prior designs. The ability to replicate both compliant and stiff loading zones suggests improved biomechanical performance and segmental stability, supporting its use as a potential alternative to spinal fusion.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106686"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410476","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":"External torque application during assessment of syndesmotic ankle lesions: A systematic review","authors":"Axel Degrande ,&nbsp;Louise Wittouck ,&nbsp;Pieter D'Hooghe ,&nbsp;Matthias Peiffer ,&nbsp;Thomas Tampere ,&nbsp;Sam Van der Jeught ,&nbsp;Arne Burssens ,&nbsp;Amélie Chevalier","doi":"10.1016/j.clinbiomech.2025.106662","DOIUrl":"10.1016/j.clinbiomech.2025.106662","url":null,"abstract":"<div><h3>Background</h3><div>Syndesmotic ankle injuries, particularly those involving the distal tibiofibular joint, are challenging to diagnose due to subtle clinical presentation and complex ankle biomechanics. Both clinical and biomechanical studies struggle with accurately assessing the severity and extent of these injuries. External torque has recently shown promise in enhancing the detection and assessment of syndesmotic injuries, especially in weight-bearing computed tomography (WBCT). This study explores the impact of external torque on the assessment of syndesmotic ankle lesions in clinical versus biomechanical studies.</div></div><div><h3>Methods</h3><div>A systematic search was conducted using PubMed, Scopus, EMBASE, The Cochrane Library, and Web of Science. The review protocol was registered on PROSPERO (CRD42024535265). Inclusion criteria were biomechanical studies on lower limbs with intact and sectioned syndesmosis; clinical studies comparing injured ankles to healthy contralateral ones; and studies applying torque or weight-bearing to injured ankles. Exclusion criteria consisted of reviews, meta-analyses, studies on syndesmosis repair, acute injuries involving fractures, and studies lacking measurements.</div></div><div><h3>Findings</h3><div>Eleven studies met the inclusion criteria, including eight biomechanical and three clinical studies.</div></div><div><h3>Interpretation</h3><div>While biomechanical evidence provides a solid foundation, its translation into clinical practice requires further validation. The importance of assessment of the ankle syndesmosis under torque has been demonstrated, and the application of external torque shows promising results. Multiple studies indicate that applying an external torque between 4.5 and 7.5 [Nm] is sufficient to distinguish between intact and sectioned syndesmotic injuries. However, the need for a standardized diagnostic tool has yet to be established.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"130 ","pages":"Article 106662"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027733","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}