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BACKGROUND: Currently available studies on the long-term functional outcomes of anterior cruciate ligament (ACL) reconstruction have yielded conflicting results. The purpose of this study was to evaluate the biomechanical characteristics of walking in the long term after ACL reconstruction. METHODS: The study included a test group of 18 patients (3.4 years from the date of ACL reconstruction on average) and a control group of 20 healthy subjects. Their gaits were assessed using functional tests at voluntary walking and fast-walking speeds. The biomechanical assessments utilized included spatiotemporal and kinematic parameters of walking, as well as surface electromyography (EMG) amplitudes of the main flexor-extensor muscles of the lower extremities. RESULTS: Fast-walking speeds and the clearances of the operated-upon limbs in the patient group exceeded those in the control group. The gait cycle in the patient group was significantly longer when walking at a voluntary speed compared to the control group. In the patient group, most of the movements were symmetrical at both speeds, and the parameters did not differ from the control group. The only exception was the hip joint amplitude and the main amplitude of the knee joint flexion, which significantly and simultaneously increased when walking at a fast speed. CONCLUSIONS: In the postoperative period, at voluntary speeds, the patient group was characterized by increased amplitudes in the hip and knee joints and higher EMG amplitudes, which almost disappeared at higher speeds.
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BACKGROUND: This study on gait biomechanics is based on a functional test (FT) performed at free and fast walking speeds. OBJECTIVE: We investigated the pattern of changes in gait biomechanical parameters and the knee function in patients after anterior cruciate ligament (ACL) injury or its reconstruction. METHODS: The study included 51 patients (33 males, 18 females) with a confirmed recent or old history of ACL tear, before or after reconstruction (26 patients). Mocap data was obtained using an inertial system. All patients were divided into three groups: 41 patients with physiological response (compensation), 6 patients with signs of decompensation, and 4 non-assessable patients. RESULTS: Increase in gait speed was associated with decrease in the walking cycle duration, stance and double support phases. In the compensation group, the physiological response of the knee was manifested in increased amplitudes. In the decompensation group, the amplitudes remained unchanged or decreased. In the compensation group, there were increases in the symmetrical muscle activity. The decompensation group was characterized by electromyography asymmetry. CONCLUSION: The observed universal physiological mechanism limiting the load on the damaged joint can be used for accurate assessment of the knee functional state in various periods of rehabilitation.
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Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Masculino , Femenino , Humanos , Lesiones del Ligamento Cruzado Anterior/cirugía , Velocidad al Caminar , Fenómenos Biomecánicos , Marcha/fisiología , Articulación de la Rodilla , Caminata/fisiologíaRESUMEN
PURPOSE: There is still controversy over the criteria for acute ACL tear. In this paper, knee joint function and walking were considered possible ones. METHOD: The study included 21 subjects with acute ACL tear and 20 healthy volunteers as a control group. Biomechanical gait analysis was performed using the inertial sensor system including EMG recording. All subjects (but for controls) were divided into two groups: Group 1-"up to 4 weeks" and Group 2-"from 4 weeks to 3 months". RESULTS: Temporal gait parameters in subjects from Group 1 demonstrate the asymmetry of 4% and more in terms of the gait cycle with a decrease in the affected limb, and are within normal range in Group 2. The amplitudes at the hip and knee joints in the affected limb are reduced which is especially pronounced in Group 1 (2-4 and 6-10 degrees, respectively). The affected knee joint shows a decrease in the range of motion by up to 5 degrees in the first half of the stance phase and flexion by less than 40 degrees in the swing phase. The tibialis anterior and quadriceps femoris muscle function is decreased in the affected limb only in Group 1 (72% and 78% from normal, respectively). CONCLUSIONS: The severity of the condition after an ACL tear is largely determined by functional changes. The time factor is of secondary importance.
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BACKGROUND: The study objective was to assess clinical outcomes and gait biomechanics in patients after 6 and 18 months after varus deformity (VD) surgical correction at knee joint (KJ). METHOD: The study included 20 patients with medial osteoarthritis (OA) of the knee of grade 2-3 and a VD of >4°. A total of 21 surgeries were performed on the patients. Full length weight bearing (FLWB) X-ray and KJ assessments were done using the KSS, KOOS and VAS scoring systems were obtained from all the patients. Biomechanical gait parameters were captured using an inertial sensor system at timepoints before, and 6 and 18 months after surgery. Temporal and kinematic parameters of walking were analyzed. RESULTS: The radiological parameters showed a stable VD correction. According to the KOOS, KS and VAS scores, there was a moderate dynamic improvement in the operated knee function during the study. The biomechanical parameters remained virtually unchanged throughout the entire follow-up period. In the following year, there were some subjective improvements but without any significant changes in gait biomechanics or knee kinematics. CONCLUSIONS: Thus, the main changes in the joint clinical condition and function occur in the first 6 months after surgery. According to the study data-assessments by VAS, KOOS, and KSS-there was a moderate clinical improvement during the long-term follow-up period, however, the biomechanical changes were minor.
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Osteoartritis de la Rodilla , Humanos , Fenómenos Biomecánicos , Osteoartritis de la Rodilla/cirugía , Análisis de la Marcha , Tibia/cirugía , Articulación de la Rodilla/cirugía , OsteotomíaRESUMEN
PURPOSE: A varus deformity (VD) of the lower limbs results in greater loading of the medial compartment of the knee joint (KJ), leading to its degenerative changes and, eventually, to progressive osteoarthritis (OA) of the joint. The aim of the study was to investigate the mid-term changes in gait biomechanics and clinical symptoms in patients with VD of KJ and OA before and six months after surgical correction. METHODS: The study enrolled 25 patients with medial OA of grade 2-3 according to Kellgren-Lawrence and a VD of > 3°, who underwent arthroscopic lavage and debridement of the knee joint followed by corrective osteotomy. The control group included 20 healthy adults. Clinical and biomechanical assessments were done twice: immediately prior to and six months after the surgical treatment. Biomechanical parameters of gait were recorded using an inertial sensor system. RESULTS: According to our findings, there was a statistically significant post-operative increase in the knee extension amplitude by 1.4° in female patients and an insignificant extension increase in male patients. The mean postoperative KOOS score was 66.7 points (46 to 91) in the patient group, 67.1 points (54 to 91) in males, and 59.5 points (46 to 64) in females. As early as six months after a valgus osteotomy, we already observed improved biomechanics of the KJ motions compared to pre-operative data. By that time, the swing flexion amplitude of the affected KJ had increased and became symmetrical, which had not been the case before surgery. We observed a total of three changes in the KJ kinematics after surgery: increased swing flexion amplitudes in both KJs, a decreased extension amplitude in the affected KJ, and increased first flexion amplitudes in both KJs. CONCLUSION: According to our study, the midterm outcomes after a valgus osteotomy showed clinical improvements based on the VAS and KOOS scores, which were however less pronounced than in similar studies with a longer assessment term after surgery. We also found a significant increase in the amplitude of joint extension, but only in females. As the function of the operated joint is concerned, valgus osteotomy restored the kinematics of walking movements to a nearly normal gait with increased first and second flexion amplitudes. The function of KJ becomes symmetric though the non-operative side. Thus, the healthy and functionally more capable side is copying the movement pattern of the affected side. Hence, the non-operative leg is functioning less efficiently than it is required by the walking pace.