Biomechanics

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11 pages, 2575 KiB

Open AccessArticle

Load Modulation Affects Pediatric Lower Limb Joint Moments During a Step-Up Task

by Vatsala Goyal, Keith E. Gordon and Theresa Sukal-Moulton

Biomechanics 2024, 4(4), 653-663; https://doi.org/10.3390/biomechanics4040047 - 6 Nov 2024

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Introduction: Performance in a single step has been suggested to be a sensitive measure of movement quality in pediatric clinical populations. Although there is less information available in children with typical development, researchers have postulated the importance of analyzing the effect of body [...] Read more.

Introduction: Performance in a single step has been suggested to be a sensitive measure of movement quality in pediatric clinical populations. Although there is less information available in children with typical development, researchers have postulated the importance of analyzing the effect of body weight modulation on the initiation of stair ascent, especially during single-limb stance where upright stability is most critical. The purpose of this study was to investigate the effect of load modulation from −20% to +15% of body weight on typical pediatric lower limb joint moments during a step-up task. Methods: Fourteen participants between 5 and 21 years who did not have any neurological or musculoskeletal concerns were recruited to perform multiple step-up trials. Peak extensor support and hip abduction moments were identified during the push-off and pull-up stance phases. Linear regressions were used to determine the relationship between peak moments and load. Mixed-effects models were used to estimate the effect of load on hip, knee, and ankle percent contributions to peak support moments. Results: There was a positive linear relationship between peak support moments and load in both stance phases, where these moments scaled with load. There was no relationship between peak hip abduction moments and load. While the ankle and knee were the primary contributors to the support moments, the hip contributed more than expected in the pull-up phase. Discussion: Clinicians can use these results to contextualize movement differences in pediatric clinical populations, including in those with cerebral palsy, and highlight potential target areas for rehabilitation for populations such as adolescent athletes. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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A participant in the experimental set-up with retro-reflective markers. Full article ">Figure 2
Representative kinetic (A,C) and kinematic (B,D) profiles from one participant during a no-load step up for the trailing leg (A,B) and the leading leg (C,D). On each x-axis, 0% corresponds to the start of a step-up trial at leading leg lift-off while 100% corresponds to the end of the trial at trailing leg initial contact with the step. On each y-axis, a positive magnitude indicates joint flexion/abduction while a negative magnitude indicates joint extension/adduction. Average hip abduction moments are in red. Individual lower limb sagittal plane moments are in gray, including the hip (gray dash), knee (gray dash–dot), and ankle (gray dot). The sum of these individual joint moments equals the extensor support moments shown in blue. Shaded regions represent one standard deviation. The black boxes on plots (A,C) indicate the push-off and pull-up stance phases, respectively. Full article ">Figure 3
Peak support moments vs. load for the (A) push-off and (B) pull-up stance phases. All values are divided by their respective values in the no-load condition. The linear regression for both stance phases showed a significant relationship between the two variables, with y = 0.817x + 0.973 for the push-off phase (R2 = 0.278) and y = 0.933x + 1.02 for the pull-up phase (R2 = 0.498). Full article ">Figure 4
Individual hip (orange), knee (yellow), and ankle (green) percent contributions to peak extensor support moment at the time of peak support moment for all loading conditions in the push-off stance phase (A,C,E) and the pull-up stance phase (B,D,F). A negative percent contribution represents a joint moment in flexion, while a positive percent contribution represents a joint moment in extension. Significant pairwise comparisons are shown by black brackets (corrected p < 0.001). Full article ">Figure 5
Peak hip abduction moments (red) and peak support moments (blue) vs. age for the no-load condition during the push-off and pull-up stance phases. Each point represents an individual no-load trial. All moment values are divided by participant weight, and colored arrows on the far left show the direction of increasing moment magnitude. Pearson’s correlation was significant for all relationships, with r-values of (A) +0.830, (B) +0.833, (C) +0.304, and (D) +0.358. Results indicate that the magnitude of peak hip abduction increases with age, while the magnitude of peak support moment decreases with age. Full article ">

9 pages, 1144 KiB

Open AccessCommunication

Classifications Based on Dynamic Navicular Drop during Gait and Characteristics of Flat Foot Muscle Morphology

by Kengo Fukuda, Kazunori Okamura, Tomohiro Ikeda, Kohei Egawa and Shusaku Kanai

Biomechanics 2024, 4(4), 633-641; https://doi.org/10.3390/biomechanics4040045 - 16 Oct 2024

Viewed by 470

Abstract

This study investigated the collapse of the medial longitudinal arch (MLA) as a risk factor for medial tibial stress syndrome (MTSS), hypothesizing that overuse of extrinsic foot muscles to prevent MLA collapse can lead to disability. Twenty healthy adults (age: 20.8 ± 0.8, [...] Read more.

This study investigated the collapse of the medial longitudinal arch (MLA) as a risk factor for medial tibial stress syndrome (MTSS), hypothesizing that overuse of extrinsic foot muscles to prevent MLA collapse can lead to disability. Twenty healthy adults (age: 20.8 ± 0.8, height: 162.2 ± 10.4, weight: 54.9 ± 9, BMI: 20.8 ± 1.7) (39 feet) with a foot posture index score below 6 and no recent lower extremity orthopedic history participated. Ultrasonography measured foot muscle cross-sectional areas, while three-dimensional motion analysis using VICON assessed foot kinematics during gait, focusing on navicular height at initial contact (ICNH) and dynamic navicular drop (DND) during the stance phase. Hierarchical cluster analysis based on ICNH and DND compared muscle cross-sectional areas between clusters using ANOVA or Kruskal–Wallis test. The analysis indicated that ICNH was lower in clusters 1 and 3 than in cluster 2, and DND was smaller in clusters 1 and 2 than in cluster 3. Although there was no significant difference in muscle cross-sectional area between the clusters, the flexor hallucis longus tended to be thicker in cluster 1 than in cluster 3 (p = 0.051). The findings suggest that flexor digitorum longus may help prevent MLA compression during loading, indicating that overuse of extrinsic foot muscles may contribute to MTSS development. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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10 pages, 969 KiB

Open AccessArticle

Use of the Modified Thomas Test for Hip Flexor Stretching: What Are the Acute and Prolonged Effects?

by Dalibor Kiseljak and Vatroslav Jelovica

Biomechanics 2024, 4(4), 585-594; https://doi.org/10.3390/biomechanics4040041 - 28 Sep 2024

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Abstract

Background/Objectives: The flexibility deficits of hip flexors have been identified as potential biomechanical risk factors for the lumbo–pelvic–hip complex, with postural repercussions on the trunk and lower limbs. The purpose of this study was to conduct a single gravity stretching experiment and to [...] Read more.

Background/Objectives: The flexibility deficits of hip flexors have been identified as potential biomechanical risk factors for the lumbo–pelvic–hip complex, with postural repercussions on the trunk and lower limbs. The purpose of this study was to conduct a single gravity stretching experiment and to monitor its acute and prolonged effects. Methods: The sample comprised 14 healthy participants (8 females and 6 males). Data were collected during two-day measurement sessions. These analyzed via Kinovea software. The single intervention (i.e., gravity stretching) was performed on the first day. A modified Thomas test was used at the same time in two ways, both as a measurement and as an intervention tool. Stretching was achieved by relaxing in a position to perform the modified Thomas test where, each participant lies completely relaxed for 3 min, allowing gravity to stretch the hip flexors of the examined limb. Results: After intervention, a significant acute increase in hip extension range of motion and a decrease in knee extension range of motion were found. We did not find any significant prolonged effects; moreover, after 48 h, the hip range of motion almost returned to the initial value. Conclusions: A single 3 min stretch is very effective in terms of achieving immediate changes in the range of motion, but insufficient for long-term improvements in flexibility. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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15 pages, 3719 KiB

Open AccessArticle

The Impact of Fatigue in Foot-Stabilizing Muscles on Foot Pronation during Gait and a Comparison of Static and Dynamic Navicular Drop Assessments

by Stephan Becker, Robin Göddel, Carlo Dindorf, David Littig, Michael Fröhlich and Oliver Ludwig

Biomechanics 2024, 4(3), 551-565; https://doi.org/10.3390/biomechanics4030039 - 5 Sep 2024

Viewed by 776

Abstract

Background: Individuals may exhibit altered foot pronation during gait when fatigue sets in. Therefore, a more evidence-based understanding of these fatigue-induced changes may be helpful for future gait analysis and return-to-play tests since fatigue can provide new insights that might explain a person’s [...] Read more.

Background: Individuals may exhibit altered foot pronation during gait when fatigue sets in. Therefore, a more evidence-based understanding of these fatigue-induced changes may be helpful for future gait analysis and return-to-play tests since fatigue can provide new insights that might explain a person’s complaints. Methods: A total of 25 healthy individuals (12♂, 13♀; 24.3 ± 2.7 years; 174.9 ± 9.09 cm; 70 ± 14.2 kg; BMI: 22.7 ± 2.8) participated in this controlled non-randomized study of unilateral fatigue of the right foot’s stabilizing muscles with regard to the pronation of the foot, measured by navicular drop (ND) in static (statND; standing) and dynamic (dynND; walking) states. The left foot served as the control. Surface electromyography was used to verify fatigue. Results: While the statND did not change, the dynND increased significantly by 1.44 ± 2.1 mm (=22.3%) after the foot-stabilizing muscles experienced fatigue. No correlation was found between the statND and dynND. Conclusions: Muscular fatigue can affect foot pronation. The dynND appears to be more representative of the loads in everyday life, whereby most studies use the statND. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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9 pages, 2504 KiB

Open AccessArticle

Ankle Stability and Dynamic Single-Leg Balance in Collegiate Jumping Athletes versus Non-Athletes

by Grant Garza, Braden Harrison, Tim O’Meara, Zachary Potts and You-jou Hung

Biomechanics 2024, 4(3), 542-550; https://doi.org/10.3390/biomechanics4030038 - 5 Sep 2024

Viewed by 727

Abstract

The purpose of this study was to compare ankle stability and dynamic single-leg balance between jumping athletes and non-athletes, and to examine the correlation between ankle stability and dynamic single-leg balance. Thirty-eight jumping athletes and thirty-seven non-athletes participated in this study. The Cumberland [...] Read more.

The purpose of this study was to compare ankle stability and dynamic single-leg balance between jumping athletes and non-athletes, and to examine the correlation between ankle stability and dynamic single-leg balance. Thirty-eight jumping athletes and thirty-seven non-athletes participated in this study. The Cumberland Ankle Instability Tool (CAIT) was used to assess ankle stability. The Y-Balance Test (YBT) was used to examine single-leg balance in the anterior (AN), posteromedial (PM), and posterolateral (PL) directions. The results show that 42.11% of jumping athletes and 21.62% of non-athletes exhibited chronic ankle instability (CAI) in their examined leg. In addition, jumping athletes exhibited significantly worse ankle stability than non-athletes (p = 0.038). The two groups showed no significant difference in the YBT scores in all directions (p = 0.113 AN, 0.567 PM, 0.542 PL). Very low correlations were found between the CAIT and the YBT scores in all directions (r < 0.107). In conclusion, single-leg jumping athletes experienced a higher prevalence of CAI and significantly worse ankle stability than non-athletes. However, the results of the YBT did not correlate strongly with the CAIT scores, suggesting an inability to predict dynamic single-leg balance deficits based on perceived ankle stability alone in this population. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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13 pages, 1875 KiB

Open AccessArticle

Effects of Aging on Patellofemoral Joint Stress during Stair Negotiation on Challenging Surfaces

by Nicholas L. Hunt, Amy E. Holcomb, Clare K. Fitzpatrick and Tyler N. Brown

Biomechanics 2024, 4(3), 507-519; https://doi.org/10.3390/biomechanics4030036 - 2 Sep 2024

Viewed by 657

Abstract

This study examined the effect of age and surface on patellofemoral joint (PFJ) stress magnitude and waveform during stair ascent and descent tasks. A total of 12 young and 12 older adults had knee biomechanics quantified while they ascended and descended stairs on [...] Read more.

This study examined the effect of age and surface on patellofemoral joint (PFJ) stress magnitude and waveform during stair ascent and descent tasks. A total of 12 young and 12 older adults had knee biomechanics quantified while they ascended and descended stairs on normal, slick, and uneven surfaces. The peak of stance (0–100%) PFJ stress and associated components were submitted to a two-way repeated measures ANOVA, while the PFJ stress waveform was submitted to statistical parametric mapping two-way ANOVA. During stair ascent, older adults exhibited greater PFJ stress waveforms, from 55 to 59% and 74 to 84% of stance (p < 0.001) as well as greater PFJ stress–time integral across stance (p = 0.003), and later peak PFJ stress, than young adults (p = 0.002). When ascending on the uneven surface, participants exhibited smaller PFJ stress from 9 to 24% of stance compared to the normal surface, but greater PFJ stress from 75 to 88% and from 63 to 68% of stance (p < 0.001) as well as greater PFJ stress–time integrals compared to normal and slick surfaces (p < 0.032). During stair descent, older adults exhibited a smaller PFJ contact area range (p = 0.034) and peak knee flexion angle (p = 0.022) than young adults. When descending on the slick surface, participants exhibited smaller PFJ stress from 5 to 18% of stance, but greater stress, from 92 to 98% of stance (both: p < 0.001), compared to the normal surface. Negotiating slick and uneven stairs may produce knee biomechanics that increase PFJ stress, and the larger, later PFJ stress exhibited by older adults may further increase their risk of PFJ pain. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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13 pages, 16844 KiB

Open AccessArticle

The Effects of Midfoot/Hindfoot Fusions on the Behaviour of Peroneus Longus Tendon in Adult-Acquired Flatfoot Deformity: A Biomechanical and Finite Element Analysis

by Nicolás Yanguma-Muñoz, Brayan David Solorzano Quevedo, Chandra Pasapula, Isabel Austin, Ricardo Larrainzar-Garijo, Javier Bayod and Christian Cifuentes-De la Portilla

Biomechanics 2024, 4(3), 494-506; https://doi.org/10.3390/biomechanics4030035 - 23 Aug 2024

Viewed by 664

Abstract

Adult-acquired flatfoot has been considered to arise from tibialis posterior tendon deficiency. Recent evidence shows that arch stability is mainly maintained by structures such as plantar fascia and spring ligament. The dysfunction of these ’passive’ stabilizers results in loss of arch integrity that [...] Read more.

Adult-acquired flatfoot has been considered to arise from tibialis posterior tendon deficiency. Recent evidence shows that arch stability is mainly maintained by structures such as plantar fascia and spring ligament. The dysfunction of these ’passive’ stabilizers results in loss of arch integrity that causes forefoot pronation and reactive tendon overload, especially in the tibialis posterior tendon and peroneus longus tendon. The peroneus longus tendon (PLT) spans several midfoot joints and overloads with arch lengthening. The biomechanical stress/changes that occurs in this tendon are not well recognized. This study evaluates the biomechanical consequences that fusions have on peroneus longus tendon stresses in soft-tissue deficiencies associated with flatfoot deformity. A complete computational human foot model was used to simulate different scenarios related to the flatfoot deformity and associated common midfoot/hindfoot fusions, to quantify the biomechanical changes in the peroneus longus tendon. The results showed that the stress of the peroneus longus tendon is especially affected by the fusion of hindfoot joints and depends on the soft tissue types that fail, causal in generating the flatfoot. These results could be useful to surgeons when evaluating the causes of flatfoot and the secondary effects of surgical treatments on tissues such as the peroneus longus tendon. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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11 pages, 936 KiB

Open AccessArticle

Impact of Obesity on Foot Kinematics: Greater Arch Compression and Metatarsophalangeal Joint Dorsiflexion despite Similar Joint Coupling Ratios

by Freddy Sichting, Alexandra Zenner, Lutz Mirow, Robert Luck, Lydia Globig and Nico Nitzsche

Biomechanics 2024, 4(2), 235-245; https://doi.org/10.3390/biomechanics4020013 - 16 Apr 2024

Cited by 1 | Viewed by 1122

Abstract

This study investigates the sagittal plane dynamics of the foot, particularly the metatarsophalangeal (MTP) joint and medial longitudinal arch (MLA) movements, in relation to obesity and foot health. The kinematics of the MTP and arch joints were measured in 17 individuals with class [...] Read more.

This study investigates the sagittal plane dynamics of the foot, particularly the metatarsophalangeal (MTP) joint and medial longitudinal arch (MLA) movements, in relation to obesity and foot health. The kinematics of the MTP and arch joints were measured in 17 individuals with class 2–3 obesity (BMI > 35 kg/m²) and 10 normal-weight individuals (BMI ≤ 24.9 kg/m²) using marker-based tracking. Analysis was conducted during heel lifting while seated and during walking at self-selected speeds. The results indicated that obese participants exhibited 20.92% greater MTP joint dorsiflexion at the end of the push-off phase and 19.84% greater MLA compression during the stance phase compared to normal-weight controls. However, no significant differences were found in the kinematic joint coupling ratio. While these findings reveal the different biomechanical behaviors of the MTP joint and MLA in obese compared to normal-weight individuals, it is important to interpret the implications of these differences with caution. This study identifies specific biomechanical variations that could be further explored to understand their potential impact on foot health in obese populations. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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Kinematic analysis of the foot. Panel (A): Static measurements of the foot illustrating foot length (FL), truncated foot length (TFL), and dorsal height at 50% foot length (DH). Key markers (shown as black dots) are positioned at specific anatomical landmarks: the hallux (HLX), the first metatarsophalangeal joint (MET I), the navicular tuberosity (NAV), and the medial aspect of the calcaneus (CAL). Panel (B): Representation of the foot during the heel raising task in a seated position. Motion was captured in the sagittal plane using a high-speed camera, focusing on markers required to calculate the metatarsophalangeal (MTP) angle (shown as α) and the medial longitudinal arch (MLA) angle (shown as β). Panel (C): The plot represents the relationship between the MTP and MLA angles during the push-off phase of walking. The degree of coupling between the MTP and MLA joints during toe extension was determined using a sliding window analysis technique. Specifically, segments or ‘windows’ of 50 consecutive data points were examined. The correlation coefficient was calculated within each window to assess linearity and identify the segment that displayed the most linear relationship between the movements of the toe and the medial longitudinal arch. The slope of the line was then calculated using the 50 data points within this identified window (kinematic joint coupling ratio = Δβ/Δα). Full article ">Figure 2
The panels provide a comparison of MTP joint motion and MLA angle in normal-weight (NW, red lines and bars) and obese (OW, black lines and bars) subjects during walking. Panels (A,C) show the MTP joint motions observed in each group, while panels (B,D) focus on the variations in MLA angles. To differentiate between the two groups of subjects, red dashed lines are used for NW subjects and black solid lines are used for OW subjects. The shaded bands indicate the standard deviations. For box plots, black and white dots added to boxes represent means. The results of the statistical comparison between groups (p-values) are included in panels (C,D). Full article ">

10 pages, 2236 KiB

Open AccessCommunication

The Relationship between Balance Confidence and Center of Pressure in Lower-Limb Prosthesis Users

by Gary Guerra, John D. Smith and Eun-Jung Yoon

Biomechanics 2023, 3(4), 561-570; https://doi.org/10.3390/biomechanics3040045 - 1 Dec 2023

Viewed by 1427

Abstract

Background: Agreement between the activities-specific balance confidence scale (ABC) and center of pressure (CoP) in prosthesis users is still very much unknown. The purpose of this study was to investigate the agreement between ABC and CoP in lower-limb prosthesis users. Methods: Twenty-one individuals [...] Read more.

Background: Agreement between the activities-specific balance confidence scale (ABC) and center of pressure (CoP) in prosthesis users is still very much unknown. The purpose of this study was to investigate the agreement between ABC and CoP in lower-limb prosthesis users. Methods: Twenty-one individuals with lower-limb prostheses were recruited. Participants were provided with the ABC scale and performed static balance tasks during eyes opened (EO) and eyes closed (EC) conditions whilst standing on a force platform. Pearson product moment coefficients between CoP displacements and ABC scores were performed. Participants were also stratified by those who had better (≥80 on ABC scale) and less (<80 on ABC scale) perceived balance confidence. Displacement was compared using an independent t-test with Cohen’s d to estimate effect size with alpha set at 0.05 for these tests. Results: There was a significant inverse moderate relationship between eyes opened displacement (EOD) (18.3 ± 12.5 cm) and ABC (75.1 ± 18.3%), r = ₍₁₉₎−0.58, p = 0.006, as well as eyes closed displacement (ECD) (37.7 ± 22.1 cm) and ABC, r = ₍₁₉₎−0.56, p = 0.008. No significant difference in EOD (t₍₁₉₎ = 1.36, p = 0.189, d = 0.61) and ECD (t₍₁₉₎ = 1.47, p = 0.156, d = 0.66) was seen between those with greater and less balance confidence. Conclusions: Self-report and performance-based balance outcome measures are recommended when assessing lower-limb prostheses users. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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Those who had lower displacement were more likely to have greater confidence in their balance during both eyes open and eyes closed trials, p < 0.05. Full article ">Figure 2
While those with greater balance confidence displaced 19.1 cm less during EOD testing than those with lower confidence, and 36.3 cm less during ECD testing; these differences were not significant (p > 0.05). Full article ">Figure 3
During EOD testing, those with unilateral amputation displaced 21.8 cm less than those with other (transfemoral/multiple limb amputation), and 33.1 cm less during ECD testing, neither of which were significant, p > 0.05. Full article ">Figure 4
The difference in EOD (31.2 cm) between those who experienced limb loss from trauma was significant compared to those who experienced limb loss for other reasons (p = 0.022). The difference during ECD (41.9 cm) was not significant, p = 0.092. Full article ">Figure 5
There was no relationship between BMI in displacement for both EOD and ECD, p < 0.05. Full article ">

16 pages, 7478 KiB

Open AccessArticle

Definition of a Global Coordinate System in the Foot for the Surgical Planning of Forefoot Corrections

by Sanne Krakers, Anil Peters, Sybrand Homan, Judith olde Heuvel and Gabriëlle Tuijthof

Biomechanics 2023, 3(4), 523-538; https://doi.org/10.3390/biomechanics3040042 - 2 Nov 2023

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Abstract

Forefoot osteotomies to improve the alignment are difficult procedures and can lead to a variety of complications. Preoperative planning in three dimensions might assist in the successful management of forefoot deformities. The purpose of this study was to develop a global coordinate system [...] Read more.

Forefoot osteotomies to improve the alignment are difficult procedures and can lead to a variety of complications. Preoperative planning in three dimensions might assist in the successful management of forefoot deformities. The purpose of this study was to develop a global coordinate system in the foot for the planning of forefoot corrections. Two strategies (CS1 and CS2) were developed for defining a global coordinate system that meets the criteria of being well-defined, robust, highly repeatable, clinically relevant, compatible with foot CT scans, independent of the ankle joint angle, and does not include bones in the forefoot. The absolute angle of rotation was used to quantify repeatability. The anatomical planes of the coordinate systems were visually inspected by an orthopedic surgeon to evaluate the clinical relevancy. The repeatability of CS1 ranged from 0.48° to 5.86°. The definition of CS2 was fully automated and, therefore, had a perfect repeatability (0°). Clinically relevant anatomical planes were observed with CS2. In conclusion, this study presents an automated method for defining a global coordinate system in the foot according to predefined requirements for the planning of forefoot corrections. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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12 pages, 3066 KiB

Open AccessArticle

Patient-Specific 3D Virtual Surgical Planning Using Simulated Fluoroscopic Images to Improve Sacroiliac Joint Fusion

by Nick Kampkuiper, Jorm Nellensteijn, Edsko Hekman, Gabriëlle Tuijthof, Steven Lankheet, Maaike Koenrades and Femke Schröder

Biomechanics 2023, 3(4), 511-522; https://doi.org/10.3390/biomechanics3040041 - 1 Nov 2023

Cited by 2 | Viewed by 1679

Abstract

Sacroiliac (SI) joint dysfunction can lead to debilitating pain but can be treated with minimally invasive sacroiliac joint fusion (SIJF). This treatment is commonly performed using 2D fluoroscopic guidance. This makes placing the implants without damaging surrounding neural structures challenging. Virtual surgical planning [...] Read more.

Sacroiliac (SI) joint dysfunction can lead to debilitating pain but can be treated with minimally invasive sacroiliac joint fusion (SIJF). This treatment is commonly performed using 2D fluoroscopic guidance. This makes placing the implants without damaging surrounding neural structures challenging. Virtual surgical planning (VSP) using simulated fluoroscopic images may improve intraoperative guidance. This article describes a workflow with VSP in SIJF using simulated fluoroscopic images and evaluates achieved implant placement accuracy. Ten interventions were performed on 10 patients by the same surgeon, resulting in a total of 30 implants; the median age was 39 years, and all patients were female. The overall mean implant placement accuracy was 4.9 ± 1.26 mm and 4.0 ± 1.44°. There were no malpositioning complications. VSP helped the surgeon understand the anatomy and determine the optimal position and length of the implants. The planned positions of the implants could be reproduced in surgery with what appears to be a clinically acceptable level of accuracy. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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Three orientations of the pelvis in which fluoroscopy images are made during sacroiliac joint fusion (SIJF). During the procedure, the patient is placed in a prone position, and images are made in the lateral (A), inlet (B), and outlet (C) views. A central sagittal plane (D) is shown in which the directions of the inlet and outlet view are displayed. Full article ">Figure 2
Visualization of the three steps to create a virtual surgical plan. Step 1: Based on preoperative CT imaging, the pelvis and synovial part of the sacroiliac (SI) joint are segmented using Materialise Mimics. Step 2: The implants are virtually inserted inside the CT slices. Afterwards, the 3D models of the pelvis and SI joint, along with the implants, can be visualized. Step 3: Based on the position of the implants, guide pins and torus shapes that resemble the entry point of the guide pin in the ilium are made. Subsequently, the guide pins, torus shapes, and segmented pelvis are used to create simulated fluoroscopic images. To visualize the important landmarks in the segmented lateral view, the left ICD, the right ICD, and the anterior sacral wall are highlighted in the lateral view in Step 2 (see <a href="#biomechanics-03-00041-f001" class="html-fig">Figure 1</a> for an explanation of the different fluoroscopy views). The blue arrow in step 1 indicates the transition from CT data to 3D models. In step 3 the blue arrow indicates the transition from 3D models to 2D simulated fluoroscopic images. The implants are depicted in different colors for convenient identification of the implants, the first implant (cephalad S1) is depicted in red, the second implant (caudal S1) is depicted in green and the third (S2 implant) is depicted in blue. Full article ">Figure 3
Overview of the intraoperative set up with a C-arm during SIJF. (A) Side-by-side view of the intraoperative and simulated images; (B,C) enhanced view of the simulated and intraoperative fluoroscopic images, respectively. Full article ">Figure 4
Overview of the method used to determine the implant deviation between the virtual surgical plan and the postoperative situation. In the first element of this figure, it is shown how the CT coordinate system is located with respect to the preoperative pelvis. The pelvis from the virtual surgical plan and postoperative pelvis are matched, i.e., registered. Subsequently, analytical primitives are placed in all implants. The deviations are then calculated based on the coordinates of the apex and end of the analytical primitives. A preoperative planned implant and postoperatively placed implant are shown (A) with their corresponding analytical primitives (B). The positional deviations are the ΔX, ΔY, ΔZ, and total distance between the apexes of the planned and postoperative implant. Furthermore, it is shown how the 2D and 3D angles between the implants are determined. In the right part of the figure, the magnitude of the deviation is intentionally amplified in order to enhance visual clarity. The preoperatively planned implants are depicted in cyan and the postoperatively placed implants are depicted in yellow. The segmentation of the postoperative pelvis is depicted in red. Full article ">Figure 5
Boxplots containing the implant placement accuracy measures of 30 implants. In (A), the boxplots of the positional deviations are shown, and in (B), the angular deviations are shown. The colors of each boxplot correspond to the color that is used in <a href="#biomechanics-03-00041-f004" class="html-fig">Figure 4</a> to explain the direction of deviation. The boxplots represent the median, quartile 1, quartile 3, minimum, maximum, and outliers. Additionally, the mean values are depicted using asterisks. Full article ">Figure 6
In this figure, the accuracy per intervention per implant is shown. During each intervention three implants were placed, comprising thirty implants per graph. (A) shows the total position deviations, and (B) shows the total angular deviations. The colors match the colors of the variables in <a href="#biomechanics-03-00041-f004" class="html-fig">Figure 4</a> and <a href="#biomechanics-03-00041-f005" class="html-fig">Figure 5</a>. The coefficients of determination were calculated; these are <math display="inline"><semantics> <mrow> <msup> <mrow> <mi>R</mi> </mrow> <mrow> <mn>2</mn> </mrow> </msup> <mo>=</mo> <mn>0.01002</mn> </mrow> </semantics></math> and <math display="inline"><semantics> <mrow> <msup> <mrow> <mi>R</mi> </mrow> <mrow> <mn>2</mn> </mrow> </msup> <mo>=</mo> <mn>0.19162</mn> </mrow> </semantics></math> for the total positional deviation and the total angular deviation, respectively. Full article ">

12 pages, 2630 KiB

Open AccessArticle

Relationship between Body Center of Mass Velocity and Lower Limb Joint Angles during Advance Lunge in Skilled Male University Fencers

by Kenta Chida, Takayuki Inami, Shota Yamaguchi, Yasumasa Yoshida and Naohiko Kohtake

Biomechanics 2023, 3(3), 377-388; https://doi.org/10.3390/biomechanics3030031 - 18 Aug 2023

Cited by 2 | Viewed by 1723

Abstract

We investigated the influence of advance lunging in fencing from the perspective of velocity and lower limb joint angles to identify how the joint angles contribute to the peak velocity in a lunge with advance (LWA). Fourteen skilled athletes (age: 19.6 ± 0.9 [...] Read more.

We investigated the influence of advance lunging in fencing from the perspective of velocity and lower limb joint angles to identify how the joint angles contribute to the peak velocity in a lunge with advance (LWA). Fourteen skilled athletes (age: 19.6 ± 0.9 years, height: 171.2 cm ± 5.2 cm, weight: 63.7 kg ± 5.3 kg, and fencing experience: 9.7 ± 3.1 years) participated by performing two types of attacking movements, and data were collected with a 3D movement analysis system. A correlation between the peak velocity of the body center of mass (CoM) in an advance lunge and several joint angle variables (rear hip peak flexion angle (r = 0.63), rear ankle peak dorsiflexion angle (r = −0.66), rear ankle range of motion (r = −0.59), and front hip peak extension angle (r = 0.54)) was revealed. In addition, the joint angle variables that significantly predicted peak CoM velocity during an LWA were the rear knee peak flexion angle (β = 0.542), rear knee peak extension angle (β = −0.537), and front knee peak extension angle (β = −0.460). Our findings suggest that the rear leg hip joint, rear leg ankle joint, and front leg hip joint may control the acceleration generated by an LWA. Furthermore, more flexion of the rear leg knee joint in the early phase of the lunge and greater extension of the rear and front leg knee joints at the end of the lunge phase may help increase peak velocity. Full article

(This article belongs to the Special Issue Personalized Biomechanics and Orthopedics of the Lower Extremity)

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