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Background: Although increases in knee adduction moment (KAM) and angle (KAA) during gait are considered key pathologies that produce mechanical overload in the medial compartment of knee osteoarthritis (OA), it is unclear how these pathologies are related to subjective pain. The purpose of this study was to examine how subjective pain is related to such pathologies., Methods: Gait analysis was performed in 31 participants with medial knee OA. The knees were classified into three groups based on Kellgren-Lawrence (KL) grade: early (0 and 1), moderate (2), and severe (3 and 4). Subjective pain was evaluated by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index pain score. The knees were classified into low- and high-pain groups based on the pain score., Results: The WOMAC pain score did not correlate with either peak KAM or peak KAA. Although a positive correlation between static limb alignment and peak KAA was observed in the low-pain group, it was not observed in the high-pain group. Knee flexion angle at heel strike correlated negatively with the gap between static femorotibial angle and peak KAA in the high-pain group., Conclusions: Although a direct correlation between subjective pain and peak KAM or KAA was not observed, our results suggest a compensatory movement in the high-pain group of participants to reduce KAA increases in the early stance phase. Such movements would be one of the reasons why it is difficult to obtain a consistent relationship between subjective pain and load-related parameters., Competing Interests: Declaration of competing interest The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. This study was financially supported by Teijin Limited., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: To clarify the effect of posterior correction and fusion surgery on the trunk-pelvic kinematics during gait in adolescent idiopathic scoliosis (AIS) patients with single thoracic major curve., Methods: Among preoperative AIS patients who planned correction surgery, 18 patients with Lenke type 1A or B were selected for this study. All patients were female. The patients' trunk and pelvic kinematics during gait were measured three-dimensionally and dynamically using reflective markers, optoelectronic motion capture system. The gait analysis was performed before and 1-2 years after surgery. The trunk and pelvic symmetry during gait was evaluated at coronal, sagittal, and transverse planes between concave and convex sides., Results: The trunk and pelvic angles in sagittal and coronal planes were equivalent between concave and convex sides before and after surgery. Preoperatively, transverse trunk rotation angles were significantly deviated toward the concave (left) side during both static standing (4.3 ± 2.0°) and gait (8.8 ± 0.6°, p < 0.01). Preoperative transverse pelvic rotation angles were significantly deviated toward the convex side during static standing (4.0 ± 3.8°). However, pelvis displayed with symmetric rotational kinematics during gait. Postoperatively, the deviated transverse trunk rotation angle significantly decreased (1.6 ± 0.3°), and the transverse rotational kinematics of both trunk and pelvis improved to symmetric., Conclusions: Posterior correction and fusion surgery have improved preoperative asymmetric global rotational kinematics of trunk and pelvis in transverse plane to symmetric postoperatively in AIS patients with thoracic single major curve. These slides can be retrieved under Electronic Supplementary Material.

To clarify the mechanism underlying the development of foot disorders such as diabetic ulcers and deformities, it is important to understand how the foot surface elongates and contracts during gait. Such information is also helpful for improving the prevention and treatment of foot disorders. We therefore measured temporal changes in the strain distribution on the foot surface during human walking. Five adult male participants walked across a glass platform placed over an angled mirror set in a wooden walkway at a self-selected speed and the dorsolateral and plantar surfaces of the foot were filmed using two pairs of synchronized high-speed cameras. Three-dimensional (3D) digital image correlation was used to quantify the spatial strain distribution on the foot surface with respect to that during quiet standing. Using the proposed method, we observed the 3D patterns of foot surface strain distribution during walking. Large strain was generated around the ball on the plantar surface of the foot throughout the entire stance phase, due to the windlass mechanism. The dorsal surface around the cuboid was stretched in the late stance phase, possibly due to lateral protruding movement of the cuboid. It may be possible to use this technique to non-invasively estimate movements of the foot bones under the skin using the surface strain distribution. The proposed technique may be an effective tool with which to analyze foot deformation in the fields of diabetology, clinical orthopedics, and ergonomics., (Copyright © 2017. Published by Elsevier Ltd.)

Background: Analysis of dynamic knee loading during gait is essential to prevent mechanical failures following total knee arthroplasty. External knee adduction moment during gait is the primary factor producing medial joint reaction force, and an increase in the moment is directly related to an increase in the medial compartment load on the knee., Methods: Knee adduction moment during gait in 39 knees of 32 female patients following a posterior stabilized knee replacement with a single surgeon was evaluated at 1.3months following surgery. A cut-off moment was determined as mean+1 standard deviation (SD) of the moment from 10 healthy subjects, and patients' knees were divided into high- and normal-moment groups. Significant differences in clinical assessments and gait parameters between the two groups were assessed., Results: Based on the cut-off moment, 23 knees were grouped into normal knees and 16 knees were grouped into high-moment knees. High-moment knees showed identical femorotibial angles and knee society scores but had greater toe-out angles and medially directed ground reaction forces compared to normal-moment knees. High-moment knees showed strong correlations between peak moment and knee adduction angle, and frontal plain moment arm., Conclusions: The clinical significance of a high knee adduction moment following total knee arthroplasty remains unclear, but dynamic frontal alignment during gait is one of the key factors for residual high-moment knees following surgery., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background and Purpose: Adolescent idiopathic scoliosis (AIS) is a structural, lateral curvature with rotation of the spine that develops around puberty. The influence of this spinal deformity on three-dimensional trunk movements during gait has not yet been elucidated. The aim of this study was to determine the influence of spinal curve pattern (single thoracic curve vs. single lumbar curve) on trunk kinematics during gait., Methods: Twenty-two patients with a single thoracic curve (Lenke type 1) and 17 patients with a single lumbar curve (Lenke type 5) were included in this study. Trunk symmetry in the sagittal, coronal, and transverse planes during gait was evaluated using an optoelectronic motion capture system., Results: In the type 1 group, the trunk was significantly rotated towards the concave side in the transverse plane during gait (mean difference of transverse rotation angle between concave side load and the convex side load, 8.8±0.6°, p<0.01). In the type 5 group, the trunk was significantly rotated towards the convex side in the coronal plane throughout the stance phase of gait (mean difference of coronal inclination angle, 1.9±0.3°, p<0.05)., Conclusions: The AIS patients with a single thoracic curve showed asymmetrical trunk movement in the transverse plane, and patients with a single lumbar curve showed asymmetrical trunk movement in the coronal plane. These results indicate that the spinal curve pattern influenced trunk kinematics, and suggest that the global postural control strategy of patients with AIS differs according to the curve pattern., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: To date, the knee kinematics of a discoid lateral meniscus (DLM) has not been elucidated. The aim was to investigate the three-dimensional knee kinematics in knees with a DLM using gait analysis., Methods: Ten patients (mean: 14years) diagnosed with bilateral DLM and unilaterally symptomatic snapping as well as 10 healthy controls (mean: 23years) participated in the study. Each patient with a DLM had unilaterally snapping knee in full extension and deep flexion. The three-dimensional gait analysis was performed with the point cluster technique. All subjects were asked to walk on a level floor at the speed of their choice. In the sagittal plane, knee excursion was separately evaluated during the weight acceptance phase and the mid-stance phase. In the axial plane, knee excursion during the stance phase was assessed. Finally, knee excursion during the whole gait cycle was evaluated in the frontal plane. Statistical comparison was conducted between groups, and between both sides in the DLM group., Results: In the sagittal plane, knee excursions during the weight acceptance phase and the mid-stance phase were significantly smaller in the DLM group than in the control group; in addition, these were smaller on the symptomatic side than on the asymptomatic side in the DLM group. In the axial plane, knee excursion was also significantly smaller on the symptomatic side than on the asymptomatic side in the DLM group, whereas the frontal knee motion did not differ significantly., Conclusion: Less knee motion in the sagittal plane may prevent snapping during extension and flexion in patients with a DLM., Level of Evidence: III., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The purpose of the current study was to longitudinally evaluate how preoperative knee kinematics change after ACL reconstruction. Three-dimensional gait analysis using the point cluster method was undertaken on the same subjects preoperatively and at 3, 6, and 12 months after ACL reconstructive surgery. Thirteen subjects (7 males, 6 females) were examined while performing 2 different activities at self-selected speeds: walking and walk-pivoting (walking, pivoting toward the landed limb side and walking away). The contralateral knees of subjects at 12 months postoperatively were selected as control knees. Flexion range in the stance phase increased with time after surgery, but remained lower than in the contralateral knee, even at 12 months postoperatively (P < .05) during walking and walk-pivoting. The rotation pattern during walking and walk-pivoting showed an offset toward external rotation by 6 months postoperatively compared with control knees, while at 12 months postoperatively the offset had nearly disappeared and the movement pattern resembled that in control knees. These findings suggest that a return to sport participation by 6 months after ACL reconstruction requires careful consideration. Depending on the type of sport, activity restriction even after 12 months may need to be considered to allow complete kinematic restoration.

Background: Our purpose was to clarify the differences of three-dimensional knee kinematics in anterior cruciate ligament (ACL)-deficient patients between with and without meniscal injury using gait analysis., Methods: A total of 72 knees in 36 young athletes with primary and unilateral ACL injury, with a mean age of 22 years, participated. Gait analysis was done before surgery. According to the arthroscopic findings, patients were divided into two groups. The patients with an unstable meniscal tear were allocated to the meniscal injury group (ACL+M group), and the patients without a meniscal tear were allocated to the no meniscal injury group (ACL group). In the gait analysis, three-dimensional knee kinematics was evaluated and compared., Results: The patients in both groups exhibited lower sagittal plane knee excursions and peak knee extension angles on the affected limb than on the unaffected limb during the mid-stance. In terms of the axial plane, a rotation angle was significantly smaller in the affected knees than in the unaffected knees in the ACL group. On the other hand, an opposite phenomenon was observed in the ACL+M group. Moreover, a significantly larger rotation angle in the affected knees during the stance phase and the whole gait cycle was observed in the ACL+M group than in the ACL group., Conclusion: Increased rotational motion during the gait was observed in the ACL-deficient knees combined with unstable meniscal injuries. Meniscal condition may be a key factor for compensatory gait mechanics to prevent rotatory instability in ACL-deficient patients patients., Level of Evidence: III., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Varus thrust is an abnormal lateral knee motion frequently seen in patients with medial knee osteoarthritis (OA) during gait. It is a worsening of the alignment in the stance phase of the gait cycle and closely relates to disease progression. In this study, we measured the thrust quantitatively using skin markers and examined the relationship to other static and dynamic parameters. Forty-four knees in 32 patients (mean age, 72years; range, 64-81years) who exhibited the radiographic OA at least grade 2 according to the Kellgren-Lawrence (K-L) scale were enrolled. Gait analysis was performed for each patient to measure the amount of thrust and knee adduction moment. The amounts of thrust in subjects with K-L grades 2 (25 knees), 3 (13 knees), and 4 (6 knees) were 2.4°(±1.3°), 2.8°(±1.4°), and 7.2°(±5.3°), respectively and the knee adduction moments were 3.6(±1.5) %BW⁎Ht, 3.9(±1.2) %BW⁎Ht and 6.9(±2.2%) BW⁎Ht, respectively. The amount of thrust also exhibited significant correlation to static radiographic alignment (R=0.47: 95% confidence interval 0.67-0.21, p=0.0038) and showed greater correlation to the knee adduction moment (R=0.73: 95% confidence interval 0.84-0.55, p<0.001), which has been identified as an important dynamic index of the disease. The amount of thrust, which is able to be measured by simple inexpensive equipment, correlated to static and dynamic parameters and may offer an important clinical index for knee OA., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The purpose of the current study was to investigate the effect of knee flexion contracture on the knee mechanics both in affected and contralateral limbs during gait. Ten healthy old women, with mean age of 62 years, participated. Unilateral knee flexion contractures of 0, 15, and 30 degrees were simulated with a knee brace. All subjects performed walking trials with or without the simulation. Net knee extension moments, net knee adduction moments (%BW Ht), external knee forces (%BW), and maximum axial loading rate (%BW/s) at the knee were calculated both in contracture side and non-contracture side under different contracture conditions. Bilateral net knee extension moment gradually increased as the angle of contracture increased. The net knee extension moments in non-contracture limb were significantly larger with 15 and 30 degrees contracture than those without the contracture. Net knee adduction moment in non-contracture limb significantly increased with 15 and 30 degrees contracture. The knee shearing forces in contracture side and the knee compressive force in non-contracture side also significantly increased with 15 and 30 degrees simulation. As the flexion contracture became greater than 15 degrees , maximum axial loading rate also significantly increased in non-contracture side. From our results, the knee flexion contracture greater than 15 degrees led to mechanical overloads in both limbs. Correction of the contracture is clinically important to avoid any adverse effect.

Knee flexion contracture influences the physiological movements in lower extremities and may cause the kinematic changes of the trunk. Our purpose was to investigate static and dynamic changes in trunk kinematics with simulated knee flexion contracture. Ten healthy females averaged 62 years participated in our study. Unilateral knee flexion contractures of 15 degrees and 30 degrees were simulated with a knee brace. Relaxed standing and level walking were measured at our laboratory using a motion analysis system which consisted of five cameras, a force plate, and thirteen retro-reflective markers. Three-dimensional trunk kinematics and vertical knee forces (% Body Weight) with the contractures were compared with those without the contracture. The 15 degrees contracture did not significantly change trunk kinematics. However, the 30 degrees contracture significantly changed the kinematics in each of the following planes. In the coronal plane, the trunk tilted to the contracture side in standing and walking. In the sagittal plane, posterior inclination of the pelvis in standing significantly increased. In addition, anterior inclination of the trunk and pelvis during walking significantly increased. In the axial plane, trunk rotation to the unaffected side significantly decreased during walking. The vertical knee force in the contracture limb decreased, being accompanied by the increase of the force in the unaffected limb during standing and walking. Results of our study suggest that knee flexion contracture significantly influences three-dimensional trunk kinematics during relaxed standing and level walking, and will lead to spinal imbalance. These facts may explain the onset of the "Knee-Spine Syndrome".

Objective: Two lateral wedged insoles were compared: one with, and the other without, subtalar strapping.Methods: Twenty-one patients (age 58-83, mean 72) with medial knee osteoarthritis (OA) were enrolled. Thirty-seven knees in the patients were divided into three groups based on the Kellgren and Lawrence OA grading system; grades 2 (cases=20), 3 (cases=11), and 4 (cases=6). The subjects were tested during walking barefoot and during walking with a silicon rubber lateral wedged insole with elevation of 10 mm attached to a barefoot. Gait analysis was performed on a 10 m walkway for each subject under three different walking conditions; barefoot, wearing a conventional insole, and a subtalar strapping insole. Peak knee varus moment during gait was measured under each condition, and compared between the three conditions and between the OA grades.Results: On the whole (cases=37), the peak varus moment was significantly reduced by wearing either of the insoles, compared to walking barefoot. The reduction was more obvious with the strapping insole (-13%, P<0.01), compared with the conventional insole (-8%, P<0.05). In moderate OA patients (grades 2 and 3), the moments were significantly lower with the strapping insole, compared with the conventional insole (P=0.0048 and 0.005, respectively). However, no significant difference was detected in severe OA patients (grade 4) between the two types of insoles (P=0.4).Conclusions: Both lateral wedged insoles significantly reduced the peak medial compartment load during gait. The subtalar strapping insole had a greater effect than the conventional insole, particularly in patients with moderate medial knee OA. [ABSTRACT FROM AUTHOR]