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14. Association Between Knee Load and Pain: Within‐Patient, Between‐Knees, Case–Control Study in Patients With Knee Osteoarthritis

Author

Birmingham, Trevor B., primary, Marriott, Kendal A., additional, Leitch, Kristyn M., additional, Moyer, Rebecca F., additional, Lorbergs, Amanda L., additional, Walton, Dave M., additional, Willits, Kevin, additional, Litchfield, Robert B., additional, Getgood, Alan, additional, Fowler, Peter J., additional, and Giffin, J. Robert, additional

Published
2019
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15. Dynamic Loading and Pain in Knee Osteoarthritis: Effects of Limb Realignment and Ligament Reconstruction Surgeries

Author

Marriott, Kendal

Subjects
musculoskeletal diseases, high tibial osteotomy, Physical Therapy, anterior cruciate ligament reconstruction, musculoskeletal system, human activities, knee osteoarthritis, gait biomechanics, varus alignment
Abstract

Painful loading of the knee during walking is a key feature of knee osteoarthritis (OA). The external knee moments derived from three-dimensional gait analysis represent dynamic knee loads and may help evaluate surgical interventions. However, the relationships between knee moments and pain and the effects of surgery remain unclear. The overall purpose of this thesis was to investigate knee moments and pain during walking in patients with moderate medial knee OA, including the effects of limb realignment and ligament reconstruction surgeries. This thesis includes three studies investigating knee moments in patients with medial compartment tibiofemoral OA. Chapter 2 describes a cross-sectional study examining the relationship between knee pain and knee moments during walking, while controlling for extraneous factors by comparing limbs within 265 patients with medial knee OA. Using conditional logistic regression, results indicated greater odds of an increase in pain during walking with increased knee adduction moment, adduction impulse and internal rotation moment, and decreased knee flexion moment. These findings suggest a strong relationship between knee moments (in all three planes of motion) and knee pain during walking when between-person confounding is lessened. Chapter 3 describes a prospective cohort study evaluating the bilateral changes in knee moments in all three planes of motion in 33 patients undergoing combined medial opening-wedge high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction (HTO-ACLR). Patients underwent three-dimensional gait analysis, patient-reported outcomes and radiographic analysis preoperatively, 2 years postoperatively and a minimum 5 years postoperatively. Results indicated significant reductions in the knee adduction and internal rotation moments in the surgical limb, and a decrease in the knee flexion moment and an increase in the knee extension moment in both limbs. Changes in only the surgical limb suggest that HTO-ACLR reduces frontal and transverse plane knee moments. Bilateral changes suggest the passage of time, rather than the surgery, is responsible for the changes in sagittal plane knee moments. Chapter 4 describes a retrospective matched cohort study comparing preoperative and 5-year postoperative changes in the knee adduction and flexion moments in 52 patients who underwent either combined HTO-ACLR or HTO-Alone. Results indicated that both groups experienced a significant reduction in the knee adduction moment in the surgical limb. However, the HTO-Alone group also experienced a significant decrease in the knee flexion moment while the HTO-ACLR group experienced no change in sagittal plane knee moments. These findings suggest that HTO-ACLR may lessen the long-term decrease in the knee flexion moment typically observed over time in patients with knee OA. Overall, the results of this thesis support the use of investigating bilateral knee moments during walking in patients with medial knee OA, and provide rationale for future research examining whether the biomechanical changes observed in these individuals affects OA progression.

Published
2017

18. Gait biomechanics after combined HTO‐ACL reconstruction versus HTO alone: A matched cohort study.

Author

Marriott, Kendal, Birmingham, Trevor B., Pinto, Ryan, Primeau, Codie, Giffin, J. Robert, Bryant, Dianne, and Degen, Ryan

Subjects
*ANTERIOR cruciate ligament, *BIOMECHANICS, *GAIT in humans, *ANTERIOR cruciate ligament surgery, *OSTEOTOMY, *TREATMENT effectiveness
Abstract

The purpose of the present study was to compare bilateral external knee moments during gait in patients with concomitant medial compartment knee OA, varus alignment and chronic anterior cruciate ligament (ACL) deficiency who underwent either medial opening‐wedge high tibial osteotomy alone (HTO) or simultaneous HTO and ACL reconstruction (HTO‐ACLR). Fifty‐two patients (26 matched pairs) completed 3D gait analysis preoperatively and at a minimum 5 years postoperatively. Patients were matched for preoperative age, sex, body mass index and magnitude of correction. Primary outcomes selected a priori were the peak knee adduction moment (KAM) and knee flexion (KFM) moment during stance. Moments were compared using mixed model repeated measures analysis of variance (ANOVA). For the peak KAM, there was a significant time by limb interaction. For both groups, there were similar reductions in the peak KAM 5 years postoperatively in the surgical limb only [−1.34 %BW × Ht (−1.71, −0.96) and −1.72 %BW × Ht (−1.99, −1.44) for HTO and HTO‐ACLR, respectively]. For the peak KFM, there was a significant time by group by limb interaction. There was a decrease in the peak KFM 5 years postoperatively in the HTO group [−0.88 %BW × Ht (−1.45, −0.31)] but not in the HTO‐ACLR group [0.03 %BW × Ht (−0.43, 0.48)]. These results suggest that individuals with medial knee OA, varus alignment and chronic ACL deficiency who undergo simultaneous medial opening‐wedge HTO and ACL reconstruction may not experience the same long‐term (5 year) changes in sagittal plane knee biomechanics observed in patients undergoing HTO alone. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [ABSTRACT FROM AUTHOR]

Published
2019
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20. Design and Preliminary Implementation of an Air Microfluidics Enabled Soft Robotic Knee Brace Towards the Management of Osteoarthritis.

Author

Gao RZ, Marriott K, Dickerson CR, Maly MR, and Ren CL

Subjects
Biomechanical Phenomena, Braces, Humans, Microfluidics, Osteoarthritis, Knee therapy, Robotics
Abstract

A dynamic and low-profile unloader tibiofemoral knee brace is designed and prototyped by synergizing concepts from the fields of microfluidics and soft robotics. Microfluidics provides strategies for miniaturization and multiplexing while soft robotics afford the tools to create soft fluidic actuators and allow compliant and inherently safe robotic assistance as part of clothing. The unloader knee brace provides dynamic response during the gait cycle, where a three-point leverage torque is provided only during the stance phase to contribute to joint stability when required and enhance comfort and compliance.Clinical Relevance- This novel soft robotic brace has the potential to reduce device abandonment due to aesthetics, user non-compliance and discomfort due to a constant three-point leverage torque during the gait cycle. Also, this air microfluidics enabled soft robotic knee brace could be expanded upon to improve the efficacy of braces in general and augment the effects of physical therapy, rehabilitation and treatment of musculoskeletal conditions.

Published
2020
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