Tibiofemoral contact biomechanics following meniscocapsular separation and repair.

Meniscocapsular separations are often seen in knees with other intra-articular pathology. The consequences of these tears with regard to knee contact mechanics are currently unknown, and the biomechanical advantages of repair have not been measured. We hypothesize that tears to the meniscocapsular junction will cause an increase in tibiofemoral contact pressure and a decrease in contact area, with a return to more normal conditions after repair. 10 fresh-frozen cadaver knees each underwent 10 cycles of axial compressive loading in full extension under three different testing conditions: intact, meniscocapsular separation, and repair. A pressure sensor matrix was inserted into the medial joint space and used to measure magnitude and location of contact pressure and area. Mean contact pressure increased from 0.80±0.17 MPa in the intact knee to 0.88±0.19 MPa with separation, with a decrease to 0.78±0.14 MPa following repair. Peak pressures followed a similar trend with 2.59±0.41, 3.03±0.48, and 2.84±0.40 MPa for the same three groups, respectively. While none of the changes seen was statistically significant, even these small changes would potentially create degenerative changes at the articular surface over prolonged (i. e., months or years) standing, walking, and activity in the unrepaired state.

Swing kinematics for male and female pro golfers.

The purpose of the study was to compare golf swing kinematics between female and male professional golfers, with particular focus on areas where different risks of injury exist and variables that may be related to driving distance. Twenty-five LPGA golfers and twenty-five PGA golfers were tested. Customized computer software was developed to analyze kinematic data obtained with an optoelectronic system at 240 Hz. At the peak of back swing, significant differences were found in trunk forward tilt (LPGA: 25 +/- 4 degrees and PGA: 31 +/- 4 degrees ), and in pelvis orientation (LPGA: 49 +/- 8 degrees and PGA: 42 +/- 7 degrees ). Significantly different pelvis rotation at the ball impact was found (LPGA: - 52 +/- 11 degrees and PGA: - 42 +/- 12 degrees ). The LPGA group produced significantly less angular velocities of the club shaft (2049 +/- 512 degrees /s), the left wrist (816 +/- 186 degrees /s), the right wrist (864 +/- 198 degrees /s) and the elbow extension (705 +/- 109 degrees /s) than the PGA group. The results of this study show there are differences in the swing mechanics for men and women at the professional level. Major differences were found at the wrist and elbow, where different incidences of injury were previously reported.

Kinematic analysis of swing in pro and amateur golfers.

As golf grows in popularity, golf related injuries have increased. The purpose of this study was to calculate and compare upper body kinematics of healthy male golfers from different skill levels. Kinematic data were obtained from 18 professional, 18 low handicap, 18 mid handicap and 18 high handicap golfers with an optoelectronic system at 240 frames per second. Ten displacement parameters were calculated at address, peak of back swing and ball contact. Angular velocity parameters and respective temporal data were calculated during the downswing phase. Most parameters were significantly different between the higher skilled golfers (professional, low handicap) and the least skilled golfers (high handicap). At the peak of the swing, professionals produced the largest magnitudes for left shoulder horizontal adduction (125 +/- 6 degrees ), right shoulder external rotation (66 +/- 11 degrees ), and trunk rotation (60 +/- 7 degrees ). During the downswing, the professionals produced the largest angular velocities for the club shaft (2413 +/- 442 degrees /s), right elbow extension (854 +/- 150 degrees /s), right wrist (1183 +/- 299 degrees /s) and left wrist (1085 +/- 338 degrees /s). The results of this study show that improper mechanics of golf swing existed in middle and high handicap groups. These improper mechanics may contribute to golf related injuries.

Relationship of ulnar collateral ligament strain to amount of medial olecranon osteotomy.

Athletes at risk for valgus extension overload are also at risk for tears of the anterior bundle of the ulnar collateral ligament. Some athletes develop ligament tears after procedures for valgus extension overload such as posteromedial olecranon osteotomy. The amount of posteromedial olecranon that can be resected before ulnar collateral ligament strain, and risk of injury, increases is unknown. We dissected and mounted five fresh-frozen human cadaveric elbows to allow strain gauge monitoring of the ulnar collateral ligament with varying valgus stress, elbow flexion angle, and medial osteotomy. The average strain to failure was 11.96%+/-6.51%, corresponding to a load of 347.71+/-46.42 N. The maximum tensile force recorded at failure was 416.24 N. Three-way repeated-measures analysis of variance revealed no significant change in strain with change in the amount of osteotomy for a given applied load and angle of flexion. On the basis of these data, we conclude that the effect of medial olecranon osteotomy on ulnar collateral ligament strain may be small. Small sample size, elderly specimens, and the variables inherent in the experimental setup and mathematical modeling make it difficult to extrapolate these results to in vivo behavior of the anterior ulnar collateral ligament. Further work is needed before definitive guidelines for olecranon osteotomy can be formulated.

Longitudinal study of elbow and shoulder pain in youth baseball pitchers.

PURPOSE: Previous studies among young pitchers have focused on the frequency and description of elbow injuries. The purpose of this study was to evaluate the frequency of elbow and shoulder complaints in young pitchers and to identify the associations between pitch types, pitch volume, and other risk factors for these conditions. METHODS: A prospective cohort study of 298 youth pitchers was conducted over two seasons. Each participant was contacted via telephone after each game pitched to identify arm complaints. Generalized estimating equations were used to assess associations between arm complaints and independent variables. RESULTS: The frequency of elbow pain was 26%; that of shoulder pain, 32%. Risk factors for elbow pain were increased age, increased weight, decreased height, lifting weights during the season, playing baseball outside the league, decreased self-satisfaction, arm fatigue during the game pitched, and throwing fewer than 300 or more than 600 pitches during the season. Risk factors for shoulder pain included decreased satisfaction, arm fatigue during the game pitched, throwing more than 75 pitches in a game, and throwing fewer than 300 pitches during the season. CONCLUSION: Arm complaints are common, with nearly half of the subjects reporting pain. The factors associated with elbow and shoulder pain were different, suggesting differing etiologies. Developmental factors may be important in both. To lower the risk of pain at both locations, young pitchers probably should not throw more than 75 pitches in a game. Other recommendations are to remove pitchers from a game if they demonstrate arm fatigue and limit pitching in nonleague games.

Effects of technique variations on knee biomechanics during the squat and leg press.

PURPOSE: The specific aim of this project was to quantify knee forces and muscle activity while performing squat and leg press exercises with technique variations. METHODS: Ten experienced male lifters performed the squat, a high foot placement leg press (LPH), and a low foot placement leg press (LPL) employing a wide stance (WS), narrow stance (NS), and two foot angle positions (feet straight and feet turned out 30 degrees ). RESULTS: No differences were found in muscle activity or knee forces between foot angle variations. The squat generated greater quadriceps and hamstrings activity than the LPH and LPL, the WS-LPH generated greater hamstrings activity than the NS-LPH, whereas the NS squat produced greater gastrocnemius activity than the WS squat. No ACL forces were produced for any exercise variation. Tibiofemoral (TF) compressive forces, PCL tensile forces, and patellofemoral (PF) compressive forces were generally greater in the squat than the LPH and LPL, and there were no differences in knee forces between the LPH and LPL. For all exercises, the WS generated greater PCL tensile forces than the NS, the NS produced greater TF and PF compressive forces than the WS during the LPH and LPL, whereas the WS generated greater TF and PF compressive forces than the NS during the squat. For all exercises, muscle activity and knee forces were generally greater in the knee extending phase than the knee flexing phase. CONCLUSIONS: The greater muscle activity and knee forces in the squat compared with the LPL and LPH implies the squat may be more effective in muscle development but should be used cautiously in those with PCL and PF disorders, especially at greater knee flexion angles. Because all forces increased with knee flexion, training within the functional 0-50 degrees range may be efficacious for those whose goal is to minimize knee forces. The lack of ACL forces implies that all exercises may be effective during ACL rehabilitation.

Kinematic comparisons of 1996 Olympic baseball pitchers.

The aim of this study was to compare and evaluate the kinematics of baseball pitchers who participated in the 1996 XXVI Centennial Olympic Games. Two synchronized video cameras operating at 120 Hz were used to video 48 pitchers from Australia, Japan, the Netherlands, Cuba, Italy, Korea, Nicaragua and the USA. All pitchers were analysed while throwing the fastball pitch. Twenty-one kinematic parameters were measured at lead foot contact, during the arm cocking and arm acceleration phases, and at the instant of ball release. These parameters included stride length, foot angle and foot placement; shoulder abduction, shoulder horizontal adduction and shoulder external rotation; knee and elbow flexion; upper torso, shoulder internal rotation and elbow extension angular velocities; forward and lateral trunk tilt; and ball speed. A one-way analysis of variance (P < 0.01) was used to assess kinematic differences. Shoulder horizontal adduction and shoulder external rotation at lead foot contact and ball speed at the instant of ball release were significantly different among countries. The greater shoulder horizontal abduction observed in Cuban pitchers at lead foot contact is thought to be an important factor in the generation of force throughout the arm cocking and arm acceleration phases, and may in part explain why Cuban pitchers generated the greatest ball release speed. We conclude that pitching kinematics are similar among baseball pitchers from different countries.

A three-dimensional biomechanical analysis of the squat during varying stance widths.

PURPOSE: The purpose of this study was to quantify biomechanical parameters employing two-dimensional (2-D) and three-dimensional (3-D) analyses while performing the squat with varying stance widths. METHODS: Two 60-Hz cameras recorded 39 lifters during a national powerlifting championship. Stance width was normalized by shoulder width (SW), and three stance groups were defined: 1) narrow stance squat (NS), 107 +/- 10% SW; 2) medium stance squat (MS), 142 +/- 12% SW; and 3) wide stance squat (WS), 169 +/- 12% SW. RESULTS: Most biomechanical differences among the three stance groups and between 2-D and 3-D analyses occurred between the NS and WS. Compared with the NS at 45 degrees and 90 degrees knee flexion angle (KF), the hips flexed 6-11 degrees more and the thighs were 7-12 degrees more horizontal during the MS and WS. Compared with the NS at 90 degrees and maximum KF, the shanks were 5-9 degrees more vertical and the feet were turned out 6 degrees more during the WS. No significant differences occurred in trunk positions. Hip and thigh angles were 3-13 degrees less in 2-D compared with 3-D analyses. Ankle plantar flexor (10-51 N.m), knee extensor (359-573 N.m), and hip extensor (275-577 N.m) net muscle moments were generated for the NS, whereas ankle dorsiflexor (34-284 N.m), knee extensor (447-756 N.m), and hip extensor (382-628 N.m) net muscle moments were generated for the MS and WS. Significant differences in ankle and knee moment arms between 2-D and 3-D analyses were 7-9 cm during the NS, 12-14 cm during the MS, and 16-18 cm during the WS. CONCLUSIONS: Ankle plantar flexor net muscle moments were generated during the NS, ankle dorsiflexor net muscle moments were produced during the MS and WS, and knee and hip moments were greater during the WS compared with the NS. A 3-D biomechanical analysis of the squat is more accurate than a 2-D biomechanical analysis, especially during the WS.

A three-dimensional biomechanical analysis of sumo and conventional style deadlifts.

PURPOSE: Strength athletes often employ the deadlift in their training or rehabilitation regimens. The purpose of this study was to quantify kinematic and kinetic parameters by employing a three-dimensional analysis during sumo and conventional style deadlifts. METHODS: Two 60-Hz video cameras recorded 12 sumo and 12 conventional style lifters during a national powerlifting championship. Parameters were quantified at barbell liftoff (LO), at the instant the barbell passed the knees (KP), and at lift completion. Unpaired t-tests (P < 0.05) were used to compare all parameters. RESULTS: At LO and KP, thigh position was 11-16 degrees more horizontal for the sumo group, whereas the knees and hips extended approximately 12 degrees more for the conventional group. The sumo group had 5-10 degrees greater vertical trunk and thigh positions, employed a wider stance (70 +/- 11 cm vs 32 +/- 8 cm), turned their feet out more (42 +/- 8 vs 14 +/- 6 degrees). and gripped the bar with their hands closer together (47 +/- 4 cm vs 55 +/- 10 cm). Vertical bar distance, mechanical work, and predicted energy expenditure were approximately 25-40% greater in the conventional group. Hip extensor, knee extensor, and ankle dorsiflexor moments were generated for the sumo group, whereas hip extensor, knee extensor, knee flexor, and ankle plantar flexor moments were generated for the conventional group. Ankle and knee moments and moment arms were significantly different between the sumo and conventional groups, whereas hip moments and moments arms did not show any significantly differences. Three-dimensional calculations were more accurate and significantly different than two-dimensional calculations, especially for the sumo deadlift. CONCLUSIONS: Biomechanical differences between sumo and conventional deadlifts result from technique variations between these exercises. Understanding these differences will aid the strength coach or rehabilitation specialist in determining which deadlift style an athlete or patient should employ.

Effects of throwing overweight and underweight baseballs on throwing velocity and accuracy.

The purpose of this review is to determine how throwing overweight and underweight baseballs affects baseball throwing velocity and accuracy. Two studies examined how a warm-up with overweight baseballs affected throwing velocity and accuracy of 5 oz regulation baseballs. One of these studies showed significant increases in throwing velocity and accuracy, while the other study found no significant differences. Three training studies (6 to 12 weeks in duration) using overweight baseballs were conducted to determine how they affected ball accuracy while throwing regulation baseballs. No significant differences were found in any study. From these data it is concluded that warming up or training with overweight baseballs does not improve ball accuracy. Seven overweight and 4 underweight training studies (6 to 12 weeks in duration) were conducted to determine how throwing velocity of regulation baseballs was affected due to training with these overweight and underweight baseballs. The overweight baseballs ranged in weight from 5.25 to 17 oz, while the underweight baseballs were between 4 and 4.75 oz. Data from these training studies strongly support the practice of training with overweight and underweight baseballs to increase throwing velocity of regulation baseballs. Since no injuries were reported throughout the training studies, throwing overweight and underweight baseballs may not be more stressful to the throwing arm compared to throwing regulation baseballs. However, since currently there are no injury data related to throwing overweight and underweight baseballs, this should be the focus of subsequent studies. In addition, research should be initiated to determine whether throwing kinematics and kinetics are different between throwing regulation baseballs and throwing overweight and underweight baseballs.

Kinematic and kinetic comparison of baseball pitching among various levels of development.

Proper biomechanics help baseball pitchers minimize their risk of injury and maximize performance. However previous studies involved adult pitchers only. In this study, 23 youth, 33 high school, 115 college, and 60 professional baseball pitchers were analyzed. Sixteen kinematic (11 position and five velocity), eight kinetic, and six temporal parameters were calculated and compared among the four levels of competition. Only one of the 11 kinematic position parameters showed significant differences among the four levels, while all five velocity parameters showed significant differences. All eight kinetic parameters increased significantly with competition level. None of the six temporal parameters showed significant differences. Since 16 of the 17 position and temporal parameters showed no significant differences, this study supports the philosophy that a child should be taught 'proper' pitching mechanics for use throughout a career. Kinetic differences observed suggest greater injury risk at higher competition levels. Since adult pitchers did not demonstrate different position or temporal patterns than younger pitchers, increases in joint forces and torques were most likely due to increased strength and muscle mass in the higher level athlete. The greater shoulder and elbow angular velocities produced by high-level pitchers were most likely due to the greater torques they generated during the arm cocking and acceleration phases. The combination of more arm angular velocity and a longer arm resulted in greater linear ball velocity for the higher level pitcher. Thus, it appears that the natural progression for successful pitching is to learn proper mechanics as early as possible, and build strength as the body matures.

Elbow injuries in young baseball players.

The demands that throwing places on the vulnerable immature elbow frequently produce multiple injuries. Significant clues in the history include persistent medial elbow soreness, stiffness, and discomfort that lead to poor performance. Diagnosis involves identifying the injury sites by palpation and x-rays that pinpoint growth-plate separation or osteochondral changes. Nonoperative treatment, which can proceed if growth-plate separation at the medial apophysis is less than 3 mm, involves stretching, strengthening, sport-specific activities, and interval throwing. Prevention includes conditioning, limiting the number of pitches, and using age guidelines for learning new pitches.

An analytical model of the knee for estimation of internal forces during exercise.

An analytical model of the knee joint was developed to estimate the forces at the knee during exercise. Muscle forces were estimated based upon electromyographic activities during exercise and during maximum voluntary isometric contraction (MVIC), physiological cross-sectional area (PCSA), muscle fiber length at contraction and the maximum force produced by an unit PCSA under MVIC. Tibiofemoral compressive force and cruciate ligaments' tension were determined by using resultant force and torque at the knee, muscle forces, and orientations and moment arms of the muscles and ligaments. An optimization program was used to minimize the errors caused by the estimation of the muscle forces. The model was used in a ten-subject study of open kinetic chain exercise (seated knee extension) and closed kinetic chain exercises (leg press and squat). Results calculated with this model were compared to those from a previous study which did not consider muscle length and optimization. Peak tibiofemoral compressive forces were 3134 +/- 1040 N during squat, 3155 +/- 755 N during leg press and 3285 +/- 1927 N during knee extension. Peak posterior cruciate ligament tensions were 1868 +/- 878 N during squat, 1866 +/- 383 N during leg press and 959 +/- 300 N for seated knee extension. No significant anterior cruciate ligament (ACL) tension was found during leg press and squat. Peak ACL tension was 142 +/- 257 N during seated knee extension. It is demonstrated that the current model provided better estimation of knee forces during exercises, by preventing significant overestimates of tibiofemoral compressive forces and cruciate ligament tensions.

Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow.

Underhand pitching has received minimal attention in the sports medicine literature. This may be due to the perception that, compared with overhead pitching, the underhand motion creates less stress on the arm, which results in fewer injuries. The purpose of this study was to calculate kinematic and kinetic parameters for the pitching motion used in fast pitch softball. Eight female fast pitch softball pitchers were recorded with a four-camera system (200 Hz). The results indicated that high forces and torques were experienced at the shoulder and elbow during the delivery phase. Peak compressive forces at the elbow and shoulder equal to 70-98% of body weight were produced. Shoulder extension and abduction torques equal to 9-10% of body weight x height were calculated. Elbow flexion torque was exerted to control elbow extension and initiate elbow flexion. The demand on the biceps labrum complex to simultaneously resist glenohumeral distraction and produce elbow flexion makes this structure susceptible to overuse injury.

Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises.

PURPOSE: Although closed (CKCE) and open (OKCE) kinetic chain exercises are used in athletic training and clinical environments, few studies have compared knee joint biomechanics while these exercises are performed dynamically. The purpose of this study was to quantify knee forces and muscle activity in CKCE (squat and leg press) and OKCE (knee extension). METHODS: Ten male subjects performed three repetitions of each exercise at their 12-repetition maximum. Kinematic, kinetic, and electromyographic data were calculated using video cameras (60 Hz), force transducers (960 Hz), and EMG (960 Hz). Mathematical muscle modeling and optimization techniques were employed to estimate internal muscle forces. RESULTS: Overall, the squat generated approximately twice as much hamstring activity as the leg press and knee extensions. Quadriceps muscle activity was greatest in CKCE when the knee was near full flexion and in OKCE when the knee was near full extension. OKCE produced more rectus femoris activity while CKCE produced more vasti muscle activity. Tibiofemoral compressive force was greatest in CKCE near full flexion and in OKCE near full extension. Peak tension in the posterior cruciate ligament was approximately twice as great in CKCE, and increased with knee flexion. Tension in the anterior cruciate ligament was present only in OKCE, and occurred near full extension. Patellofemoral compressive force was greatest in CKCE near full flexion and in the mid-range of the knee extending phase in OKCE. CONCLUSION: An understanding of these results can help in choosing appropriate exercises for rehabilitation and training.

A comparison of tibiofemoral joint forces and electromyographic activity during open and closed kinetic chain exercises.

We chose to investigate tibiofemoral joint kinetics (compressive force, anteroposterior shear force, and extension torque) and electromyographic activity of the quadriceps, hamstring, and gastrocnemius muscles during open kinetic chain knee extension and closed kinetic chain leg press and squat. Ten uninjured male subjects performed 4 isotonic repetitions with a 12 repetition maximal weight for each exercise. Tibiofemoral forces were calculated using electromyographic, kinematic, and kinetic data. During the squat, the maximal compressive force was 6139 +/- 1708 N, occurring at 91 degrees of knee flexion; whereas the maximal compressive force for the knee extension exercise was 4598 +/- 2546 N (at 90 degrees knee flexion). During the closed kinetic chain exercises, a posterior shear force (posterior cruciate ligament stress) occurred throughout the range of motion, with the peak occurring from 85 degrees to 105 degrees of knee flexion. An anterior shear force (anterior cruciate ligament stress) was noted during open kinetic chain knee extension from 40 degrees to full extension; a peak force of 248 +/- 259 N was noted at 14 degrees of knee flexion. Electromyographic data indicated greater hamstring and quadriceps muscle co-contraction during the squat compared with the other two exercises. During the leg press, the quadriceps muscle electromyographic activity was approximately 39% to 52% of maximal velocity isometric contraction; whereas hamstring muscle activity was minimal (12% maximal velocity isometric contraction). This study demonstrated significant differences in tibiofemoral forces and muscle activity between the two closed kinetic chain exercises, and between the open and closed kinetic chain exercises.

Biomechanics of overhand throwing with implications for injuries.

Proper throwing mechanics may enable an athlete to achieve maximum performance with minimum chance of injury. While quantifiable differences do exist in proper mechanics for various sports, certain similarities are found in all overhand throws. One essential property is the utilisation of a kinetic chain to generate and transfer energy from the larger body parts to the smaller, more injury-prone upper extremity. This kinetic chain in throwing includes the following sequence of motions: stride, pelvis rotation, upper torso rotation, elbow extension, shoulder internal rotation and wrist flexion. As each joint rotates forward, the subsequent joint completes its rotation back into a cocked position, allowing the connecting segments and musculature to be stretched and eccentrically loaded. Most notable is the external rotation of the shoulder, which reaches a maximum value of approximately 180 degrees. This biomechanical measurement is a combination of true glenohumeral rotation, trunk hyperextension and scapulothoracic motion. Near the time of maximum shoulder external rotation (ERmax), shoulder and elbow musculature eccentrically contract to produce shoulder internal rotation torque and elbow varus torque. Both the shoulder and the elbow are susceptible to injury at this position. At ball release, significant energy and momentum have been transferred to the ball and throwing arm. After ball release, a kinetic chain is used to decelerate the rapidly moving arm with the entire body. Shoulder and elbow muscles produce large compressive forces to resist joint distraction. Both joints are susceptible to injury during arm deceleration.

Kinetics of baseball pitching with implications about injury mechanisms.

Elbow and shoulder kinetics for 26 highly skilled, healthy adult pitchers were calculated using high-speed motion analysis. Two critical instants were 1) shortly before the arm reached maximum external rotation, when 67 N-m of shoulder internal rotation torque and 64 N-m of elbow varus torque were generated, and 2) shortly after ball release, when 1090 N of shoulder compressive force was produced. Inability to generate sufficient elbow varus torque may result in medial tension, lateral compression, or posteromedial impingement injury. At the glenohumeral joint, compressive force, joint laxity, and 380 N of anterior force during arm cocking can lead to anterior glenoid labral tear. Rapid internal rotation in combination with these forces can produce a grinding injury factor on the labrum. After ball release, 400 N of posterior force, 1090 N of compressive force, and 97 N-m of horizontal abduction torque are generated at the shoulder; contribution of rotator cuff muscles in generating these loads may result in cuff tensile failure. Horizontal adduction, internal rotation, and superior translation of the abducted humerus may cause subacromial impingement. Tension in the biceps tendon, due to muscle contraction for both elbow flexion torque and shoulder compressive force, may tear the anterosuperior labrum.

Biomechanics of pitching with emphasis upon shoulder kinematics.

The American Sports Medicine Institute conducts research to increase understanding of mechanisms involved in upper extremity injuries to throwing athletes. This paper presents a qualitative overview of pitching and a detailed quantitative description of arm motion about the shoulder during this highly dynamic activity. Data on kinematics of arm motions about the shoulder are presented for 29 elite throwers. The major motion about the shoulder is external/internal rotation. Scapulothoracic and glenohumeral flexibility permit the arm to reach an externally rotated position of 175 degrees. Approximately 30 msec before release, the arm internally rotates 80 degrees, reaching peak angular velocities near 7,000 degrees/sec. In rehabilitation of injured throwers, there is a need to appreciate the highly dynamic nature of this skill and to attempt to simulate these dynamic motions and loads as part of the final phase of treatment before the athlete returns to competition.