Multidirectional basketball activities load different regions of the tibia: A subject-specific muscle-driven finite element study.

The tibia is a common site for bone stress injuries, which are believed to develop from microdamage accumulation to repetitive sub-yield strains. There is a need to understand how the tibia is loaded in vivo to understand how bone stress injuries develop and design exercises to build a more robust bone. Here, we use subject-specific, muscle-driven, finite element simulations of 11 basketball players to calculate strain and strain rate distributions at the midshaft and distal tibia during six activities: walking, sprinting, lateral cut, jumping after landing, changing direction from forward-to-backward sprinting, and changing direction while side shuffling. Maximum compressive strains were at least double maximum tensile strains during the stance phase of all activities. Sprinting and lateral cut had the highest compressive (-2,862 ± 662 µÎµ and -2,697 ± 495 µÎµ, respectively) and tensile (973 ± 208 µÎµ and 942 ± 223 µÎµ, respectively) strains. These activities also had the highest strains rates (peak compressive strain rate = 64,602 ± 19,068 µÎµ/s and 37,961 ± 14,210 µÎµ/s, respectively). Compressive strains principally occurred in the posterior tibia for all activities; however, tensile strain location varied. Activities involving a change in direction increased tensile loads in the anterior tibia. These observations may guide preventative and management strategies for tibial bone stress injuries. In terms of prevention, the strain distributions suggest individuals should perform activities involving changes in direction during growth to adapt different parts of the tibia and develop a more fatigue resistant bone. In terms of management, the greater strain and strain rates during sprinting than jumping suggests jumping activities may be commenced earlier than full pace running. The greater anterior tensile strains during changes in direction suggest introduction of these types of activities should be delayed during recovery from an anterior tibial bone stress injury, which have a high-risk of healing complications.

The effects of load carriage and muscle fatigue on lower-extremity joint mechanics.

UNLABELLED: Military personnel are commonly afflicted by lower-extremity overuse injuries. Load carriage and muscular fatigue are major stressors during military basic training. PURPOSE: To examine effects of load carriage and muscular fatigue on lower-extremity joint mechanics during walking. METHOD: Eighteen men performed the following tasks: unloaded walking, walking with a 32-kg load, fatigued walking with a 32-kg load, and fatigued walking. After the second walking task, muscle fatigue was elicited through a fatiguing protocol consisting of metered step-ups and heel raises with a 16-kg load. Each walking task was performed at 1.67 m x s(-1) for 5 min. Walking movement was tracked by a VICON motion capture system at 120 Hz. Ground reaction forces were collected by a tandem force instrumented treadmill (AMTI) at 2,400 Hz. Lower-extremity joint mechanics were calculated in Visual 3D. RESULTS: There was no interaction between load carriage and fatigue on lower-extremity joint mechanics (p > .05). Both load carriage and fatigue led to pronounced alterations of lower-extremity joint mechanics (p < .05). Load carriage resulted in increases of pelvis anterior tilt, hip and knee flexion at heel contact, and increases of hip, knee, and ankle joint moments and powers during weight acceptance. Muscle fatigue led to decreases of ankle dorsiflexion at heel contact, dorsiflexor moment, and joint power at weight acceptance. In addition, muscle fatigue increased demand for hip extensor moment and power at weight acceptance. CONCLUSION: Statistically significant changes in lower-extremity joint mechanics during loaded and fatigued walking may expose military personnel to increased risk for overuse injuries.

Influence of bicompartmental knee replacement on stand-to-sit movement.

Knee osteoarthritis often occurs in medial and patellofemoral compartments. A bicompartmental knee replacement system replaces these two affected knee compartments and keeps the lateral compartment and cruciate ligaments intact. It is yet to be determined whether limbs with bicompartmental knee systems can demonstrate frontal-plane knee mechanics and hamstring coactivation similar to healthy control limbs during daily activities requiring the weight-bearing knees to bend through a large range of motion (e.g., stand-to-sit). Three-dimensional knee mechanics and quadriceps and hamstring electromyographic data were collected from 8patients with a unilateral bicompartmental knee system and 10 healthy control participants. No differences in frontal-plane knee mechanics and hamstring coactivation were found among the surgical, contralateral, and control limbs during stand-to-sit (p > .05).

Influence of fatigue and load carriage on mechanical loading during walking.

Load carriage and muscular fatigue are two major stressors experienced by military recruits during basic training. The purpose of this study was to assess the influences of load carriage and muscular fatigue on ground reaction forces and ground reaction loading rates during walking. Eighteen healthy males performed the following tasks in order: unloaded and unfatigued walking, loaded and unfatigued walking, fatiguing exercise, loaded and fatigued walking, and unloaded and fatigued walking. The fatiguing exercise consisted of a series of metered step-ups and heel raises with a 16-kg rucksack. Loaded walking tasks were performed with a 32-kg rucksack. Two-way repeated measures analysis of variances were used to determine the effects of fatigue and load carriage on ground reaction forces and loading rates. Muscular fatigue has a significant influence on peak vertical ground reaction force and loading rate (p < 0.01). Load carriage has a significant influence on peak ground reaction forces and loading rates (p < 0.001). As both muscular fatigue and load carriage lead to large increases of ground reaction forces and loading rates, the high incidence of lower extremity overuse injuries in the military may be associated with muscular fatigue and load carriage.

Gait analysis after bi-compartmental knee replacement.

BACKGROUND: It is reported that a majority of the patients with knee osteoarthritis have cartilage degeneration in medial and patellofemoral compartments. A bi-compartmental knee replacement system was designed to treat osteoarthritis at medial and patellofemoral compartments. To date, there is very little information regarding the knee mechanics during gait after bi-compartmental knee replacement. The purpose of the study was to evaluate knee strength and mechanics during level walking after knee replacement. METHODS: Ten healthy control subjects and eight patients with unilateral bi-compartmental knee replacement participated in the study. Maximal isokinetic concentric knee extension strength was evaluated. 3D kinematic and kinetic analyses were conducted for level walking. Paired Student t-test was used to determine difference between surgical and non-involved limbs. One way MANOVA was used to determine difference between surgical and control groups. FINDINGS: The surgical knee exhibited less peak torque and initial abduction moment than both the non-involved and control limbs (P<0.05). The non-involved limb had less knee extension at stance and greater knee extensor moment during push-off than both the surgical and control limbs (P<0.05). No differences were found for other typical knee mechanics among the surgical, non-involved, and control limbs during walking (P>0.05). INTERPRETATIONS: Patients with bi-compartmental knee replacement exhibited good frontal plane knee mechanics and were able to produce the same level of knee extensor moment as healthy control limbs during walking. While showing some compensatory patterns during walking, patients with bi-compartmental knee replacement largely exhibited normal gait patterns and knee mechanics.