An integrated procedure to assess knee-joint kinematics and kinetics during gait using an optoelectric system and standardized X-rays

doi:10.1016/0141-5425(93)90076-B

Journal of Biomedical Engineering

Volume 15, Issue 5, September 1993, Pages 392-400

Journal of Biomedica...

https://doi.org/10.1016/0141-5425(93)90076-B Get rights and content

Abstract

This paper describes a 3-D gait analysis system, which combines optoelectric motion tracking and a standardized X-ray procedure, to calculate the net knee-joint forces and moments of a normal subject group during walking. The optoelectric system collects kinematic data from infra-red LED markers placed at selected skin surface locations and projecting probes attached to the lower limb. A standardized X-ray procedure is used to move surface markers into their designated bony landmarks based on individual bone structure, which reduces the error caused by uncertainty of skin-surface marker locations. Based on moved-in marker information, different joint coordinate systems are proposed for kinematic and kinetic analysis of the knee joint. Normalized data of knee angles, net reaction forces and net moments from 35 young, normal subjects are presented.

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Cited by (37)

Age and sex differences in normative gait patterns
2021, Gait and Posture
A comprehensive understanding of healthy gait patterns is a critical first step towards understanding age-related pathologies and disorders that are commonly associated with mobility limitations throughout aging. Further, consideration of sex-specific gait patterns throughout the lifespan is important, considering biological differences between males and females that can manifest biomechanically, and epidemiological evidence of female sex being a risk factor for some age-related pathologies such as osteoarthritis.
The aim of this study was to characterize the differences in lower extremity joint kinematics and kinetics during gait between asymptomatic adult women and men in different age groups (20–40 years, 41–50 years, 51–59 years, 60+ years).
This was a secondary analysis conducted on instrumented gait data from 154 asymptomatic adult participants (94 females, 60 males). Three-dimensional hip, knee and ankle joint angles and net external moments were calculated and waveform principal component analysis (PCA) was applied to extract major patterns of variability from each. PC scores were examined for significant sex, age and interaction effects using a two-factor ANOVA analysis (p = 0.001).
13 PC features differed between asymptomatic male and female gait patterns, and were independent of age category. No PC features significantly differed between the age groups, and there were no significant sex by age interactions.
There are significant magnitude and pattern differences in hip, knee and ankle kinematics and kinetics between asymptomatic women and men. As study participants were asymptomatic, these differences do not necessarily correlate with any injury or disease mechanisms. However, these results do suggest the importance of considering sex-specific analyses in gait study design, and the use of sex-specific normative data in clinical gait studies. These results further suggest that consideration of strict age-matching for gait analysis studies using adult controls is not as critical as sex considerations.
40th Anniversary Issue: Reflections on papers from the archive on “Biomechanics”
2019, Medical Engineering and Physics
Healthy 3D knee kinematics during gait: Differences between women and men, and correlation with x-ray alignment
2018, Gait and Posture
Citation Excerpt :
Knee internal-external tibial rotation remains controversial [5,9,11–15]. Some have shown that the knee is in internal tibial rotation throughout the gait cycle [9,11], some that it is in external tibial rotation [5,13,15], and others that it is mainly in external rotation during the stance phase and in internal rotation during the swing phase [12,14]. In our study, the knee remained in internal tibial rotation from the beginning of mid-stance (around 10% of the gait cycle) until the middle of the mid-swing phase (around 80% of the gait cycle), and in external tibial rotation during the loading response and terminal swing phases.
Normal 3D knee kinematics during gait is still not well understood, especially regarding differences between women and men.
Research question: The objective of the present study was to characterize 3D knee kinematics during gait in healthy women and men with a validated tool.
Knee kinematics was analysed with the KneeKG™ system in 90 healthy subjects (49 females and 41 males). 3D knee rotations were compared between women and men, and between right and left knees. Each subject underwent full-length weight-bearing x-rays. Correlations between abduction-adduction angles and lower-limb alignment measures on x-rays were assessed.
In the frontal plane, 2.0–5.0° more abduction occurred in women compared to men (0.000 ≤ p ≤ 0.015) throughout the entire gait cycle. In the transverse plane, 2.4–3.7° more external tibial rotation was seen in women than in men (0.002 ≤ p ≤ 0.041) during the initial and mid-swing phases. No difference was found between the right and left knees. Low correlations (−0.52 ≤ r≤−0.41, p < 0.001) were observed between radiographic hip-knee-ankle angle (HKA) and abduction-adduction angles throughout the stance phase.
Kinematic differences between women and men in the frontal plane can be partly explained by their anatomical differences: women were less in varus than men (HKA of −0.8° vs. −2.6°, p < 0.001). Our study contributes to a better understanding of healthy 3D knee kinematics during gait and highlights the need for accounting of gender differences in future investigations. Better knowledge of natural knee kinematics will be helpful in assessing pathological gait patterns or determining the efficiency of conservative and surgical treatments to restore normal kinematics.
Three-dimensional dynamic analysis of knee joint during gait in medial knee osteoarthritis using loading axis of knee
2015, Gait and Posture
We recently developed a new method for three-dimensional evaluation of mechanical factors affecting knee joint in order to help identify factors that contribute to the progression of knee osteoarthritis (KOA). This study aimed to verify the clinical validity of our method by evaluating knee joint dynamics during gait. Subjects were 41 individuals (14 normal knees; 8 mild KOAs; 19 severe KOAs). The positions of skin markers attached to the body were captured during gait, and bi-planar X-ray images of the lower extremities were obtained in standing position. The positional relationship between the markers and femorotibial bones was determined from the X-ray images. Combining this relationship with gait capture allowed for the estimation of relative movement between femorotibial bones. We also calculated the point of intersection of loading axis of knee on the tibial proximal surface (LAK point) to analyze knee joint dynamics. Knee flexion range in subjects with severe KOA during gait was significantly smaller than that in those with normal knees (p = 0.011), and knee adduction in those with severe KOA was significantly larger than in those with mild KOA (p < 0.000). LAK point was locally loaded on the medial compartment of the tibial surface as KOA progressed, with LAK point of subjects with severe KOA rapidly shifting medially during loading response. Local loading and medial shear force were applied to the tibial surface during stance phase as medial KOA progressed. Our findings suggest that our method is useful for the quantitative evaluation of mechanical factors that affect KOA progression.
The Effect of Total Knee Arthroplasty on Knee Joint Kinematics and Kinetics During Gait
2011, Journal of Arthroplasty
This study determined how total knee arthroplasty (TKA) altered knee motion and loading during gait. Three-dimensional kinematic and kinetic gait patterns of 42 patients with severe knee osteoarthritis were collected 1 week prior and 1-year post-TKA. Principal component analysis extracted major patterns of variability in the gait waveforms. Overall and midstance knee adduction moment magnitude decreased. Overall knee flexion angle magnitude increased due to an increase during swing. Increases in the early stance knee flexion moment and late stance knee extension moment were found, indicating improved impact attenuation and function. A decrease in the early stance knee external rotation moment indicated alteration in the typical rotation mechanism. Most changes moved toward an asymptomatic pattern and would be considered improvements in motion, function, and loading.
The effect of internal and external foot rotation on the adduction moment and lateral-medial shear force at the knee during gait
2008, Journal of Science and Medicine in Sport
Citation Excerpt :
The average age of participants was 22.9 years (1.8) with an average height of 176.7 cm (11.5) and an average weight of 72.4 kg (14.4). Data were collected with a modified version of a three-dimensional gait analysis system that has previously been described and validated.20–22 This system uses an optoelectronic motion tracking system (NDI, Waterloo, Ontario, Canada), an embedded force plate (AMTI, Newton, Mass, USA) and subject-specific anthropometrics to calculate 3D net forces and moments at the knee.
It has been hypothesised that those with medial compartment knee osteoarthritis tend to externally rotate their foot during gait in order to unload the diseased compartment. This has been found to decrease the adduction moment at the knee during late stance, although the effects of foot rotation on shear forces at the knee have not yet been determined. Also, the effects of internal foot rotation on the knee during gait are not clear. This study performed a gait analysis on 11 healthy participants (M: 6; mean age 22.9 ± 1.8 years) in three conditions: (1) natural foot rotation position; (2) internal foot rotation and (3) external foot rotation. Three-dimensional gait analysis calculated the knee adduction moment and lateral–medial shear force for all three foot rotation conditions. Internal rotation of the foot increased the knee adduction moment and lateral–medial shear force magnitude during late stance, while external rotation of the foot decreased the magnitude of both these measures. This implies that walking with an externally and internally rotated foot may unload the diseased compartment for those with medial and lateral compartment knee OA, respectively. Also, the relationship of foot rotation angle to the adduction moment and lateral–medial shear force was strengthened when data were corrected for the subject's normal walking condition. Knee OA subject data revealed that they were able to reduce the knee adduction moment more than normal subjects during late stance, indicating that other factors besides the rotation of the foot need to be investigated.

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PaperAn integrated procedure to assess knee-joint kinematics and kinetics during gait using an optoelectric system and standardized X-rays

Abstract

J Biomech

J Biomech

J Biomech

J Biomech

J Arthroplasty

J Biomech

J Biomech

J Biomech

J Biomech

J Biomechanics

J Biomech

J Biomech

J Biomech

The forces and moments in the leg during level walking

Trans ASME

Bioengineering analysis of force actions transmitted by the knee joint

Biomed Eng

A bioengineering analysis of force actions at the knee in normal and pathological gait

Biomed Eng

Three-dimensional coordinate data processing in human motion analysis

J Biomech Eng

Gait analysis: precise, rapid, automatic, 3-D position and orientation; kinematics and dynamics

Bull Hosp Joint Diseases Orthop Inst

Measurement of lower extremity kinematics during level walking

J Orthop Res

A study of lower-limb mechanics during stair-climbing

J Bone Joint Surg

Paper
An integrated procedure to assess knee-joint kinematics and kinetics during gait using an optoelectric system and standardized X-rays